Constituents of Household Air Pollution and Risk of Lung Cancer among Never-Smoking Women in Xuanwei and Fuyuan, China

Abstract

Background:Lung cancer rates among never-smoking women in Xuanwei and Fuyuan in China are among the highest in the world and have been attributed to the domestic use of smoky (bituminous) coal for heating and cooking. However, the key components of coal that drive lung cancer risk have not been identified.Objectives:We aimed to investigate the relationship between lifelong exposure to the constituents of smoky coal (and other fuel types) and lung cancer.Methods:Using a population-based case–control study of lung cancer among 1,015 never-smoking female cases and 485 controls, we examined the association between exposure to 43 household air pollutants and lung cancer. Pollutant predictions were derived from a comprehensive exposure assessment study, which included methylated polycyclic aromatic hydrocarbons (PAHs), which have never been directly evaluated in an epidemiological study of any cancer. Hierarchical clustering and penalized regression were applied in order to address high colinearity in exposure variables.Results:The strongest association with lung cancer was for a cluster of 25 PAHs [odds ratio (OR): 2.21; 95% confidence interval (CI): 1.67, 2.87 per 1 standard deviation (SD) change], within which 5-methylchrysene (5-MC), a mutagenic and carcinogenic PAH, had the highest individual observed OR (5.42; 95% CI: 0.94, 27.5). A positive association with nitrogen dioxide (NO2) was also observed (OR: 2.06; 95% CI: 1.19, 3.49). By contrast, neither benzo(a)pyrene (BaP) nor fine particulate matter with aerodynamic diameter ≤2.5μm (PM2.5) were associated with lung cancer in the multipollutant models.Conclusions:To our knowledge, this is the first study to comprehensively evaluate the association between lung cancer and household air pollution (HAP) constituents estimated over the entire life course. Given the global ubiquity of coal use domestically for indoor cooking and heating and commercially for electric power generation, our study suggests that more extensive monitoring of coal combustion products, including methylated PAHs, may be warranted to more accurately assess health risks and develop prevention strategies from this exposure. https://doi.org/10.1289/EHP4913

Regional Policies Targeting Residential Solid Fuel and Agricultural Emissions Can Improve Air Quality and Public Health in the Greater Bay Area and Across China

“…Reducing residential solid fuel use will also lead to further public health benefits from reductions in household PM 2.5 exposure (Aunan et al., 2018; Chan et al., 2019; Kim et al., 2016; Li et al., 2019b; S. Li et al., 2019d; Vermeulen et al., 2019; K. Yu et al., 2018; Zhao et al., 2018). A reduction in residential solid fuel use may also reduce greenhouse gas emissions (Rive & Aunan, 2010; Smith & Haigler, 2008), depending on the replacement fuel (Qin et al., 2017; Yang & Jackson, 2013).…”

“…Reducing residential solid fuel use will also lead to further public health benefits from reductions in household PM 2.5 exposure (Aunan et al, 2018;Chan et al, 2019;Kim et al, 2016;Li et al, 2019b;S. Li et al, 2019d;Vermeulen et al, 2019;K. Yu et al, 2018;Zhao et al, 2018).…”

Development and validation of the cancer symptoms discrimination scale: a cross-sectional survey of students in Yunnan, China

“…The incidence and mortality among rural residents are higher than those in urban residents [16]. For example, Xuanwei, Fuyuan [17,18] and Gejiu [19] in Yunnan province are regions with high incidence of lung cancer recognized by medical communities in both Chinese and other countries. And above reasons may further aggravate the public's biased perception of cancer, and even lead to the stigmatization and marginalization of cancer patients.…”

Expanded View of PAHs: Identifying Especially Harmful Constituents of Bituminous Coal Smoke

“…3,4 A study recently published in Environmental Health Perspectives identified specific constituents of smoke from the implicated coal that might be especially harmful-with potential significance far beyond rural China. 5 Bituminous coal is found everywhere in the world, says first author Roel Vermeulen, a professor of environmental epidemiology and exposome science at Utrecht University in the Netherlands. So why is the coal in this particular area so strongly associated with cancer risk?…”