title: Air pollution affects lung cancer survival.
abstract: Exposure to ambient air pollutants has been associated with increased lung cancer incidence and mortality, but due to the high case fatality rate, little is known about the impacts of air pollution exposures on survival after diagnosis. This study aimed to determine whether ambient air pollutant exposures are associated with the survival of patients with lung cancer.
  
  
  
  Participants were 352 053 patients with newly diagnosed lung cancer during 1988-2009 in California, ascertained by the California Cancer Registry. Average residential ambient air pollutant concentrations were estimated for each participant's follow-up period. Cox proportional hazards models were used to estimate HRs relating air pollutant exposures to all-cause mortality overall and stratified by stage (localised only, regional and distant site) and histology (squamous cell carcinoma, adenocarcinoma, small cell carcinoma, large cell carcinoma and others) at diagnosis, adjusting for potential individual and area-level confounders.
  
  
  
  Adjusting for histology and other potential confounders, the HRs associated with 1 SD increases in NO2, O3, PM10, PM2.5 for patients with localised stage at diagnosis were 1.30 (95% CI 1.28 to 1.32), 1.04 (95% CI 1.02 to 1.05), 1.26 (95% CI 1.25 to 1.28) and 1.38 (95% CI 1.35 to 1.41), respectively. Adjusted HRs were smaller in later stages and varied by histological type within stage (p<0.01, except O3). The largest associations were for patients with early-stage non-small cell cancers, particularly adenocarcinomas.
  
  
  
  These epidemiological findings support the hypothesis that air pollution exposures after lung cancer diagnosis shorten survival. Future studies should evaluate the impacts of exposure reduction.
authors: Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA.
authors: Sandrah P
authors: SP
authors: Eckel
authors: Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA.
authors: Myles
authors: M
authors: Cockburn
authors: Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
authors: Yu-Hsiang
authors: YH
authors: Shu
authors: Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA.
authors: Huiyu
authors: H
authors: Deng
authors: Sonoma Technology Inc., Petaluma, California, USA.
authors: Frederick W
authors: FW
authors: Lurmann
authors: Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA.
authors: Lihua
authors: L
authors: Liu
authors: Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA.
authors: Frank D
authors: FD
authors: Gilliland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D002140:California / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis; D004784:Environmental Monitoring / Q000379:methods; D005260:Female; D062305:Geographic Mapping; D006801:Humans; D008175:Lung Neoplasms / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000009:adverse effects / Q000032:analysis; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis; D012042:Registries; D012959:Socioeconomic Factors; D016019:Survival Analysis
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D009585:Nitrogen Dioxide
keywords: Clinical Epidemiology; Lung Cancer