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

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Arsenic and nonmelanoma skin cancer in slovakia l.jpg

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

www.icconsultants.co.uk/EXPASCAN.html


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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


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Objective

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


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Estimation of the risk of environmental arsenic exposure

  • Choose study design(s)

  • Assess exposure

  • Estimate risk

  • Discuss confounders


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Arsenic and arsenic compounds

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

WHO, Geneva

www.inchem.org


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Estimate by Distance to the Power Plant

  • Environmental As exposure

  • NMSC incidence

    Associate As exposure with NMSC risk& control for covariates



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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)


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

200

As t/a

100

0

1953

1960

1970

1980

1990

1999

Year


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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


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

All malignancies 1.1

NMSC 1.6

Lung cancer 1.0

Bladder cancer 0.9


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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


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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


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Population-based Case-Control Study

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

  • 286 population controls

    response rate 72%

    Matching by sex, age


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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


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NMSC Risk Estimation

  • Logistic regression

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

  • Potential confounders: occupational As exposure

    smoking


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Occupational As exposure (Job-Exposure Matrix)





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Exposure Assessment and Risk Estimationfor Environmental Arsenic

  • Dietary habits

  • Residential history


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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


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Arsenic Exposure with Dietary Habits


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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


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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


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Arsenic Exposure variables AsReswith Residential Data


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Environmental Arsenic Exposure & NMSC Risk variables AsRes

  • 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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