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Review
. 2020 Aug 25:10.3322/caac.21632.
doi: 10.3322/caac.21632. Online ahead of print.

Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations

Michelle C Turner  1   2   3   4 , Zorana J Andersen  5 , Andrea Baccarelli  6 , W Ryan Diver  7 , Susan M Gapstur  7 , C Arden Pope 3rd  8 , Diddier Prada  6   9 , Jonathan Samet  10 , George Thurston  11 , Aaron Cohen  12   13
Affiliations
Review

Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations

Michelle C Turner et al. CA Cancer J Clin. .

Abstract

Outdoor air pollution is a major contributor to the burden of disease worldwide. Most of the global population resides in places where air pollution levels, because of emissions from industry, power generation, transportation, and domestic burning, considerably exceed the World Health Organization's health-based air-quality guidelines. Outdoor air pollution poses an urgent worldwide public health challenge because it is ubiquitous and has numerous serious adverse human health effects, including cancer. Currently, there is substantial evidence from studies of humans and experimental animals as well as mechanistic evidence to support a causal link between outdoor (ambient) air pollution, and especially particulate matter (PM) in outdoor air, with lung cancer incidence and mortality. It is estimated that hundreds of thousands of lung cancer deaths annually worldwide are attributable to PM air pollution. Epidemiological evidence on outdoor air pollution and the risk of other types of cancer, such as bladder cancer or breast cancer, is more limited. Outdoor air pollution may also be associated with poorer cancer survival, although further research is needed. This report presents an overview of outdoor air pollutants, sources, and global levels, as well as a description of epidemiological evidence linking outdoor air pollution with cancer incidence and mortality. Biological mechanisms of air pollution-derived carcinogenesis are also described. This report concludes by summarizing public health/policy recommendations, including multilevel interventions aimed at individual, community, and regional scales. Specific roles for medical and health care communities with regard to prevention and advocacy and recommendations for further research are also described.

Keywords: breast cancer; cancer survival; lung cancer; particulate matter.

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Figures

Figure 1.
Figure 1.
Average annual population-weighted PM2.5 concentrations in 2017. Source: Health Effects Institute. 2019. State of Global Air 2019. Data source: Global Burden of Disease Study 2017. IHME, 2018.
Figure 2.
Figure 2.
Estimated adjusted HRs (and 95% CIs) for lung cancer mortality per 10 μg/m3 elevation in PM2.5 from multiple cohort studies. Black diamonds represent selected studies with the size of the diamond proportional to the relative weight in the random effect estimate using selected studies. The red squares represent random effects meta-estimates. The black line is a reference line at HR = 1. The red line is a reference line at HR equals the random effects meta-estimate using the selected studies. Source: modified and updated figure from, Pope CA III, Coleman N, Pond ZA, Burnett RT. Fine particulate air pollution and human mortality: 25+ years of cohort studies. Environ Res. 2020;183:108924. Reprinted under a CC BY-NC-ND 4.0 creative commons license.
Figure 3.
Figure 3.
Global age-standardized PM2.5-attributable trachea, bronchus, and lung cancer mortality rates per 100,000 in 2017. Source: https://vizhub.healthdata.org/gbd-compare/; accessed April 29, 2020.
Figure 4.
Figure 4.
Air pollution-related cancer: Potential pathways and mechanisms. TSG: Tumor suppressor genes.
See this image and copyright information in PMC

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