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      Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis

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          Abstract

          Background: Particulate matter (PM) in outdoor air pollution was recently designated a Group I carcinogen by the International Agency for Research on Cancer (IARC). This determination was based on the evidence regarding the relationship of PM 2.5 and PM 10 to lung cancer risk; however, the IARC evaluation did not include a quantitative summary of the evidence.

          Objective: Our goal was to provide a systematic review and quantitative summary of the evidence regarding the relationship between PM and lung cancer.

          Methods: We conducted meta-analyses of studies examining the relationship of exposure to PM 2.5 and PM 10 with lung cancer incidence and mortality. In total, 18 studies met our inclusion criteria and provided the information necessary to estimate the change in lung cancer risk per 10-μg/m 3 increase in exposure to PM. We used random-effects analyses to allow between-study variability to contribute to meta-estimates.

          Results: The meta-relative risk for lung cancer associated with PM 2.5 was 1.09 (95% CI: 1.04, 1.14). The meta-relative risk of lung cancer associated with PM 10 was similar, but less precise: 1.08 (95% CI: 1.00, 1.17). Estimates were robust to restriction to studies that considered potential confounders, as well as subanalyses by exposure assessment method. Analyses by smoking status showed that lung cancer risk associated with PM 2.5 was greatest for former smokers [1.44 (95% CI: 1.04, 1.22)], followed by never-smokers [1.18 (95% CI: 1.00, 1.39)], and then current smokers [1.06 (95% CI: 0.97, 1.15)]. In addition, meta-estimates for adenocarcinoma associated with PM 2.5 and PM 10 were 1.40 (95% CI: 1.07, 1.83) and 1.29 (95% CI: 1.02, 1.63), respectively.

          Conclusion: The results of these analyses, and the decision of the IARC Working Group to classify PM and outdoor air pollution as carcinogenic (Group 1), further justify efforts to reduce exposures to air pollutants that can arise from many sources.

          Citation: Hamra GB, Guha N, Cohen A, Laden F, Raaschou-Nielsen O, Samet JM, Vineis P, Forastiere F, Saldiva P, Yorifuji T, Loomis D. 2014. Outdoor particulate matter exposure and lung cancer: a systematic review and meta-analysis. Environ Health Perspect 122:906–911;  http://dx.doi.org/10.1289/ehp.1408092

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          Most cited references 32

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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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).

            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. 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 (PM2·5), and between 2·5 and 10 μm (PMcoarse), soot (PM2·5absorbance), 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. 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/m(3)). For PM2·5 the HR was 1·18 (0·96-1·46) per 5 μg/m(3). The same increments of PM10 and PM2·5 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/m(3)) or traffic intensity on the nearest street (HR 1·00 [0·97-1·04] per 5000 vehicles per day). Particulate matter air pollution contributes to lung cancer incidence in Europe. European Community's Seventh Framework Programme. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              Cochrane Handbook for Systematic Reviews of Interventions

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                Author and article information

                Journal
                Environ Health Perspect
                Environ. Health Perspect
                EHP
                Environmental Health Perspectives
                NLM-Export
                0091-6765
                1552-9924
                06 June 2014
                September 2014
                : 122
                : 9
                : 906-911
                Affiliations
                [1 ]International Agency for Research on Cancer, Lyon, France
                [2 ]Health Effects Institute, Boston, Massachusetts, USA
                [3 ]Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
                [4 ]Department of Environmental Health, and
                [5 ]Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
                [6 ]Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
                [7 ]Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
                [8 ]Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
                [9 ]Department of Epidemiology, Regional Health Authority, Lazio, Roma, Italy
                [10 ]Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
                [11 ]Department of Human Ecology, Graduate School of Environmental and Life Sciences, Okayama University, Okayama, Japan
                Author notes
                Address correspondence to G.B. Hamra, Section of Environment and Radiation, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69006 Lyon, France. Telephone: 33 4 72 73 89 12. E-mail: ghassan.b.hamra@ 123456drexel.edu
                Article
                ehp.1408092
                10.1289/ehp/1408092
                4154221
                24911630

                Publication of EHP lies in the public domain and is therefore without copyright. All text from EHP may be reprinted freely. Use of materials published in EHP should be acknowledged (for example, “Reproduced with permission from Environmental Health Perspectives”); pertinent reference information should be provided for the article from which the material was reproduced. Articles from EHP, especially the News section, may contain photographs or illustrations copyrighted by other commercial organizations or individuals that may not be used without obtaining prior approval from the holder of the copyright.

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