Household air pollution and lung cancer in China:a review of studies in Xuanwei

Over half of the world's population is exposed to household air pollution from the burning of solid fuels at home. Household air pollution from solid fuel use is a leading risk factor for global disease and remains a major public health problem, especially in low- and mid-income countries. This is a particularly serious problem in China, where many people in rural areas still use coal for household heating and cooking. This review focuses on several decades of research carried out in Xuanwei County, Yunnan Province, where household coal use is a major source of household air pollution and where studies have linked household air pollution exposure to high rates of lung cancer. We conducted a series of case-control and cohort studies in Xuanwei to characterize the lung cancer risk in this population and the factors associated with it. We found lung cancer risk to vary substantially between different coal types, with a higher risk associated with smoky(i.e., bituminous) coal use compared to smokeless(i.e., anthracite) coal use. The installation of a chimney in homes resulted in a substantial reduction in lung cancer incidence and mortality. Overall, our research underscores the need among existing coal users to improve ventilation, use the least toxic fuel, and eventually move toward the use of cleaner fuels, such as gas and electricity.

Tobacco, air pollution, environmental carcinogenesis, and thoughts on conquering strategies of lung cancer

Each year there will be an estimated 2.1 million new lung cancer cases and 1.8 million lung cancer deaths worldwide.Tobacco smoke is the No.1 risk factors of lung cancer,accounting for>85%lung cancer deaths.Air pollution,or haze,comprises ambient air pollution and household air pollution,which are reported to cause 252,000 and 304,000 lung cancer deaths each year,respectively.Tobacco smoke and haze(hereafter,smohaze)contain fine particles originated from insufficient combustion of biomass or coal,have quite similar carcinogens,and cause similar diseases.Smohaze exert hazardous effects on exposed populations,including induction of a large amount of mutations in the genome,alternative splicing of mRNAs,abnormalities in epigenomics,initiation of tumor-promoting chronic inflammation,and facilitating immune escape of transformed cells.Tackling smohaze and development of multi-targets-based preventive and therapeutic approaches targeting smohaze-induced carcinogenesis are the key to conquer lung cancer in the future.

Impact of fine particles in ambient air on lung cancer

Recently,the International Agency for Research on Cancer(IARC)has classified outdoor air pollution and the particulate matter component of outdoor air pollution as class I carcinogen.Air pollution is consistently associated with lung cancer in epidemiologic and experimental studies.The IARC assessment is specifically designed as hazard identification,and it does not quantify the magnitude of the cancer risk.This article addresses the magnitude of the lung cancer risk in the population due to ambient air pollution exposure.

Temporal Trend in Lung Cancer Burden Attributed to Ambient Fine Particulate Matter in Guangzhou, China

Objective To estimate the lung cancer burden that may be attributable to ambient fine particulate matter （PM2.5） pollution in Guangzhou city in China from 2005 to 2013. Methods The data regarding PM2.5 exposure were obtained from the ＆#39;Ambient air pollution exposure estimation for the Global Burden of Disease 2013＇ dataset at 0.1° ×0.1° spatial resolution. Disability-adjusted life years （DALYs） were estimated based on the information of mortality and incidence of lung cancer. Comparative risk analysis and integrated exposure-response function were used to estimate attributed disease burden. Results The population-weighted average concentration of PM2.5 was increased by 34.6% between 1990 and 2013, from 38.37 μg/m3 to 51.31 μg/m^3. The lung cancer DALYs in both men and women were increased by 36.2% from 2005 to 2013. The PM2.5 attributed lung cancer DALYs increased from 12105.0 （8181.0 for males and 3924.0 for females） in 2005 to 16489.3 （11291.7 for males and 5197.6 for females） in 2013. An average of 23.1% lung cancer burden was attributable to PM2.5 pollution in 2013. Conclusion PM2.5 has caused serious but under-appreciated public health burden in Guangzhou and the trend deteriorates. Effective strategies are needed to tackle this major public health problem.

Cancers of the lung, head and neck on the rise: perspectives on the genotoxicity of air pollution

Outdoor air pollution has been recently classified as a class I human carcinogen by the World Health Organization(WHO). Cumulative evidence from across the globe shows that polluted air is associated with increased risk of lung, head and neck, and nasopharyngeal cancers—all of which affect the upper aerodigestive tract. Importantly, these cancers have been previously linked to smoking. In this article, we review epidemiologic and experimental evidence of the genotoxic and mutagenic effects of air pollution on DNA, purportedly a key mechanism for cancer development. The alarming increase in cancers of the upper aerodigestive tract in Asia suggests a need to focus government efforts and research on reducing air pollution, promoting clean energy, and investigating the carcinogenic effects of air pollution on humans.

COHORT STUDY ON ASSOCIATION OF SMOKING AND AIR POLLUTION WITH LUNG CANCER AMONG 210，000 PERSONS IN SHANGHAI

Survey on smoking habit and other related factors has been carried out among 110 , 000 persons in urban area and 100, 000 persons in suburb and outar suburb area. The degrees of air pollution among three areas are different and the urban area is the one with the heaviest degree and the outer suburb with the lowest. Study on the relationship between smoking, air pollution and lung cancer has been carried out among the residents with the age of 40 years old and over in the three areas. The subjects were followed up for six years in urban area and five years in suburb and outer suburb. The total number of lung cancer death found in this period was 828. Most of these diagnosis were classified as group of high (I or II) degree. For nonsmoking, there were no significant differences of standardized mortality radio (SMR) of lung cancer among three areas. For male smokers. the highest SMR of lung cancer was seen in urban area. the lowest in outer suburb and these differences reached the significant lever. Cigarette smoking was significantly associated with increased risk of lung cancer by comparing the data between smokers and non-smokera in the three areas. Also, it was showed that the combined effect of smoking with air pollution probably existed. The age-specific mortality rates for lung cancer among non-smokers in Shanghai urban were much higher than those in West Europe and North America , which indicated that risk factors other than smoking may exist.

The International Agency for Research on Cancer(IARC) evaluation of the carcinogenicity of outdoor air pollution:focus on China

The International Agency for Research on Cancer(IARC)has classified outdoor air pollution and the particulate matter(PM)in outdoor air pollution as carcinogenic to humans,as based on sufficient evidence of carcinogenicity in humans and experimental animals and strong support by mechanistic studies.The data with important contributions to the evaluation are reviewed,highlighting the data with particular relevance to China,and implications of the evaluation with respect to China are discussed.The air pollution levels in Chinese cities are among the highest observed in the world today and frequently exceed healthbased national and international guidelines.Data from high-quality epidemiologic studies in Asia,Europe,and North America consistently show positive associations between lung cancer and PM exposure and other indicators of air pollution,which persist after adjustment for important lung cancer risk factors,such as tobacco smoking.Epidemiologic data from China are limited but nevertheless indicate an increased risk of lung cancer associated with several air pollutants.Excess cancer risk is also observed in experimental animals exposed to polluted outdoor air or extracted PM.The exposure of several species to outdoor air pollution is associated with markers of genetic damage that have been linked to increased cancer risk in humans.Numerous studies from China,especially genetic biomarker studies in exposed populations,support that the polluted air in China is genotoxic and carcinogenic to humans.The evaluation by IARC indicates both the need for further research into the cancer risks associated with exposure to air pollution in China and the urgent need to act to reduce exposure to the population.

空气污染混合暴露与相对端粒长度对非吸烟女性肺癌的影响研究

目的分析空气污染混合暴露与相对端粒长度(relative telomere length,TL)对非吸烟女性肺癌(non-smoking female lung cancer,NFLC)患病风险的影响,及其对NFLC患病风险的交互作用。方法自2017年8月至2021年8月,在我国安徽、江苏、辽宁和青海省收集18~79岁NFLC及对照组,通过结构化问卷收集研究对象的一般人口学特征、暴露因素、家庭史等,并根据问卷信息计算空气污染暴露(包括被动吸烟、煤烟油烟暴露、燃香暴露、职业暴露、户外作业等)情况;采用实时定量聚合酶链式反应相对定量法检测TL。利用加权分位数和回归(WQS)评估空气污染混合暴露水平对NFLC患病风险的影响,利用多因素Logistic回归评估空气污染及TL对NFLC患病风险的交互作用。结果最终纳入1315例研究对象(对照组634人,病例组681人)。病例组和对照组间的地区、体质指数、妊娠次数、癌症家族史、被动吸烟等差异有统计学意义(P<0.05);病例组和对照组间的年龄、民族、最高学历水平、TL等差异无统计学意义(P>0.10)。肺鳞癌、小细胞肺癌患者和对照组的TL差异有边缘统计学意义(P<0.10)。WQS显示空气污染混合暴露对NFLC、肺腺癌和非小细胞肺癌患病风险存在统计学意义(P<0.001),空气污染混合暴露每增加1个10分位数,NFLC、肺腺癌和非小细胞肺癌患病风险分别增加60%(校正OR=1.60,95%CI:1.17~2.22)、82%(校正OR=1.82,95%CI:1.21~2.75)和121%(校正OR=2.21,95%CI:1.39~3.56)。多因素Logistic回归分析显示空气污染混合暴露与TL对NFLC患病风险影响无相乘、无相加交互作用。结论空气污染混合暴露及TL均与NFLC患病风险相关,本研究未发现空气污染与TL对NFLC患病风险存在交互作用。

宣威地区燃煤排放颗粒物毒理学及肺癌地质起因研究

云南省宣威市是我国肺癌最严重的地区,该区肺癌发病率和死亡率均居世界首位。对宣威肺癌患者的基因组学研究发现,宣威肺癌具有与众不同的基因特征,是一种与环境相关的独特发病模式。通过综述宣威肺癌的流行特征以及燃煤排放物的污染水平和毒理学特征,并结合二叠纪末期C_(1)煤层的地球化学特征探讨宣威肺癌的地质起因。宣威肺癌主要流行特征表现在,肺癌死亡率男女比接近1.22,女性肺癌死亡率明显偏高。前人研究表明,室内燃煤排放颗粒物的长期、高浓度暴露,是宣威肺癌的主要诱因。综述毒理学研究结果可知,宣威室内燃煤排放颗粒物中的重金属、多环芳烃和微晶石英矿物浓度均高于其他地区,且被证实可能会引起更严重的DNA损伤和细胞破坏。通过对比宣威肺癌死亡率的空间分布和不同煤矿的煤层分布发现,可采煤层包含C_(1)煤的来宾和龙场地区同时也是宣威肺癌的高发地区,推断C_(1)煤的燃烧可能与宣威肺癌高发有关。C_(1)煤作为晚二叠世最后一层煤,成煤期间受二叠纪−三叠纪生物大灭绝事件影响,形成了独特的地球化学特征。高含量的重金属、多环芳烃和微晶石英矿物等潜在致癌物不仅存在于C_(1)煤中,也随着室内燃煤被释放到空气中,并通过呼吸系统进入人体体内,破坏细胞及DNA结构,造成肺阻塞、肺炎等一系列呼吸道疾病,严重的可能导致肺癌发生。

宣威肺癌危险因素研究概述（1979～1993）

我国云南省宣威县（１９７９～１９９３）男性肺癌年龄调整死亡率是２７．７／１０５，属全国肺癌高发区之一，女性肺癌年龄调整死亡率是２５．３／１０５，居全国之首。为了研究引起肺癌高发的主要危险因素，探索暴露与疾病之间的关联强度及方向，我们以宣威县为研究基地，开展了多学科的综合性研究。其主要结论如下：（１）与工业污染未见明显联系；（２）吸烟不是宣威肺癌的主要危险因素；（３）生活燃料与宣威肺癌死亡率间存在明显联系；（４）与室内燃煤空气污染联系密切。

烹调引起的室内空气污染与女性非吸烟者肺癌关系的病例─对照研究

在上海市区进行的一次女性肺癌病例一对照研究共调查５０４名不吸烟的肺癌新病例和按年龄、性别及吸烟状态配对的人群对照６０１例。结果揭示：１．厨房通风差，或与卧室分隔不好，或在卧室内烧饭，肺癌危险性增加；２．烹调时眼睛经常有受抽烟烟雾刺激之感觉和／或室内充满烟雾，肺癌危险性上升；３．烹调中经常使用菜油或经常烹调油炸食品，肺癌危险性亦会增加；４．肺癌危险性随居室通风面积的增加而降低，线性趋势在调整年龄、家庭人均月收入、居室面积后有显著性；５．烹调所用燃料类型与肺癌危险性无显著联系。

宣威地区改炉改灶干预措施预防肺癌效果评价

为探讨改炉改灶干预措施对降低宣威地区肺癌发病率的效果，１９９２年进行了一次回顾性队列研究。改灶措施Ⅰ及措施Ⅱ均与肺癌发病率下降有较强的联系，其降低的程度大致与改灶时的年龄成反比。一生烧烟煤，在≤３０岁、３１～５０岁以及≥５１岁开始改灶与一生中未改灶的人群比较，男性患肺癌的相对危险度ＲＲ值分别为０．４２、０．６６及０．７５，女性分别为０．４２、０．６６及０．６６（以未改灶组为参照组，即其ＲＲ值为１．０）。男、女性在改灶后患肺癌危险性下降的程度相似。这些结果不仅支持了烧烟煤造成的室内空气污染与宣威地区肺癌之间具有因果关系的论点。

控烟是预防肺癌的主要措施——记太原市肺癌病例对照流行病学调查

背景与目的:山西省太原市空气污染常较为严重。了解各种类型肺癌的危险因素,以采取有效的预防措施。方法:2005年3月—2007年9月,山西省太原市396例肺癌新发病例和465名健康对照者纳入本研究。利用太原市肿瘤医院病理学检查确诊的肺癌病例,配以人群为基础、随机选择的对照,进行病例对照询问调查和环境监测。分析时注意排除病例对照危险因素以外的危险因素并加以平衡,同时进行趋势检验;采用多因素非条件logistic回归分析法,分析各种危险因素,包括比值比(odds ratio,OR)及95%可信区间(95%confidence interval,95%CI)。结果:吸烟与肺癌密切相关。吸烟者发生肺癌危险度比不吸烟者显著升高(OR=3.75,95%CI:2.39~5.89),特别是肺鳞癌和小细胞肺癌(OR=5.01和5.06)。肺癌与吸烟量、吸烟年数、吸烟深度均有显著的剂量效应关系。被动吸烟或长期在厨房使用固体燃料烹饪、取暖等亦对肺癌的发生、发展起着重要作用。PM2.5的研究刚刚开始,尚未发现室内颗粒物的污染与肺癌的发生明显相关。结论:太原市居民吸烟仍是肺癌的主要危险因素。被动吸烟、固体燃料烹饪也不容忽视。

煤烟型大气污染对儿童肺功能的影响

为观察煤烟型大气污染对儿童健康的影响 ,选择了太原市 3个污染程度不同地区的 45 0名儿童进行肺功能测试和问卷调查。研究结果显示 ,儿童呼吸功能表现为重度污染区 <中度污染区 <相对清洁区 ;肺通气功能阻塞性异常率表现为重度污染区 >中度污染区 >相对清洁区 ;Logistic回归分析发现肺通气功能阻塞性异常率与小学生家庭的取暖方式、厨房和卧室是否分开以及污染物的水平有关 ;多元线性回归分析显示重度污染区儿童的FVC、FEF5 0与相对清洁区相比分别减少了 65 80ml、119 2 7ml,中度污染区儿童的FVC、FEF5 0与相对清洁区相比分别减少了 5 7 2 8ml和 114 2 9ml;Ln(SO2 )每升高一个单位 ,FVC和FEF5 0分别减少69 10ml和 119 79ml,Ln(PM1 0 )每升高一个单位 ,FVC、FEF5 0等分别减少了 193 5 0ml和 171 69ml。结果提示 ,太原市煤烟型大气污染对儿童呼吸系统产生了危害。

我国大气污染与居民肺癌发病与死亡的灰色关联度分析——基于我国肿瘤登记地区的数据

基于2004—2012年中国肿瘤登记地区的数据,采用灰色关联分析方法,计算了大气污染物与肺癌发病及死亡率的关联度,并对大气污染物致肺癌死亡的潜伏期作了定量分析.研究结果表明:(1)二氧化硫是我国男性肺癌发病和死亡最主要影响因素;(2)烟(粉)尘是我国女性肺癌发病的最主要影响因素,但二氧化硫是我国女性肺癌死亡的最主要影响因素;(3)二氧化硫对男性肺癌死亡及发病的影响都要比女性大,氮氧化物和烟(粉)尘对女性肺癌发病的影响都要比男性大,但氮氧化物和烟(粉)尘对男性肺癌死亡的影响都要比女性大;(4)二氧化硫、氮氧化物及烟(粉)尘致男性肺癌的潜伏期分别为5年、3年、5年,致女性肺癌的潜伏期分别为5年、4年、5年.

基于疾病与环境科学数据的跨领域关联分析及应用

基于美国环境健康领域开放科学数据,采用数据挖掘技术研究空气污染物、细颗粒物、气象条件、有毒物质等环境因素与肺癌、哮喘等疾病的关联分析方法,同时实现了关联分析在实践中的应用,为我国环境与疾病关联研究提供参考和借鉴。

空气污染与肺癌死亡率:来自山东省自然实验的证据

将2009年山东省青岛市在我国第十一届运动会期间实行的控制空气污染政策作为一次自然实验,运用双重差分模型实证检验了控制空气污染的政策对肺癌死亡率的影响。认为控制空气污染的政策对于降低肺癌死亡率效果显著,且这种显著的效果源于对于女性肺癌死亡率的影响,而对于男性肺癌死亡率的效果则不显著,这个研究结论不受模型设定所限保持稳健。肺癌作为一种对人群健康和生命威胁最大的恶性肿瘤之一,其死亡率可以受到控制空气污染政策的影响而显著下降,这个结论可以为我国环境规制和公共卫生政策提供科学依据。

室内燃煤与大气污染对儿童肺功能的交互影响

目的研究室内燃煤与大气污染对儿童肺功能的交互作用影响。方法1995-1996年间在中国4城市的城区和郊区的8所小学对6～12岁的儿童进行肺功能的队列测试,每年分冷、暖两季进行。通过3步回归过程进行统计分析。结果室外空气颗粒物与儿童第1秒最大呼气量(FEV1)、用力肺活量(FVC)和FEV1/FVC都有显著的负相关关系。家庭燃煤与TSP对FEV1和FVC有较显著的交互作用。家庭燃煤与PM10对肺功能的交互作用较弱,但有加重颗粒物对肺功能产生不利影响的趋势。未发现室内燃煤与SO2和NOx对肺功能有显著的交互影响作用。结论家庭燃煤这种室内污染因素加重了环境空气颗粒物污染,特别是TSP对儿童肺功能的不利影响。

北京市大兴区民用燃煤汞污染研究

采用Lumex RA915＋M测汞仪对北京黄村镇3个自然村56户家庭进行了入户检测、采样。结果表明56户人家烟气中汞浓度均值为723 ng/m3。空气汞测定表明生活燃煤汞排放导致三个自然村的空气汞浓度提高到7～13 ng/m3，显著高于未受燃煤影响的附近念坛水库周边空气汞浓度（1.7 ng/m3）。调查发现，较高价格蜂窝煤中汞含量较低（均值163 ng/g），廉价蜂窝煤中汞含量较高（均值552 ng/g）。总之，生活燃煤确实存在汞排放，廉价劣质的蜂窝煤流向民用市场更可能导致生活燃煤汞排放加剧。