Mortality due to lung, laryngeal and bladder cancer in towns lying in the vicinity of combustion installations
Introduction
Residential proximity to fossil-fuel-fired (i.e., coal, oil, and natural gas) power plants might imply exposure to a considerable number of toxic substances. Recent studies have linked these emissions to respiratory problems (Karavus et al., 2002), pregnancy complications (Tang et al., 2008), and premature mortality (Hermann et al., 2004) among populations residing in its vicinity. It has been known for some time that these industries release known or suspected carcinogens (Natusch, 1978), including metals such as chromium and nickel, radionuclides such as radon and uranium, and polycyclic organic matter such as benzo[a]pyrene (Samet and Cohen, 2006). Great interest therefore lies in assessing the possible relationship between these installations and cancer. Among the tumors that can be associated with the above carcinogens are those of lung (Siemiatycki et al., 2004), larynx (Maier et al., 1991) and bladder (Boffetta et al., 1997).
In Spain, lung cancer is the leading neoplasm among men, and was responsible for 16,891 male and 2638 female deaths in 2006. Spain, moreover, has the highest male laryngeal cancer mortality and incidence in Europe (Lopez-Abente et al., 2006b), with 1482 deaths in 2006; in contrast, it is the country with the lowest female mortality and incidence rates, with only 59 deaths in the same year. Lastly, Spain also has one of the highest bladder cancer mortality and incidence rates in Europe: in 2006, there were 3742 male deaths and 784 female deaths attributable to this cause. Not only does the geographic mortality pattern plotted by these tumors display points in common (Lopez-Abente et al., 2006b), but some risk factors also coincide, namely: smoking (Levi, 1999, Olshan, 2006, Silverman et al., 2006); occupational exposure to asbestos, aromatic amines and polycyclic aromatic hydrocarbons (PAHs) (Boffetta et al., 1997, Clapp et al., 2005, Kogevinas et al., 2003, Maier et al., 1991, Mastrangelo et al., 1996, Silverman et al., 2006, Spitz et al., 2006); and pollutant emissions from industrial installations (Benedetti et al., 2001, Biggeri et al., 1996, Clapp et al., 2005, Lee et al., 2002, Maier et al., 1991).
The European Pollutant Emission Register (EPER) (EPER, 2008), a public inventory of industries set up by the European Commission under the terms of Directive 96/61/EC, constitutes a valuable resource for monitoring industrial pollution, and enables the possible influence of such pollution on geographic mortality patterns to be examined (Garcia-Perez et al., 2007). One of the EPER industrial groups covers combustion installations, providing data on pollutants released and the geographic coordinates of the respective facilities.
This paper sought to ascertain whether there was excess lung, larynx and bladder cancer mortality among the population residing in the vicinity of Spanish combustion installations which report their emissions to the EPER.
Section snippets
Materials and methods
We designed an ecologic study that modeled standardized mortality ratios (SMRs) for lung, laryngeal and bladder tumors in Spain's 8073 towns, over the period 1994–2003. The analysis was performed separately for each sex (except in the case of laryngeal cancer, which was only studied among men, due to its low frequency among women).
SMRs were calculated as the ratio of observed to expected deaths, and exact methods were used to establish the 95% confidence intervals (95%CI). Observed municipal
Results
From 1994 to 2003 there were 172,142 deaths due to lung cancer, 18,175 due to laryngeal cancer, and 38,396 due to bladder cancer in both sexes.
Fig. 1 depicts the geographic distribution of the 57 combustion installations studied, along with their EPER codes and year of commencement of operations. In 2001, Spanish combustion installations reported releasing to air: 2,400 metric tons (mt) of CO; 94,200,000 mt of CO2; 1040 mt of N2O; 291,000 mt of NO2; 938,000 mt of SO2; 2.08 mt of arsenic;
Discussion
This is one of the first studies to use EPER-based information to explore the effects on cancer mortality of pollution emitted by a specific industrial sector. Our results indicate excess risk of dying of lung and laryngeal tumors among males in the proximity of Spanish combustion installations, for the industry as a whole and after elimination of the newest plants, whose possible influence is more debatable if minimum tumor latency periods are borne in mind. In the case of lung cancer,
Conclusion
The results of this study could support the hypothesis that residence in towns in the vicinity of combustion installations in Spain is associated with excess risk in lung, laryngeal and bladder cancer mortality, since the effect estimators obtained are statistically significant, not merely for analysis of the industry as a whole, but also for individualized analysis of specific facilities. Furthermore, increased risk with proximity was observed in the environs of a number of installations. Risk
Acknowledgments
This study was funded by Spain's Health Research Fund (Fondo de Investigación Sanitaria - FIS 040041) and formed part of the MEDEA project (Mortalidad en áreas pequeñas Españolas y Desigualdades socio-Económicas y Ambientales — Mortality in small Spanish areas and socio-economic and environmental inequalities).
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