Cell type specificity of lung cancer associated with air pollution
Introduction
Since 1982, lung cancer has been the second leading cause of cancer mortality for males and the leading cause for females in Taiwan. The prevalence rate of smoking remained stable over the past 30 years and was about 3–4% for females (Bureau of Tobacco & Alcohol Monopoly, 2001). According to Cheng et al. (2003), the prevalence rate of smoking is about 46.5% for males and 4.2% for females based on the 2001 National Health Interview Survey in Taiwan.
The results in Guo's study showed that the cell type-specific squamous cell carcinoma (SCC) appeared to be related to arsenic ingestion but not adenocarcinoma (AC) (Guo et al., 2004). However, when it comes to inhalation arsenic exposures, a link to a specific cell type of lung cancer is less clear (Pershagen et al., 1987) or AC appeared to be a more common case than SCC (Wicks et al., 1981). Numerous studies have shown an association between smoking and squamous/small cell carcinoma in both genders (Radzikowska et al., 2002, Lee et al., 2001, Stellman et al., 1997). Because in Taiwan the prevalence of smoking in women is low and AC, rather than SCC, is the primary lung cancer cell type among women, it seems possible that risk factors other than smoking exist that may play a more important role in the pathogenesis. In other words, this could indicate that other environmental risk factors (e.g., air pollution or environmental tobacco smoke) play a more important role than smoking and are responsible for the increasing rate of lung cancer in females in Taiwan.
Many studies have shown that air pollution could elevate lung cancer (Nafstad et al., 2004, Choi et al., 1997, Nyberg et al., 2000, Naess et al., 2007). However, data from previous studies on pathological cell types are quite limited. The aim of this study is to explore whether lung cancer associated with air pollution has cell type specificity, which might provide new insights for future studies.
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Materials and methods
Data from 42 air quality monitoring stations in different municipalities, established by the Environmental Protection Administration (EPA) in western Taiwan, were analyzed. These 42 municipalities provide an opportunity to investigate the issue of air pollution. The monitoring stations were fully automated and provided daily readings of levels of sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), and nitrogen oxides (NOx). We obtained air quality data (SO2, CO, O3, NOx) from the Taiwan
Results
Table 1 shows the correlation coefficients between each air quality index (i.e., the level of NOx, CO, SO2, and O3 respectively) and lung cancer ASR for both genders. The SO2 showed no significant association with either male or female lung cancer incidence rates. Interestingly, the traffic-related NOx and CO showed significant correlations with female lung cancer incidence rates, with Pearson's correlation coefficients at 0.33 (P = 0.03) and 0.40 (P = 0.01) respectively. However, the correlations
Discussion
There were some limitations in this study. First, our study design assumed that patients were exposed to air pollution in their “place of residence” recorded on the cancer registry and that one spent most of his or her daily life in the residential municipality. Second, only outdoor exposures were assessed, although personal exposure to some pollutants also occurs indoors at levels sometimes higher than those found outdoors. However, data from German and Mexican cities provide consistent
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