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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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Slide 1

Arsenic and Nonmelanoma Skin Cancer in Slovakia

Beate Pesch

Environmental Health Research Institute, Germany

Slide 2

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

www.icconsultants.co.uk/EXPASCAN.html

Slide 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

Slide 4

Objective

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

Slide 5

Estimation of the risk of environmental arsenic exposure

  • Choose study design(s)

  • Assess exposure

  • Estimate risk

  • Discuss confounders

Slide 6

Arsenic and arsenic compounds

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

WHO, Geneva

www.inchem.org

Slide 7

Estimate by Distance to the Power Plant

  • Environmental As exposure

  • NMSC incidence

    Associate As exposure with NMSC risk& control for covariates

Slide 8

ENO Power Plant (Slovakia)

Slide 9

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)

Slide 10

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

200

As t/a

100

0

1953

1960

1970

1980

1990

1999

Year

Slide 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

Slide 15

Cancer Incidence Analysis

  • Prievidza district versus Slovakia

  • Within Prievidza district by distance to the plant

Slide 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

Slide 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

Slide 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

Slide 19

Population-based Case-Control Study

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

  • 286 population controls

    response rate 72%

    Matching by sex, age

Slide 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

Slide 21

NMSC Risk Estimation

  • Logistic regression

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

  • Potential confounders: occupational As exposure

    smoking

Slide 22

Occupational As exposure (Job-Exposure Matrix)

Slide 23

Cigarette Smoking

Slide 24

Skin Type & UV Exposure

Slide 25

Fresh Vegetables & Fruits

Slide 26

Exposure Assessment and Risk Estimationfor Environmental Arsenic

  • Dietary habits

  • Residential history

Slide 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

Slide 28

Arsenic Exposure with Dietary Habits

Slide 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

Slide 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

Slide 31

Arsenic Exposure with Residential Data

Slide 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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