Long-term exposure to traffic-related air pollution and cancer among survivors of myocardial infarction: A 20-year follow-up study.
Previous studies suggested a carcinogenic effect of exposure to traffic-related air pollution. Recently, higher rates of cancer incidence were observed among myocardial infarction survivors compared with the general population. We examined the association between chronic exposure to nitrogen oxides, a proxy measure for traffic-related air pollution, and cancer incidence and mortality in a cohort of myocardial infarction patients.



Patients aged ≤65 years admitted to hospital in central Israel with a first myocardial infarction in 1992-1993 were followed to 2013 for cancer incidence and cause-specific mortality. Data on sociodemographic and cancer risk factors were obtained, including time-varying information on smoking. Using land use regression models, annual averages of nitrogen oxides during follow-up were estimated individually according to home addresses. Cox proportional hazards models were constructed to study the relationships with cancer outcomes.



During a mean follow-up of 16 (SD 7) years, 262 incident cancers and 105 cancer deaths were identified among 1393 cancer-free patients at baseline (mean age 54 years; 81% men). In adjusted models, a 10 ppb increase in mean nitrogen oxide exposure was associated with a hazard ratio (HR) of 1.06 (95% confidence interval (CI) 0.96-1.18) for cancer incidence and HR of 1.08 (95% CI 0.93-1.26) for cancer mortality. The association with lung, bladder, kidney or prostate cancer (previously linked to air pollution) was stronger (HR 1.16; 95% CI 1.00-1.33).



Chronic exposure to traffic-related air pollution may constitute an environmental risk factor for cancer post-myocardial infarction. Variation in the strength of association between specific cancers needs to be explored further.
Department of Epidemiology and Preventive Medicine, Tel Aviv University, Israel.
Gali
G
Cohen
Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel.
Ilan
I
Levy
Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel.
Yuval
Epidemiology Unit, Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Organization, Israel.
Jeremy D
JD
Kark
Department of Geography, Hebrew University of Jerusalem, Israel.
Noam
N
Levin
Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel.
David M
DM
Broday
Department of Statistics and Operations Research, Tel Aviv University, Israel.
David M
DM
Steinberg
Department of Epidemiology and Preventive Medicine, Tel Aviv University, Israel yarivg@post.tau.ac.il.
Yariv
Y
Gerber
D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D000397:Air Pollution / Q000009:adverse effects*; D002423:Cause of Death; D016009:Chi-Square Distribution; D004784:Environmental Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D019570:Inhalation Exposure / Q000009:adverse effects*; D007557:Israel / Q000453:epidemiology; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D009369:Neoplasms / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D009589:Nitrogen Oxides / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D001335:Vehicle Emissions
D000393:Air Pollutants; D009589:Nitrogen Oxides; D001335:Vehicle Emissions
Air pollution; cancer risk; cohort study; myocardial infarction