Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE) - 27/07/13

Doi : 10.1016/S1470-2045(13)70279-1

Ole Raaschou-Nielsen, DrPhD ^a,^⁎ , Zorana J Andersen, PhD ^a,^b, Rob Beelen, PhD ^c, Evangelia Samoli, PhD ^d, Massimo Stafoggia, MSc ^e, Gudrun Weinmayr, PhD ^f,^g, Barbara Hoffmann, ProfMD ^g,^h, Paul Fischer, MSc ⁱ, Mark J Nieuwenhuijsen, PhD ^j, Bert Brunekreef, ProfPhD ^c,^k, Wei W Xun, MPH ^l, Klea Katsouyanni, ProfPhD ^d, Konstantina Dimakopoulou, MSc ^d, Johan Sommar, MSc ^m, Bertil Forsberg, ProfPhD ^m, Lars Modig, PhD ^m, Anna Oudin, PhD ^m, Bente Oftedal, PhD ⁿ, Per E Schwarze, PhD ⁿ, Per Nafstad, ProfMD ^n,^o, Ulf De Faire, ProfPhD ^p, Nancy L Pedersen, ProfPhD ^q, Claes-Göran Östenson, ProfPhD ^r, Laura Fratiglioni, PhD ^s, Johanna Penell, PhD ^p, Michal Korek, MSc ^p, Göran Pershagen, ProfPhD ^p, Kirsten T Eriksen, PhD ^a, Mette Sørensen, PhD ^a, Anne Tjønneland, DMSc ^a, Thomas Ellermann, PhD ^t, Marloes Eeftens, MSc ^c, Petra H Peeters, ProfPhD ^k, Kees Meliefste, BSc ^c, Meng Wang, MSc ^c, Bas Bueno-de-Mesquita, PhD ⁱ, Timothy J Key, ProfDPhil ^u, Kees de Hoogh, PhD ^l, Hans Concin, MD ^v, Gabriele Nagel, PhD ^f,^v, Alice Vilier, MSc ^w,^x,^y, Sara Grioni, BSc ^z, Vittorio Krogh, MD ^z, Ming-Yi Tsai, PhD ^aa,^ab, Fulvio Ricceri, PhD ^ac, Carlotta Sacerdote, PhD ^ad, Claudia Galassi, MD ^ad, Enrica Migliore, MSc ^ad, Andrea Ranzi, PhD ^ae, Giulia Cesaroni, MSc ^e, Chiara Badaloni, MSc ^e, Francesco Forastiere, PhD ^e, Ibon Tamayo, MSc ^af, Pilar Amiano, MSc ^ag, Miren Dorronsoro, MD ^ag, Antonia Trichopoulou, ProfMD ^d,^ah, Christina Bamia, PhD ^d, Paolo Vineis, ProfMPH ^l,^{^{†
Joint last authors}}, Gerard Hoek, PhD ^c,^{^{†
Joint last authors}}

^a Danish Cancer Society Research Center, Copenhagen, Denmark

^b Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

^c Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands

^d Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece

^e Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RME, Rome, Italy

^f Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany

^g IUF–Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany

^h Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany

ⁱ National Institute for Public Health and the Environment, Bilthoven, Netherlands

^j Center for Research in Environmental Epidemiology, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain

^k Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands

^l MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary’s Campus, London, UK

^m Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

ⁿ Norwegian Institute of Public Health, Oslo, Norway

^o Institute of Health and Society, University of Oslo, Oslo, Norway

^p Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden

^q Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden

^r Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden

^s Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden

^t Department of Environmental Science, Aarhus University, Roskilde, Denmark

^u Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

^v Agency for Preventive and Social Medicine, Bregenz, Austria

^w INSERM, Centre for Research in Epidemiology and Population Health, U 1018, Nutrition, Hormones and Women’s Health Team, Villejuif, France

^x University Paris Sud, UMRS 1018, Villejuif, France

^y Institut Gustave-Roussy, Villejuif, France

^z Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

^aa Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland

^ab Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA

^ac Human Genetics Foundation, Turin, Italy

^ad Unit of Cancer Epidemiology, AO Citta’ della Salute e della Scienza–University of Turin and Center for Cancer Prevention, Turin, Italy

^ae Environmental Health Reference Centre–Regional Agency for Environmental Prevention of Emilia-Romagna, Modena, Italy

^af Health Division of Gipuzkoa, Research Institute of BioDonostia, Donostia-San Sebastian, Spain

^ag CIBERESP, Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain

^ah Hellenic Health Foundation, Athens, Greece

^* Correspondence to: Dr Ole Raaschou-Nielsen, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark

Summary

Background

Ambient air pollution is suspected to cause lung cancer. We aimed to assess the association between long-term exposure to ambient air pollution and lung cancer incidence in European populations.

Methods

This prospective analysis of data obtained by the European Study of Cohorts for Air Pollution Effects used data from 17 cohort studies based in nine European countries. Baseline addresses were geocoded and we assessed air pollution by land-use regression models for particulate matter (PM) with diameter of less than 10 μm (PM₁₀), less than 2·5 μm (PM_2·5), and between 2·5 and 10 μm (PM_coarse), soot (PM_{2·5absorbance}), nitrogen oxides, and two traffic indicators. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effects models for meta-analyses.

Findings

The 312 944 cohort members contributed 4 013 131 person-years at risk. During follow-up (mean 12·8 years), 2095 incident lung cancer cases were diagnosed. The meta-analyses showed a statistically significant association between risk for lung cancer and PM₁₀ (hazard ratio [HR] 1·22 [95% CI 1·03–1·45] per 10 μg/m³). For PM_2·5 the HR was 1·18 (0·96–1·46) per 5 μg/m³. The same increments of PM₁₀ and PM_2·5 were associated with HRs for adenocarcinomas of the lung of 1·51 (1·10–2·08) and 1·55 (1·05–2·29), respectively. An increase in road traffic of 4000 vehicle-km per day within 100 m of the residence was associated with an HR for lung cancer of 1·09 (0·99–1·21). The results showed no association between lung cancer and nitrogen oxides concentration (HR 1·01 [0·95–1·07] per 20 μg/m³) or traffic intensity on the nearest street (HR 1·00 [0·97–1·04] per 5000 vehicles per day).

Interpretation

Particulate matter air pollution contributes to lung cancer incidence in Europe.

Funding

European Community’s Seventh Framework Programme.

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Introduction

Methods

Study design and participants

Procedures

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Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE) - 27/07/13

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