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Arsenic and Nonmelanoma Skin Cancer in Slovakia






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Arsenic and Nonmelanoma Skin Cancer in Slovakia. Beate Pesch Environmental Health Research Institute, Germany. Part of the EU-funded Project EXPASCAN ‚Exposure to Arsenic and Cancer in Central & Eastern Europe‘. www.icconsultants.co.uk/ EXPASCAN.html. PARTNERS
Arsenic and Nonmelanoma Skin Cancer in Slovakia

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Arsenic and nonmelanoma skin cancer in slovakia l.jpgSlide 1

Arsenic and Nonmelanoma Skin Cancer in Slovakia

Beate Pesch

Environmental Health Research Institute, Germany

Part of the eu funded project expascan exposure to arsenic and cancer in central eastern europe l.jpgSlide 2

Part of the EU-funded Project EXPASCAN‚Exposure to Arsenic and Cancer in Central & Eastern Europe‘

www.icconsultants.co.uk/EXPASCAN.html

Slide3 l.jpgSlide 3

PARTNERS

Imperial College & IC Consultants, London, UK

State Health Institutes, Prievidza, Bankska Bystrica, SK

Institute of Hygiene and Epidemiology, Prague, CZ

Environmental Health Research Institute, Duesseldorf, D

University of Cluj, RO

Objective l.jpgSlide 4

Objective

Estimation of the risk of environmental arsenic exposure from power plant emissions for non-melanoma skin cancer (NMSC)

Estimation of the risk of environmental arsenic exposure l.jpgSlide 5

Estimation of the risk of environmental arsenic exposure

  • Choose study design(s)

  • Assess exposure

  • Estimate risk

  • Discuss confounders

Arsenic and arsenic compounds l.jpgSlide 6

Arsenic and arsenic compounds

Environmental Health Criteria (EHC) 2nd edition, 224; 2001

WHO, Geneva

www.inchem.org

Estimate by distance to the power plant l.jpgSlide 7

Estimate by Distance to the Power Plant

  • Environmental As exposure

  • NMSC incidence

    Associate As exposure with NMSC risk& control for covariates

Eno power plant slovakia l.jpgSlide 8

ENO Power Plant (Slovakia)

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Environmental Arsenic Exposure

  • Historical As exposure

    Air pollution modelling

    (Colvile et al. 2001)

  • Current As exposure

    Measurement of As in soil, house dust

    (Keegan et al. 2002)

Slide10 l.jpgSlide 10

Arsenic Emissions (tons/year) of the ENO Power Plant, Slovakia

200

As t/a

100

0

1953

1960

1970

1980

1990

1999

Year

Slide12 l.jpgSlide 12

Arsenic (mg/g) in soil 1999

by distance from the plant

Distance N Median Min Max

< 5 km 40 41 14 134

5-10 km 102 23 9 139

>10 km 68 20 10 53

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Cancer Incidence Analysis

  • Prievidza district versus Slovakia

  • Within Prievidza district by distance to the plant

Comparative incidence figures cif prievidza district versus slovakia 1975 84 l.jpgSlide 16

Comparative Incidence Figures (CIF) Prievidza district versusSlovakia 1975-84

All malignancies 1.1

NMSC 1.6

Lung cancer 1.0

Bladder cancer 0.9

Cif by distance to the power plant cutoff 7 5 km 1977 1991 l.jpgSlide 17

CIF by Distance to the Power Plantcutoff 7.5 km 1977-1991

Basal cell carcinoma 1.6Squamous cell ca. 1.6

Lung cancer 1.0

Bladder cancer 1.1

Sir nmsc 1996 1999 by distance to the plant l.jpgSlide 18

SIR NMSC (1996-1999)by Distance to the Plant

<5km5-10 km >10km

Reference

District 1.21.1 0.8

0.9- 1.6 1.0-1.3 0.6-0.9

Slovakia 1.6 1.5 1.0

1.2- 2.2 1.3-1.7 0.9-1.3

Population based case control study l.jpgSlide 19

Population-based Case-Control Study

  • 264 NMSC cases (1996-99)response rate 80%

  • 286 population controls

    response rate 72%

    Matching by sex, age

Statistical power l.jpgSlide 20

Statistical Power

  •  = 5% one-sided

  • = 20% (power 80%)

  • controls exposed to As=10%

  • N cases = 264

  • N controls = 286

  • RR to be detected >= 1.9

Nmsc risk estimation l.jpgSlide 21

NMSC Risk Estimation

  • Logistic regression

    conditional on age, gender:Odds Ratio (OR), 95% CI

  • Potential confounders: occupational As exposure

    smoking

Occupational as exposure job exposure matrix l.jpgSlide 22

Occupational As exposure (Job-Exposure Matrix)

Cigarette smoking l.jpgSlide 23

Cigarette Smoking

Skin type uv exposure l.jpgSlide 24

Skin Type & UV Exposure

Fresh vegetables fruits l.jpgSlide 25

Fresh Vegetables & Fruits

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Exposure Assessment and Risk Estimationfor Environmental Arsenic

  • Dietary habits

  • Residential history

Arsenic exposure from dietary habits l.jpgSlide 27

Arsenic Exposurefrom Dietary Habits

  • AsNut1 = Σ w(f )* I(f)25 food items f: w(f) food frequencies I(f) annual As intake

  • AsNut2 = AsNut1 * s if self-support s= 2, else 1

Arsenic exposure with dietary habits l.jpgSlide 28

Arsenic Exposure with Dietary Habits

As exposure from residential data l.jpgSlide 29

As Exposurefrom Residential Data

AsRes1 = Σ E(t)* w(d(t),t)

for all places of residence:E(t) annual emissionw(d(t),t) immission weight

Correction of spatial selection bias for distance related variables asres l.jpgSlide 30

Correction of spatial selection bias for distance-related variables AsRes

  • (1) Random re-sampling of controls SAS Surveyselect

  • (2) Bootstrap method OR, 95% CI for R=800 re-sampled groups

Arsenic exposure with residential data l.jpgSlide 31

Arsenic Exposure with Residential Data

Environmental arsenic exposure nmsc risk l.jpgSlide 32

Environmental Arsenic Exposure & NMSC Risk

  • Elevated NMSC incidence in the vicinity of the plant.

  • As exposure from dietary and residential data are associated with excess risk.

  • Residual confounding can not be excluded.


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