5741 - Arsenic and Nonmelanoma Skin Cancer in Slovakia...

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Unformatted text preview: Arsenic and Nonmelanoma Skin Cancer in Slovakia Beate Pesch Environmental Health Research Institute, Germany Part of the EUfunded Project ,Exposure to Arsenic and Cancer in Central & Eastern Europe` www.icconsultants.co.uk/ EXPASCAN.html EXPASCAN PARTNERS Imperial College & IC Consultants, London, UK State Health Institutes, Prievidza, Bankska Bystrica, SK Institute of Hygiene and Epidemiology, Prague, CZ Environmental Health Research Institute, Duesseldorf, D University of Cluj, RO Objective Estimation of the risk of environmental arsenic exposure from power plant emissions for non melanoma skin cancer (NMSC) Estimation of the risk of environmental arsenic exposure s Choose study design(s) s Assess exposure s Estimate risk s Discuss confounders Arsenic and arsenic compounds Environmental Health Criteria (EHC) 2nd edition, 224; 2001 WHO, Geneva www.inchem.org Estimate by Distance to the Power Plant s Environmental As exposure s NMSC incidence Associate As exposure with NMSC risk & control for covariates ENO Power Plant (Slovakia) Environmental Arsenic Exposure s Historical As exposure Air pollution modelling (Colvile et al. 2001) s Current As exposure Measurement of As in soil, house dust (Keegan et al. 2002) Arsenic Emissions (tons/year) of the ENO Power Plant, Slovakia 200 As t/a 100 0 1953 1960 1970 1980 Year 1990 1999 Arsenic immission profile around the Electrarne Novaky power plant, Slovakia 1000 100000 Metreso ufrom f rpower l aplant M e tre s s th -n o rth o m p o w e r p n t 8000 6000 4000 2000 0 0 -2 0 0 0 -4 0 0 0 -6 0 0 0 -8 0 0 0 3 .1 E 1 .8 E 1 .0 E 5 .6 E 3 .1 E 1 .8 E 1 .0 E 5 .6 E 3 .1 E 1 .8 E 1 .0 E 5 .6 E 3 .1 E 1 .8 E 1 .0 E -0 0 2 -0 0 2 -0 0 2 -0 0 3 -0 0 3 -0 0 3 -0 0 3 -0 0 4 -0 0 4 -0 0 4 -0 0 4 -0 0 5 -0 0 5 -0 0 5 -0 0 5 -100000 -1 0 0 0 -10000 M e t r e s w e s t - e a s t0r o m p o w e r p l a n t 10000 f Metres from power plant -1 0 0 0 0 -6 0 0 0 -2 0 0 0 2000 6000 10000 Arsenic (mg/g) in soil 1999 by distance from the plant Distance N Median Min Max < 5 km 40 41 23 20 14 9 10 134 139 53 5-10 km 102 >10 km 68 Urinary arsenic (As III+As V+MMA+DMA) [g/l] 10 1 < 5 km 5-10 km Distance to the power plant > 10 km 90% 10% 75% 25% Median Maximum Minimum r = 0.21 (p<0.01) y = 3.025 * x n = 159 0.237 +As V +MMA+DMA) [g/l] Urinary Arsenic (As III 10 1 10 Arsenic in soil [g/g] 100 Cancer Incidence Analysis s Prievidza district versus Slovakia s Within Prievidza district by distance to the plant Comparative Incidence Figures (CIF) Prievidza district versus Slovakia 197584 All malignancies 1.1 NMSC 1.6 Lung cancer 1.0 Power Plant cutoff 7.5 km 19771991 Basal cell carcinoma 1.6 Squamous cell ca. 1.6 Lung cancer 1.0 Bladder cancer 1.1 CIF by Distance to the SIR NMSC (19961999) by Distance to the Plant <5km 510 km >10km Reference District 1.2 1.1 0.8 0.9 1.6 1.01.3 0.60.9 Slovakia 1.6 1.5 1.0 1.2 2.2 1.31.7 0.91.3 Populationbased CaseControl Study s 264 NMSC cases (199699) response rate 80% s 286 population controls response rate 72% Matching by sex, age Statistical Power s = 5% onesided s = 20% (power 80%) s N cases = 264 s controls exposed to As=10% s N controls = 286 s RR to be detected >= 1.9 NMSC Risk Estimation s Logistic regression conditional on age, gender: Odds Ratio (OR), 95% CI s Potential confounders: occupational As exposure smoking Occupational As exposure (JobExposure Matrix) As Cas Exp. No 159 Low High 83 22 Con 180 73 33 OR 95% CI 1 1.3 0.9-1.9 0.8 0.4-1.4 Cigarette Smoking Pack years < 1 1 < 10 10 < 20 20 + Cases Controls 163 31 31 39 165 21 41 59 OR 95% CI 1 1.4 0.72.6 0.7 0.41.2 0.6 0.41.0 Skin Type & UV Exposure Type Frequent sunburns Light eyes Blonde/ red hair Many freckles Cas Con 264 286 22 14 OR 95% CI 1.8 0.93.5 1.4 1.02.0 2.6 1.35.2 2.2 0.95.3 148 137 29 16 13 8 Fresh Vegetables & Fruits Regular Cas consump. 264 1/ week Vegetab. Fruits 237 239 Con OR 286 95% CI 0.7 0.41.2 270 0.6 0.31.1 265 Exposure Assessment and Risk Estimation for Environmental Arsenic s Dietary habits s Residential history Arsenic Exposure from Dietary Habits s AsNut1 25 food items f: = w(f )* I(f) w(f) food frequencies I(f) annual As intake s AsNut2 = AsNut1 * s if selfsupport s= 2, else 1 Arsenic Exposure with Dietary Habits AsNut2 Cas Con OR 95% CI Low 74 91 1 Medium 157 173 1.1 0.81.6 High 33 22 1.8 1.03.4 Trend 1.3 1.01.7 As Exposure from Residential Data AsRes1 = E(t)* w(d(t),t) for all places of residence: E(t) annual emission w(d(t),t) immission weight Correction of spatial selection bias for distance related variables AsRes s (1) Random resampling of controls SAS Surveyselect s (2) Bootstrap method OR, 95% CI for R=800 resampled groups Arsenic Exposure with Residential Data AsRes1 Low Medium High Trend OR 95% CI 1 1.7 1.42.1 1.9 1.42.6 1.5 1.31.7 Environmental Arsenic Exposure & NMSC Risk s Elevated NMSC incidence in the vicinity of the plant. s As exposure from dietary and residential data are associated with excess risk. s Residual confounding can not be excluded. ...
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