|Year : 2022 | Volume
| Issue : 2 | Page : 66-70
Air pollution and cancer: Growing concern in low- and middle-income countries
Abhishek Shankar1, Deepak Saini2, Shubham Roy3
1 Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Materia Medica, Lal Bahadur Shastri Homoeopathic Medical College and Hospital, Prayagraj, India
3 Shining Stars Child Development Clinic, Delhi, India
|Date of Submission||05-Nov-2022|
|Date of Acceptance||07-Nov-2022|
|Date of Web Publication||18-Nov-2022|
Dr. Abhishek Shankar
Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, Bihar
Source of Support: None, Conflict of Interest: None
Air pollution has become a major health issue affecting billions of people and effects are more pronounced in low- and Middle-income countries (LMICs). Air pollution is a major contributor to the burden of disease worldwide. Most of the global population resides in places where air pollution levels exceed the WHO acceptable limits, caused by various industries, power generation, transportation, and domestic burning. More than 85% of total air pollution death are observed in LMICs. There are many carcinogens that are found in air pollution. There is substantial evidence from studies of humans and experimental animals as well as mechanistic evidence to support a causal link between outdoor (ambient) air pollution and cancer.
Keywords: Breast cancer, childhood cancer, low- and middle-income countries, lung cancer, pollution
|How to cite this article:|
Shankar A, Saini D, Roy S. Air pollution and cancer: Growing concern in low- and middle-income countries. Ann Oncol Res Ther 2022;2:66-70
|How to cite this URL:|
Shankar A, Saini D, Roy S. Air pollution and cancer: Growing concern in low- and middle-income countries. Ann Oncol Res Ther [serial online] 2022 [cited 2022 Nov 29];2:66-70. Available from: http://www.aort.com/text.asp?2022/2/2/66/361498
| Introduction|| |
There are 19.3 million cancer cases and 9.9 million deaths globally, of which 9.5 million cases and 5.8 million deaths are reported in Asia. Apart from tobacco, alcohol, infection, and obesity as major risk factors for cancer, air pollution has emerged as an important risk factor., Globally, more than 6.5 million people die of air pollution and half of these deaths are attributed to outdoor air pollution.
Air pollution has become a major health issue affecting billions of people and its effects are more pronounced in low- and middle-income countries (LMICs). Air pollution is a major contributor to the burden of disease worldwide. Noncommunicable diseasess, including cancer, have been associated with different forms of air pollution, leading to the death of millions of people in LMICs. Most of the polluted places on earth belong to LMICs, with 63 out of 100 in India. Most of the global population resides in places where air pollution levels exceed the WHO acceptable limits, caused by various industries, power generation, transportation, and domestic burning. More than 85% of total air pollution death are observed in LMICs. India reports the death of near to 2 million people in India attributed to air pollution.
Air pollution is a combined result of various anthropogenic activities emitting pollutants such as particulate matter 2.5 and 10 (PM 2.5, PM 10), ozone, dioxide of sulfur and nitrogen, fossil fuel and biomass burning, and industrial emissions., Many components of air pollution, which include benzene, engine exhaust, aromatic hydrocarbons, and involuntary smoking, have been categorized as carcinogenic and probably carcinogenic to humans (categorized in Group 1 and 2A) by International Agency for Research on Cancer (IARC).
There have been various studies that have proven the link between exposure to air pollution and the risk of different cancer types. Exposure to air pollution is linked with inflammation, immune and oxidative response, DNA damage, and alteration in gene expression and mutation.,,
| Air Pollution and Carcinogenesis|| |
Air pollutants have inhaled particles such as polycyclic aromatic hydrocarbons (PAH), volatile compounds, metals, and insoluble particles that get deposited in thoracic and alveolar regions. There is a nonlinear dose-response relationship between air pollution PAH and DNA adducts and it increases the chances of cancer. There is an enhanced frequency of chromosome aberrations and micronuclei in lymphocytes, along with changes in the expression of genes involved in DNA damage and repair, inflammation, immune and oxidative stress response, altered telomere length, and DNA methylation. These cascades of events turn on oncogenes and turn off tumor suppressor genes, leading to gene mutations and cancer. There are many carcinogens that are found in air pollution. Air pollution components and related risks of cancer types are described in [Table 1].
| Air Pollution and Lung Cancer|| |
Lung cancer rank on the top among commonly diagnosed cancers at the advanced stage, along with poor survival, account nearly 20% of all cancer deaths. Nearly 62,000 lung cancer deaths are estimated to be due to air pollution. Air pollution is known, and probably carcinogens such as benzene, benzopyrene, butadiene, ozone, oxide of nitrogen, and sulfur are found in polluted air. Air pollution, commonly diagnosed as lung cancer, is associated with high fatality and low survival rates, with variations in incidence and mortality across the globe. Polynesia, Micronesia, part of Asia, and Europe have high age-standardized incidence rates of lung cancer in men, while parts of America and Europe have a high incidence of lung cancer among women.,
Although lung cancer is primarily associated with cigarette smoking, the incidence of lung cancer in nonsmokers is seeing upward trends. This increased incidence of lung cancer among nonsmokers is reported to be linked to air pollution. Exposure to smoke of burning of biomass and fossil fuel, engine exhaust, organic and inorganic chemical, second-hand smoke, along with exposure to carcinogens at the workplace have been reported to be linked with lung cancer., Air pollution poses an elevated risk of lung cancer development in both smokers and nonsmokers. Studies have found a positive association in incidence and mortality of lung cancer and the concentration of PM 2.5 and PM 10.,,
Indoor air pollution also elevates the risk of lung cancer. Using biomass for cooking and heating release carcinogens such as PAHs, benzene, and formaldehyde, contributing to indoor air pollution along with the habit of smoking in a family member, increasing the risk of lung cancer in the household.
Lung cancer has been linked to long-term exposure to air pollution worldwide. In vitro experiments have reported genotoxicity and DNA damage in tissue by engine exhaust, PM matter even at low concentrations. Human biomarker data indicate genotoxicity as the principal mechanism, and studies on exposure to air pollution in various study settings and different age groups have shown genotoxicity by DNA and protein adducts, DNA break, and chromosomal aberration., Damaged to lung tissue by air pollution is well established, but it also damages other organs and tissues of the body. Air pollution is majorly associated with lung cancer, but the risk of the development of other cancer has also been linked to air pollution. A positive correlation has been found between PM 2.5 and various cancer sites, including oral, urogenital, renal, and gastrointestinal.,
In Tehran, a high incidence of lung cancer was found in cities with a higher concentration of oxide of nitrogen, benzene, ethylbenzene, and xylene in air pollution indicating a positive linked between air pollution and lung cancer risk.
| Air Pollution and Childhood Cancer|| |
Exposure to air pollution among children is associated with adverse health outcomes affecting their overall development. High PM level was found to be associated with lower birth weight. The risk of cancer development in children increases with long exposure to air pollution during their outdoor activity and indoor air pollution.,,,
Studies suggest the role of air pollution in the development of neoplasm in children, especially hematological malignancies., Exposure to second-hand smoke in the house due to the smoking habits of family members increase the risk of childhood cancer along with residing in the area with the unhygienic condition and polluted air. Air pollution due to engine exhaust and traffic was found to be associated with hematological cancer, retinoblastoma, and teratomas in childhood in California, USA, and Switzerland., Finding suggests increased mortality in children with cancer exposed to PM 2.5.
| Air Pollution and Urological Cancer|| |
Exposure to air pollution, including cigarette smoking, chlorinated hydrocarbons, polycyclic amines, and aromatic amines, have associated with an increased risk of urological cancer, which includes prostate, renal, bladder, and testicular cancer. Studies have linked exposure to these carcinogens at the workplace in the development of these cancer types.,,,
Use of benzene-based dyes such as 2-naphthylamine and benzidine at the workplace are associated with increased risk of development of prostate, renal, and bladder cancer in industries such as rubber, paint, chemical, and metal.,, Hydrocarbons such as PAH emitted during biomass burning and industrial emission as categorized as carcinogens and posed an elevated risk of bladder and renal cancer development., Second-hand smoke is one of the common causes of exposure to carcinogens, having elevated risk of bladder and renal cancer., Air pollution containing oxide of nitrogen, generally a result of traffic, is associated with an elevated risk of prostate cancer.
There is limited evidence of the association of bladder cancer with PM as few studies found an association, and others did not.,, IARC report suggests exposure to air pollution, engine exhaust, and exposure in occupational settings to carcinogens may have an association with bladder cancer. Zare Sakhvidi et al., in the systemic review, reported link between air pollution and the risk of bladder and kidney cancer among the general public, with many gaps in studies conducted.
| Air Pollution and Breast Cancer|| |
Many Studies have linked the elevated risk of breast cancer and exposure to air pollution due to PM and oxides of nitrogen. Exposure to PAHs has been linked with breast cancer risk. Biomass burning is a major source of PAH in indoor air pollution, which has been found to be positively associated with an increased risk of breast cancer in long-term exposure. Exposure to ultrafine particles of size < 0.1 μm and NO2 was found to be associated with an increased risk of postmenopausal breast cancer. The Sister Study among US women indicates a positive association between the risk of breast cancer and exposure to NO2. Studies also suggest an association between second-hand smoke and breast cancer.,,,
California Teacher Study found higher concentrations of carcinogens such as benzenes, methylene chloride, CCl4, butadiene, and vinyl chloride, along with other mammary gland carcinogens. This study suggests a significant elevated risk of breast cancer on exposure to these carcinogens (P < 0.5). Exposure to higher concentrations of benzene was associated with an elevated risk of estrogen-receptor negative and progesterone-receptor negative subtype of breast cancer with a hazard ratio of 1.45.
| Air Pollution and Other Types of Cancer|| |
A strong association of risk of brain cancer was found with exposure to benzene, PM 10, and Ozone, with a hazard ratio in some exposure more than 3. Traffic-related air pollution responsible for increased concentration of oxides of nitrogen resultant of emission of engine exhaust was found associated with an elevated risk of cervical cancer and brain cancer.,
Air pollution may cause damage to the liver, increasing risk of the development of hepatocellular malignancy. Exposure to fine PM was found to be associated with an increased level of alanine aminotransferase (ALT), which is associated with liver cancer. Deng et al. suggest exposure to PM 2.5 after liver cancer diagnosis was associated with a lower survival period.
Toxic emission from engine exhaust, including benzene, butadiene, toluene, and ethyl benzene, was found to be associated with the risk of retinoblastoma. Dehghani et al. suggest exposure to PM and polluted air due to traffic are associated with an increased risk of ovarian cancer. Exposure to higher concentrations of PM2.5 and oxides of nitrogen also found to lower the survival period in ovarian cancer survival.,
| Conclusion|| |
Currently, there is substantial evidence from studies of humans and experimental animals as well as mechanistic evidence to support a causal link between outdoor (ambient) air pollution, especially PM in outdoor air, with lung cancer incidence and mortality. There is an increase in the percentage of lung cancer cases caused by risk factors other than cigarette smoking, and air pollution has emerged as an important risk factor. It has a risk for other cancer types, such as bladder cancer or breast cancer but in limited numbers. Outdoor air pollution may also be associated with poorer cancer survival, although further research is needed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al.
Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49.
International Agency for Research on Cancer. Cancer Today. Lyon, France. 2022. Available from: https://gco.iarc.fr/today/home
. [Last accessed on 2022 Nov 01].
Dhimal M, Chirico F, Bista B, Sharma S, Chalise B, Dhimal ML, et al. Impact of air pollution on global burden of disease in 2019. Processes 2021;9:1719.
International Agency for Research on Cancer. Air Pollution and Cancer. Lyon, France: International Agency for Research on Cancer; 2013.
Shankar A, Dubey A, Saini D, Singh M, Prasad CP, Roy S, et al.
Environmental and occupational determinants of lung cancer. Transl Lung Cancer Res 2019;8:S31-49.
Turner MC, Andersen ZJ, Baccarelli A, Diver WR, Gapstur SM, Pope CA 3rd, et al. Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations. CA Cancer J Clin 2020;70:460-79.
Loomis D, Grosse Y, Lauby-Secretan B, El Ghissassi F, Bouvard V, Benbrahim-Tallaa L, et al.
The carcinogenicity of outdoor air pollution. Lancet Oncol 2013;14:1262-3.
Su SY, Liaw YP, Jhuang JR, Hsu SY, Chiang CJ, Yang YW, et al.
Associations between ambient air pollution and cancer incidence in Taiwan: An ecological study of geographical variations. BMC Public Health 2019;19:1496.
Gharibvand L, Shavlik D, Ghamsary M, Beeson WL, Soret S, Knutsen R, et al.
The association between ambient fine particulate air pollution and lung cancer incidence: Results from the AHSMOG-2 study. Environ Health Perspect 2017;125:378-84.
Shankar A, Saini D, Dubey A, Roy S, Bharati SJ, Singh N, et al.
Feasibility of lung cancer screening in developing countries: Challenges, opportunities and way forward. Transl Lung Cancer Res 2019;8:S106-21.
Cohen AJ. Air pollution and lung cancer: What more do we need to know? Thorax 2003;58:1010-2.
Hamra GB, Guha N, Cohen A, Laden F, Raaschou-Nielsen O, Samet JM, et al.
Outdoor particulate matter exposure and lung cancer: A systematic review and meta-analysis. Environ Health Perspect 2014;122:906-11.
Krewski D, Jerrett M, Burnett RT, Ma R, Hughes E, Shi Y, et al. Extended follow-up and spatial analysis of the American Cancer Society study linking particulate air pollution and mortality. Res Rep Health Eff Inst 2009;140:5-114.
Raaschou-Nielsen O, Andersen ZJ, Beelen R, Samoli E, Stafoggia M, Weinmayr G, et al.
Air pollution and lung cancer incidence in 17 European cohorts: Prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE). Lancet Oncol 2013;14:813-22.
Shankar A, Roy S, Rath GK, Julka PK, Kamal VK, Malik A, et al.
Aromatase Inhibition and capecitabine combination as 1st
line treatment for metastatic breast cancer – A retrospective analysis. Asian Pac J Cancer Prev 2015;16:6359-64.
Schraufnagel DE, Balmes JR, Cowl CT, De Matteis S, Jung SH, Mortimer K, et al.
Air pollution and noncommunicable diseases: A review by the forum of international respiratory societies' environmental committee, Part 2: Air pollution and organ systems. Chest 2019;155:417-26.
Khorrami Z, Pourkhosravani M, Rezapour M, Etemad K, Taghavi-Shahri SM, Künzli N, et al.
Multiple air pollutant exposure and lung cancer in Tehran, Iran. Sci Rep 2021;11:9239.
Mazloumi Tabrizi M, Hosseini SA, Akbarzadeh Khiyavi A. Exposure to air pollution and risk of cancer in children – A case control study. Asian Pac J Cancer Biol 2017;2:13-5.
Mahapatra B, Walia M, Avis WR, Saggurti N. Effect of exposure to PM< sub> 10</sub> on child health: Evidence based on a large-scale survey from 184 cities in India. BMJ Glob Health 2020;5:e002597.
Reuben A, Arseneault L, Beddows A, Beevers SD, Moffitt TE, Ambler A, et al.
Association of air pollution exposure in childhood and adolescence with psychopathology at the transition to adulthood. JAMA Netw Open 2021;4:e217508.
Hvidtfeldt UA, Erdmann F, Urhøj SK, Brandt J, Geels C, Ketzel M, et al.
Air pollution exposure at the residence and risk of childhood cancers in Denmark: A nationwide register-based case-control study. EClinicalMedicine 2020;28:100569.
Reynolds P, Von Behren J, Gunier RB, Goldberg DE, Hertz A, Smith DF. Childhood cancer incidence rates and hazardous air pollutants in California: An exploratory analysis. Environ Health Perspect 2003;111:663-8.
Heck JE, Wu J, Lombardi C, Qiu J, Meyers TJ, Wilhelm M, et al.
Childhood cancer and traffic-related air pollution exposure in pregnancy and early life. Environ Health Perspect 2013;121:1385-91.
Kreis C, Héritier H, Scheinemann K, Hengartner H, de Hoogh K, Röösli M, et al.
Childhood cancer and traffic-related air pollution in Switzerland: A nationwide census-based cohort study. Environ Int 2022;166:107380.
Ou JY, Hanson HA, Ramsay JM, Kaddas HK, Pope CA 3rd
, Leiser CL, et al.
Fine Particulate matter air pollution and mortality among pediatric, adolescent, and young adult cancer patients. Cancer Epidemiol Biomarkers Prev 2020;29:1929-39.
Zare Sakhvidi MJ, Lequy E, Goldberg M, Jacquemin B. Air pollution exposure and bladder, kidney and urinary tract cancer risk: A systematic review. Environ Pollut 2020;267:115328.
Cogliano VJ, Baan R, Straif K, Grosse Y, Lauby-Secretan B, El Ghissassi F, et al.
Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
Kiriluk KJ, Prasad SM, Patel AR, Steinberg GD, Smith ND. Bladder cancer risk from occupational and environmental exposures. Urol Oncol 2012;30:199-211.
Scelo G, Larose TL. Epidemiology and Risk Factors for Kidney Cancer. J Clin Oncol 2018;36:JCO2018791905.
Ferrís J, Garcia J, Berbel O, Ortega JA. Constitutional and occupational risk factors associated with bladder cancer. Actas Urol Esp 2013;37:513-22.
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Some Aromatic Amines, Organic Dyes, and Related Exposures. Lyon (FR): International Agency for Research on Cancer; 2010.
Mullins JK, Loeb S. Environmental exposures and prostate cancer. Urol Oncol 2012;30:216-9.
Siemiatycki J, Richardson L, Straif K, Latreille B, Lakhani R, Campbell S, et al.
Listing occupational carcinogens. Environ Health Perspect 2004;112:1447-59.
Theis RP, Dolwick Grieb SM, Burr D, Siddiqui T, Asal NR. Smoking, environmental tobacco Smoke, and risk of renal cell cancer: A population-based case-control study. BMC Cancer 2008;8:387.
Leppert JT, Shvarts O, Kawaoka K, Lieberman R, Belldegrun AS, Pantuck AJ. Prevention of bladder cancer: A review. Eur Urol 2006;49:226-34.
Parent MÉ, Goldberg MS, Crouse DL, Ross NA, Chen H, Valois MF, et al.
Traffic-related air pollution and prostate cancer risk: A case-control study in Montreal, Canada. Occup Environ Med 2013;70:511-8.
Coleman NC, Burnett RT, Higbee JD, Lefler JS, Merrill RM, Ezzati M, et al.
Cancer mortality risk, fine particulate air pollution, and smoking in a large, representative cohort of US adults. Cancer Causes Control 2020;31:767-76.
Chen J, Rodopoulou S, Strak M, de Hoogh K, Taj T, Poulsen AH, et al.
Long-term exposure to ambient air pollution and bladder cancer incidence in a pooled European cohort: The ELAPSE project. Br J Cancer 2022;126:1499-507.
Reding KW, Young MT, Szpiro AA, Han CJ, DeRoo LA, Weinberg C, et al.
Breast Cancer risk in relation to ambient air pollution exposure at residences in the sister study cohort. Cancer Epidemiol Biomarkers Prev 2015;24:1907-9.
Stults WP, Wei Y. Ambient air emissions of polycyclic aromatic hydrocarbons and female breast cancer incidence in US. Med Oncol 2018;35:88.
White AJ, Teitelbaum SL, Stellman SD, Beyea J, Steck SE, Mordukhovich I, et al.
Indoor air pollution exposure from use of indoor stoves and fireplaces in association with breast cancer: A case-control study. Environ Health 2014;13:108.
Malik A, Jeyaraj PA, Shankar A, Rath GK, Mukhopadhyay S, Kamal VK. Passive Smoking and breast cancer – A suspicious link. Asian Pac J Cancer Prev 2015;16:5715-9.
Garcia E, Hurley S, Nelson DO, Hertz A, Reynolds P. Hazardous air pollutants and breast cancer risk in California teachers: A cohort study. Environ Health 2015;14:14.
Raaschou-Nielsen O, Andersen ZJ, Hvidberg M, Jensen SS, Ketzel M, Sørensen M, et al.
Air pollution from traffic and cancer incidence: A Danish cohort study. Environ Health 2011;10:67.
Wu AH, Wu J, Tseng C, Yang J, Shariff-Marco S, Fruin S, et al.
Association between outdoor air pollution and risk of malignant and benign brain tumors: The multiethnic cohort study. JNCI Cancer Spectr 2020;4:pkz107.
Deng H, Eckel SP, Liu L, Lurmann FW, Cockburn MG, Gilliland FD. Particulate matter air pollution and liver cancer survival. Int J Cancer 2017;141:744-9.
Heck JE, Park AS, Qiu J, Cockburn M, Ritz B. Retinoblastoma and ambient exposure to air toxics in the perinatal period. J Expo Sci Environ Epidemiol 2015;25:182-6.
Dehghani S, Moshfeghinia R, Ramezani M, Vali M, Oskoei V, Amiri-Ardekani E, et al. Exposure to air pollution and risk of ovarian cancer: A review. Rev Environ Health; 2022 May 17. Epub ahead of print. doi: 10.1515/reveh-2021-0129.
Villanueva C, Chang J, Ziogas A, Bristow RE, Vieira VM. Ambient air pollution and ovarian cancer survival in California. Gynecol Oncol 2021;163:155-61.