Air pollution and lung cancer survival in Pennsylvania. (August 2022)

• Record Type: Journal Article
• Authors: McKeon, Thomas P.; Anil Vachani, ; Penning, Trevor M.; Hwang, Wei-Ting
• Is Part Of: Lung cancer. Volume 170(2022)
• Page Start: 65
• Page End: 73
• Publication Date: 2022-08
• Subjects: Lung cancer -- Air pollution -- Survival analysis -- Geospatial -- Exposomics -- Public health; OAP Outdoor Air Pollution -- EPA Environmental Protection Agency -- NO2 Nitrogen Dioxide -- NOx Nitrogen oxides -- O3 Ozone -- PM2.5 Fine Particulates < 2.5 micometers -- PM10 Fine Particulates < 10 micometers -- SEER Surveillance, Epidemiology, and End Results Program -- HR Hazard Ratios -- CIs Confidence Intervals -- WHO World Health Organization -- IARC International Agency for Research on Cancer -- FRM Federal Reference Methods -- FEM Federal Equivalent Methods -- ALA American Lung Association -- Nrf2 Nuclear factor-erythroid factor 2-related factor 2 -- PCR Pennsylvania Cancer Registry -- NAACCR North American Association of Central Cancer Registries -- KM Kaplan-Meier -- ICD International Classification of Diseases; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2022.06.004
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Increasing magnitude of air pollution exposure impacts lung cancer survival in Pennsylvania. This association was greatest for NO2 and for patients with localized cancer staging. Exposure to O3 and PM10 pollutants expressed strong dose–response curves reminiscent of the hormesis principle. Abstract: Objective: Lung cancer is a leading cause of cancer death in the United States. Exposure to outdoor air pollution (OAP) is associated with increased lung cancer incidence, however little is known about the association of OAP and survival after diagnosis. Methods: We investigated the effects of OAP and lung cancer survival in Pennsylvania using data from Pennsylvania Cancer Registry. The study population consisted of 252, 123 patients diagnosed between 1990 and 2017. The Environmental Protection Agency&#39;s ambient air monitoring network provided information on OAP exposure of NO2, O3, PM2.5, and PM10 . Mean OAP exposures were calculated by interpolating exposure concentrations from the five nearest monitors within a 50-kilometer radius of each patient&#39;s residential address from date of diagnosis to date of death or last contact. Cox proportional-hazards models were used to estimate the hazard ratios (HR) for OAP exposures for overall and lung cancer-specific survival. Statistical analyses were stratified by SEER cancer stage groupings (localized, regional, and distant) and adjusted for individual-level and area-level covariates. Results: Median survival time was 0.76 [CIs: 0.75, 0.77] years for the study population and for localized, regional, and distant site diagnosis were 2.2 [CIs: 2.17, 2.23], 1.13 [CIs: 1.12, 1.15], and 0.42 [CIs: 0.41, 0.43] years, respectively. NO2 indicated the greatest HR which increased with increasing magnitude of exposure across all cancer staging groups for deaths before 2-years post-diagnosis. HRs varied by stage and magnitude of OAP exposure with greatest overall effects shown in NO2 followed by PM2.5, O3, and PM10 . A subgroup analysis of patients with treatment status information (2010–2017) showed similar associations of increasing HRs with increasing exposure. Conclusion: These findings supported the hypotheses that OAP can influence the carcinogenic process, impairing chemotherapy treatment, and provide important public health implications since environmental factors are not often considered in prognosis of survival after diagnosis.