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

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

www.icconsultants.co.uk/EXPASCAN.html

slide3

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
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
Estimation of the risk of environmental arsenic exposure
  • Choose study design(s)
  • Assess exposure
  • Estimate risk
  • Discuss confounders
arsenic and arsenic compounds
Arsenic and arsenic compounds

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

WHO, Geneva

www.inchem.org

estimate by distance to the power plant
Estimate by Distance to the Power Plant
  • Environmental As exposure
  • NMSC incidence

Associate As exposure with NMSC risk& control for covariates

slide9

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

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

200

As t/a

100

0

1953

1960

1970

1980

1990

1999

Year

slide12

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

cancer incidence analysis
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
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
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
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
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
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
NMSC Risk Estimation
  • Logistic regression

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

  • Potential confounders: occupational As exposure

smoking

exposure assessment and risk estimation for environmental arsenic
Exposure Assessment and Risk Estimationfor Environmental Arsenic
  • Dietary habits
  • Residential history
arsenic exposure from dietary habits
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
as exposure from residential data
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
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
environmental arsenic exposure nmsc risk
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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