Ambient air pollution and cancer mortality in the cancer prevention study II

Michelle C. Turner, Daniel Krewski, W. Ryan Diver, C. Arden Pope, Richard T. Burnett, Michael Jerrett, Julian D. Marshall, Susan M. Gapstur

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124 Scopus citations


Background: The International Agency for Research on Cancer classified both outdoor air pollution and airborne particulate matter as carcinogenic to humans (Group 1) for lung cancer. There may be associations with cancer at other sites; however, the epidemiological evidence is limited. OBJECTIVE: The aim of this study was to clarify whether ambient air pollution is associated with specific types of cancer other than lung cancer by examining associations of ambient air pollution with nonlung cancer death in the Cancer Prevention Study II (CPS-II). Methods: Analysis included 623,048 CPS-II participants who were followed for 22 y (1982-2004). Modeled estimates of particulate matter with aerodynamic diameter <2.5 μm (PM2.5) (1999-2004), nitrogen dioxide (NO2) (2006), and ozone (O3) (2002-2004) concentrations were linked to the participant residence at enrollment. Cox proportional hazards models were used to estimate associations per each fifth percentile-mean increment with cancer mortality at 29 anatomic sites, adjusted for individual and ecological covariates. Results: We observed 43,320 nonlung cancer deaths. PM2 5 was significantly positively associated with death from cancers of the kidney {adjusted hazard ratio (HR) per 4.4 μg/m3 = 1.14 [95% confidence interval (CI): 1.03, 1.27]} and bladder [HR = 1.13 (95% CI: 1.03, 1.23)]. NO2 was positively associated with colorectal cancer mortality [HR per 6.5ppb = 1.06 (95% CI: 1.02, 1.10). The results were similar in two-pollutant models including PM2 5 and NO2 and in three-pollutant models with O3. We observed no statistically significant positive associations with death from other types of cancer based on results from adjusted models. Conclusions: The results from this large prospective study suggest that ambient air pollution was not associated with death from most nonlung cancers, but associations with kidney, bladder, and colorectal cancer death warrant further investigation.

Original languageEnglish (US)
JournalEnvironmental health perspectives
Issue number8
StatePublished - Aug 2017

Bibliographical note

Funding Information:
M.C.T. reports personal fees from ICF Incorporated, LLC, outside this work. D.K. reports serving as Chief Risk Scientist and CEO at Risk Sciences International (, a Canadian company established in 2006 in partnership with the University of Ottawa conducting work in air quality risk assessment for both public and private sector clients. D.K. also holds an Industrial Research Chair in Risk Science under a peer-reviewed university–industry partnership program administered by the Natural Sciences and Engineering Research Council of Canada, which involves methodological research in air pollution risk assessment. D.K. also recently served as Chair of the U.S. Health Effects Institute Diesel Epidemiology Panel, which conducted an evaluation of recent epidemiological evidence on quantitative risk assessment of diesel emissions and lung cancer.

Funding Information:
M.C.T. was funded by a Canadian Institutes of Health Research Fellowship. D.K. is the McLaughlin Chair in Risk Science at the University of Ottawa. Health Canada, the Centers for Disease Control and Prevention, grant 200-2010-37394, and the National Institutes of Health, grant 5R01ES019573-04, funded the development of the PM2.5 exposure model. The American Cancer Society funded the creation, maintenance, and follow-up of the Cancer Prevention Study II cohort.

Publisher Copyright:
© 2017, Public Health Services, US Dept of Health and Human Services. All rights reserved.


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