Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.

BACKGROUND: Prevention, control, and treatment of respiratory tract cancers are important steps towards achieving target 3.4 of the UN Sustainable Development Goals (SDGs)-a one-third reduction in premature mortality due to non-communicable diseases by 2030. We aimed to provide global, regional, and national estimates of the burden of tracheal, bronchus, and lung cancer and larynx cancer and their attributable risks from 1990 to 2019. METHODS: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) of respiratory tract cancers (ie, tracheal, bronchus, and lung cancer and larynx cancer). Deaths from tracheal, bronchus, and lung cancer and larynx cancer attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on the 2010-19 period. FINDINGS: Globally, there were 2·26 million (95% uncertainty interval 2·07 to 2·45) new cases of tracheal, bronchus, and lung cancer, and 2·04 million (1·88 to 2·19) deaths and 45·9 million (42·3 to 49·3) DALYs due to tracheal, bronchus, and lung cancer in 2019. There were 209 000 (194 000 to 225 000) new cases of larynx cancer, and 123 000 (115 000 to 133 000) deaths and 3·26 million (3·03 to 3·51) DALYs due to larynx cancer globally in 2019. From 2010 to 2019, the number of new tracheal, bronchus, and lung cancer cases increased by 23·3% (12·9 to 33·6) globally and the number of larynx cancer cases increased by 24·7% (16·0 to 34·1) globally. Global age-standardised incidence rates of tracheal, bronchus, and lung cancer decreased by 7·4% (-16·8 to 1·6) and age-standardised incidence rates of larynx cancer decreased by 3·0% (-10·5 to 5·0) in males over the past decade; however, during the same period, age-standardised incidence rates in females increased by 0·9% (-8·2 to 10·2) for tracheal, bronchus, and lung cancer and decreased by 0·5% (-8·4 to 8·1) for larynx cancer. Furthermore, although age-standardised incidence and death rates declined in both sexes combined from 2010 to 2019 at the global level for tracheal, bronchus, lung and larynx cancers, some locations had rising rates, particularly those on the lower end of the SDI range. Smoking contributed to an estimated 64·2% (61·9-66·4) of all deaths from tracheal, bronchus, and lung cancer and 63·4% (56·3-69·3) of all deaths from larynx cancer in 2019. For males and for both sexes combined, smoking was the leading specific risk factor for age-standardised deaths from tracheal, bronchus, and lung cancer per 100 000 in all SDI quintiles and GBD regions in 2019. However, among females, household air pollution from solid fuels was the leading specific risk factor in the low SDI quintile and in three GBD regions (central, eastern, and western sub-Saharan Africa) in 2019. INTERPRETATION: The numbers of incident cases and deaths from tracheal, bronchus, and lung cancer and larynx cancer increased globally during the past decade. Even more concerning, age-standardised incidence and death rates due to tracheal, bronchus, lung cancer and larynx cancer increased in some populations-namely, in the lower SDI quintiles and among females. Preventive measures such as smoking control interventions, air quality management programmes focused on major air pollution sources, and widespread access to clean energy should be prioritised in these settings. FUNDING: Bill & Melinda Gates Foundation.

Characteristics and Outcomes of Airway Involvement in Esophageal Cancer.

BACKGROUND: Airway involvement, such as airway invasion, compression, and tracheobronchoesophageal fistula (TEF), in esophageal cancer is associated with significant morbidity. However, the risk factors and outcomes of airway complications remain unclear, with limited evidence to guide management. METHODS: This retrospective analysis included 804 patients with a diagnosis of esophageal cancer from 1998 to 2018 at a tertiary care medical center (Singapore General Hospital, Singapore). Patients' demographics, treatment details, and airway involvement, as determined by bronchoscopic evaluation or computed tomographic imaging, were recorded and analyzed to determine risk factors and outcomes of airway involvement. RESULTS: The incidence of airway involvement and TEF was 36.6% and 13.1%, respectively. Airway involvement was associated with reduced survival from the time of diagnosis (hazard ratio, 1.52; 95% confidence interval [CI], 1.30 to 1.79) and increased hospitalizations per year (4.53 ± 4.80 vs 2.75 ± 3.68; P < .001). On multivariate analysis, midesophageal tumors (odds ratio [OR], 11.0; 95% CI, 6.3 to 19.0) and upper esophageal tumors (OR, 8.5; 95% CI, 4.7 to 15.6), previous treatment with esophageal stenting (OR, 17.8; 95% CI, 4.1 to 77.6), and chemotherapy or radiotherapy were associated with development of airway involvement. In patients with TEF, treatment with chemotherapy (OR, 0.34; 95% CI, 0.20 to 0.60) and combined airway and esophageal stenting (OR, 0.48; 95% CI, 0.25 to 0.91) were independently associated with improved survival. CONCLUSIONS: Airway involvement and TEF are common and are associated with increased morbidity and poorer survival. Clinicians should remain vigilant for airway complications after treatment with esophageal stenting, chemotherapy, or radiotherapy, especially in patients with midesophageal and upper esophageal cancers. In patients with TEFs, survival is improved when they are treated with airway stenting, esophageal stenting, or chemotherapy.

Airway Hemangiomas in PHACE Syndrome: A Multicenter Experience.

OBJECTIVE: To describe the prevalence and clinical characteristics of airway findings in a multi-institutional cohort of PHACE patients. STUDY DESIGN: Multicenter retrospective case series. SETTING: Multidisciplinary vascular anomalies clinics at 2 institutions. METHODS: Data were collected from the electronic medical record, including clinical presentation, airway findings, treatment, and outcomes. RESULTS: Of 55 PHACE patients, 22 (40%) had airway hemangiomas. Patients with airway involvement were more commonly female (P = .034, odds ratio [OR] 23, 95% confidence interval [CI] 1.3-410) and of Caucasian ethnicity (P = .020, OR 5.3, 95% CI 1.3-21). Anatomically, patients with bilateral S3 involvement had higher rates of airway disease (P = .0012, OR 15, 95% CI 2.9-77). Most patients with airway hemangiomas had stridor (68%). Of the patients managed in the propranolol era (2008 or later, n = 35), 14 had airway involvement. All 14 were treated with propranolol, whereas 13 (62%) of 21 nonairway patients were treated with propranolol. The average treatment duration was longer in the airway patients (22.1 vs 16.7 months). All patients who underwent tracheostomy (n = 4) did so before 2008. CONCLUSION: Risk factors for airway involvement in PHACE include female gender, Caucasian ethnicity, and stridor. Since the widespread use of propranolol, fewer patients have required surgical management of their airway disease. Given the high prevalence of airway involvement even in patients without stridor, assessment of the airway is a crucial component of a comprehensive PHACE workup.

Systematic review and meta-analysis of epidemiological literature evaluating the association between exposure to man-made vitreous fibers and respiratory tract cancers.

We conducted a systematic review and meta-analysis of epidemiological studies that evaluated occupational exposure to man-made vitreous fibers (MMVF) including glass, rock, and slag wools, and respiratory tract cancers (RTC) including cancers of the larynx, trachea, bronchus, and lung. The MEDLINE/PubMed and Web of Science databases were searched in order to identify epidemiological studies that evaluated the association between occupational MMVF exposure and RTCs. We performed random-effects meta-analyses of relevant studies identified by our literature search, and evaluated sources of between-study heterogeneity. The pooled relative risk (RR) of RTC among workers exposed to MMVFs was 1.09 (95% CI = 0.97, 1.22). The RR was closer to 1.0 when limiting the analysis to effect estimates from studies that accounted for the main a priori risk factors for RTC, asbestos exposure and smoking (RR = 1.03, 95% CI = 0.90, 1.18). Overall, our synthesis of the epidemiological literature suggests that occupational MMVF exposure is not associated with risk of RTC.

[Influence of vehicular traffic density on hospital admissions due to respiratory tract cancer in the city of São Paulo, Brazil]. / Influência da densidade de tráfego veicular na internação por câncer do aparelho respiratório no Município de São Paulo, Brasil.

Pollution related to traffic is a major problem in urban centers and a large portion of the population is vulnerable to its health effects. This study sought to identify a potential association between hospital admissions due to respiratory tract cancer and vehicular traffic density in the city of São Paulo, Brazil. It is an ecological study of the public (Hospital Inpatient Authorization - AIH, in Portuguese) and private (Hospital Inpatient Communication - CIH, in Portuguese) health care systems, from 2004 to 2006, geocoded by individuals' residential addresses. Using a Besag-York-Mollié ecological model, we initially evaluated the relationship between number of cases of hospital admission due to respiratory tract cancer in each weighting area and the standardized co-variables: traffic density and Municipal Human Development Index (MHDI) as indicator of socioeconomic status. Using a classic Poisson model, we then evaluated the risk associated with growing traffic density categories. The Besag-York-Mollié model estimated a RR = 1.09 (95%CI: 1.02-1.15) and RR = 1.19 (95%CI: 1.10-1.29) of admission due to respiratory tract cancer for each increase of one standard deviation of traffic and MHDI, respectively. The Poisson model also showed a clear exposure-response gradient for admission due to respiratory tract cancer (IRR = 1.11; 95%CI: 1.07-1.15, for each 10 units of added traffic density). This study suggests that there is an association between residing in areas with high traffic density and hospital admissions due to respiratory tract cancer in the city of São Paulo.

A poluição relacionada ao tráfego é um grande problema nos centros urbanos, e uma grande parcela da população fica vulnerável aos seus efeitos à saúde. Este trabalho teve como objetivo identificar potencial associação entre as internações hospitalares por câncer do aparelho respiratório com a densidade de tráfego veicular no Município de São Paulo, Brasil. É um estudo ecológico com dados de internações hospitalares por câncer dos sistemas público (Autorização de Internação Hospitalar - AIH) e particular (Comunicação de Internação Hospitalar - CIH), de 2004 a 2006, geocodificados por endereço de residência do indivíduo. Mediante um modelo ecológico de Besag-York-Mollié foi avaliada inicialmente a relação entre o número de casos de internação por câncer do aparelho respiratório em cada área de ponderação e as covariáveis padronizadas: densidade de tráfego e Índice de Desenvolvimento Humano Municipal (IDHM) como indicador de status socioeconômico. Sequencialmente, com um modelo clássico de Poisson, procedeu-se uma avaliação do risco associado às categorias crescentes de densidade de tráfego. O modelo de Besag-York-Mollié estimou um RR = 1,09 (IC95%: 1,02-1,15) e RR = 1,19 (IC95%: 1,10-1,29) de internação por câncer do aparelho respiratório, para cada aumento de um desvio padrão da densidade de tráfego e IDHM, respectivamente. Foi também evidenciado pelo modelo de Poisson um claro gradiente de exposição-resposta para internação por câncer respiratório (IRR = 1,11; IC95%: 1,07-1,15, para cada dez unidades de acréscimo da densidade de tráfego). Este trabalho sugere que há associação entre residir em áreas com alta densidade de tráfego e internação por câncer do aparelho respiratório no Município de São Paulo.

La contaminación relacionada con el tráfico es un gran problema en los centros urbanos, y una gran parte de la población es vulnerable a sus efectos para la salud. El objetivo de este trabajo fue identificar la potencial asociación entre los internamientos hospitalarios por cáncer del aparato respiratorio con la densidad del tráfico vehicular en el Municipio de São Paulo, Brasil. Es un estudio ecológico con datos de internamientos hospitalarios por cáncer de los sistemas público (Autorización de Internación Hospitalaria - AIH) y particular (Comunicación de Internación Hospitalaria - CIH), de 2004 a 2006, geocodificados por dirección de residencia del individuo. Mediante el modelo ecológico de Besag-York-Mollié se evaluó inicialmente la relación entre el número de casos de internamiento por cáncer del aparato respiratorio en cada área de ponderación y covariables estandarizadas: densidad de tráfico e Índice de Desarrollo Humano Municipal (IDHM), como indicador de estatus socioeconómico. Secuencialmente, con un modelo clásico de Poisson, se procedió a una evaluación del riesgo asociado a las categorías crecientes de densidad de tráfico. El modelo de Besag-York-Mollié estimó un RR = 1,09 (IC95%: 1,02-1,15) y RR = 1,19 (IC95%: 1,10-1,29) de internamiento por cáncer del aparato respiratorio, para cada aumento de un desvío estándar de la densidad de tráfico e IDHM, respectivamente. Se evidenció también, a través del modelo de Poisson, un claro gradiente de exposición-respuesta para el internamiento por cáncer respiratorio (IRR = 1,11; IC95%: 1,07-1,15, para cada 10 unidades de incremento de la densidad de tráfico). Este trabajo sugiere que existe una asociación entre residir en áreas con alta densidad de tráfico y el internamiento por cáncer del aparato respiratorio en el Municipio de São Paulo.

Influence of Smoking and Histologic Subtype on Developing Extrathymic Malignancy in Thymoma Patients.

BACKGROUND: Patients with thymomas are at high risk of developing extrathymic malignancies. We investigated the impact of extrathymic malignancies on the prognosis of patients with thymoma who underwent surgery and the risk factors for postoperative extrathymic malignancies. METHODS: A multicenter retrospective review of 252 patients who underwent surgical resection of thymomas from January 1977 to March 2016 was conducted. The exclusion criteria were recurrent thymoma, rare types of thymoma, and missing data. The overall number and incidence of extrathymic malignancies were calculated. Potential predictors of extrathymic malignancies were also evaluated. RESULTS: Two hundred twenty-eight patients were analyzed. Fifty-five extrathymic malignancies were observed (23 postoperative, 8 synchronous, and 24 preoperative). Among the overall cohort, the incidence of extrathymic malignancies significantly increased the patients' risk of death (hazard ratio [HR], 4.02; 95% confidence interval [CI], 1.72 to 9.40; p < 0.01). Among patients aged less than 70 years, the incidence of extrathymic malignancies was an independent risk factor for death. The incidence of postoperative extrathymic malignancies was significantly higher in patients with indolent forms of thymoma (type A/AB/B1) than aggressive forms (type B2/B3) (p = 0.02). In the multivariate analysis, indolent forms of thymoma (type A/AB/B1) (HR, 4.03; 95% CI, 1.12 to 14.6, p = 0.03) and a history of ever having smoked (HR, 5.29; 95% CI, 1.30 to 21.6; p = 0.02) were significant risk factors for the cumulative incidence of postoperative extrathymic malignancies. CONCLUSIONS: Extrathymic malignancies increased the risk of death in patients with thymomas. Indolent forms of thymoma and a history of ever having smoked were risk factors for postoperative extrathymic malignancies.

Incidence and mortality for respiratory cancer and traffic-related air pollution in São Paulo, Brazil.

BACKGROUND: Multiple lines of evidence have associated exposure to ambient air pollution with an increased risk of respiratory malignancies. However, there is a dearth of evidence from low-middle income countries, including those within South America, where the social inequalities are more marked. OBJECTIVES: To quantify the association between exposures to traffic related air pollution and respiratory cancer incidence and mortality within São Paulo, Brazil. Further, we aim to investigate the role of socioeconomic status (SES) upon these outcomes. METHODS: Cancer incidence between 2002 and 2011 was derived from the population-based cancer registry. Mortality data (between 2002 and 2013) was derived from the Municipal Health Department. A traffic density database and an annual nitrogen dioxide (NO2) land use regression model were used as markers of exposure. Age-adjusted Binomial Negative Regression models were developed, stratifying by SES and gender. RESULTS: We observed an increased rate of respiratory cancer incidence and mortality in association with increased traffic density and NO2 concentrations, which was higher among those regions with the lowest SES. For cancer mortality and traffic exposure, those in the most deprived region, had an incidence rate ratio (IRR) of 2.19 (95% CI: 1.70, 2.82) when comparing the highest exposure centile (top 90%) to the lowest (lowest 25%). By contrast, in the least deprived area, the IRR for the same exposure contrast was.1.07 (95% CI: 0.95, 1.20). For NO2 in the most deprived regions, the IRR for cancer mortality in the highest exposed group was 1.44 (95% CI: 1.10, 1.88) while in the least deprived area, the IRR for the highest exposed group was 1.11 (95% CI: 1.01, 1.23). CONCLUSIONS: Traffic density and NO2 were associated with an increased rate of respiratory cancer incidence and mortality in São Paulo. Residents from poor regions may suffer more from the impact of traffic air pollution.

Influência da densidade de tráfego veicular na internação por câncer do aparelho respiratório no Município de São Paulo, Brasil / Influence of vehicular traffic density on hospital admissions due to respiratory tract cancer in the city of São Paulo, Brazil / Influencia de la densidad de tráfico vehicular en el internamiento por cáncer del aparato respiratorio en el Municipio de São Paulo, Brasil

A poluição relacionada ao tráfego é um grande problema nos centros urbanos, e uma grande parcela da população fica vulnerável aos seus efeitos à saúde. Este trabalho teve como objetivo identificar potencial associação entre as internações hospitalares por câncer do aparelho respiratório com a densidade de tráfego veicular no Município de São Paulo, Brasil. É um estudo ecológico com dados de internações hospitalares por câncer dos sistemas público (Autorização de Internação Hospitalar - AIH) e particular (Comunicação de Internação Hospitalar - CIH), de 2004 a 2006, geocodificados por endereço de residência do indivíduo. Mediante um modelo ecológico de Besag-York-Mollié foi avaliada inicialmente a relação entre o número de casos de internação por câncer do aparelho respiratório em cada área de ponderação e as covariáveis padronizadas: densidade de tráfego e Índice de Desenvolvimento Humano Municipal (IDHM) como indicador de status socioeconômico. Sequencialmente, com um modelo clássico de Poisson, procedeu-se uma avaliação do risco associado às categorias crescentes de densidade de tráfego. O modelo de Besag-York-Mollié estimou um RR = 1,09 (IC95%: 1,02-1,15) e RR = 1,19 (IC95%: 1,10-1,29) de internação por câncer do aparelho respiratório, para cada aumento de um desvio padrão da densidade de tráfego e IDHM, respectivamente. Foi também evidenciado pelo modelo de Poisson um claro gradiente de exposição-resposta para internação por câncer respiratório (IRR = 1,11; IC95%: 1,07-1,15, para cada dez unidades de acréscimo da densidade de tráfego). Este trabalho sugere que há associação entre residir em áreas com alta densidade de tráfego e internação por câncer do aparelho respiratório no Município de São Paulo.

Pollution related to traffic is a major problem in urban centers and a large portion of the population is vulnerable to its health effects. This study sought to identify a potential association between hospital admissions due to respiratory tract cancer and vehicular traffic density in the city of São Paulo, Brazil. It is an ecological study of the public (Hospital Inpatient Authorization - AIH, in Portuguese) and private (Hospital Inpatient Communication - CIH, in Portuguese) health care systems, from 2004 to 2006, geocoded by individuals' residential addresses. Using a Besag-York-Mollié ecological model, we initially evaluated the relationship between number of cases of hospital admission due to respiratory tract cancer in each weighting area and the standardized co-variables: traffic density and Municipal Human Development Index (MHDI) as indicator of socioeconomic status. Using a classic Poisson model, we then evaluated the risk associated with growing traffic density categories. The Besag-York-Mollié model estimated a RR = 1.09 (95%CI: 1.02-1.15) and RR = 1.19 (95%CI: 1.10-1.29) of admission due to respiratory tract cancer for each increase of one standard deviation of traffic and MHDI, respectively. The Poisson model also showed a clear exposure-response gradient for admission due to respiratory tract cancer (IRR = 1.11; 95%CI: 1.07-1.15, for each 10 units of added traffic density). This study suggests that there is an association between residing in areas with high traffic density and hospital admissions due to respiratory tract cancer in the city of São Paulo.

La contaminación relacionada con el tráfico es un gran problema en los centros urbanos, y una gran parte de la población es vulnerable a sus efectos para la salud. El objetivo de este trabajo fue identificar la potencial asociación entre los internamientos hospitalarios por cáncer del aparato respiratorio con la densidad del tráfico vehicular en el Municipio de São Paulo, Brasil. Es un estudio ecológico con datos de internamientos hospitalarios por cáncer de los sistemas público (Autorización de Internación Hospitalaria - AIH) y particular (Comunicación de Internación Hospitalaria - CIH), de 2004 a 2006, geocodificados por dirección de residencia del individuo. Mediante el modelo ecológico de Besag-York-Mollié se evaluó inicialmente la relación entre el número de casos de internamiento por cáncer del aparato respiratorio en cada área de ponderación y covariables estandarizadas: densidad de tráfico e Índice de Desarrollo Humano Municipal (IDHM), como indicador de estatus socioeconómico. Secuencialmente, con un modelo clásico de Poisson, se procedió a una evaluación del riesgo asociado a las categorías crecientes de densidad de tráfico. El modelo de Besag-York-Mollié estimó un RR = 1,09 (IC95%: 1,02-1,15) y RR = 1,19 (IC95%: 1,10-1,29) de internamiento por cáncer del aparato respiratorio, para cada aumento de un desvío estándar de la densidad de tráfico e IDHM, respectivamente. Se evidenció también, a través del modelo de Poisson, un claro gradiente de exposición-respuesta para el internamiento por cáncer respiratorio (IRR = 1,11; IC95%: 1,07-1,15, para cada 10 unidades de incremento de la densidad de tráfico). Este trabajo sugiere que existe una asociación entre residir en áreas con alta densidad de tráfico y el internamiento por cáncer del aparato respiratorio en el Municipio de São Paulo.

Cancer incidence among merchant seafarers: an extended follow-up of a Danish cohort.

OBJECTIVES: While maritime safety generally has improved dramatically over the last century, modern seafarers are still faced with numerous occupational hazards potentially affecting their risk of chronic diseases such as cancer. The aim of this study is to offer updated information on the incidence of specific cancers among both male and female seafarers. METHODS: Using records from the Danish Seafarer Registry, all seafarers employed on Danish ships during 1986-1999 were identified, resulting in a cohort of 33 084 men and 11 209 women. Information on vital status and cancer was linked to each member of the cohort from the Danish Civil Registration System and the Danish Cancer Registry using the unique Danish personal identification number. SIRs were estimated for specific cancers using national rates. RESULTS: The overall incidence of cancer was increased for both male and female seafarers (SIR 1.19, 95% CI 1.15 to 1.23, and SIR 1.14, 95% CI 1.07 to 1.22) compared with the general population. This excess was primarily driven by increases in gastrointestinal, respiratory and genitourinary cancers. In addition, male seafarers working in areas with asbestos exposure showed significantly increased risk of mesothelioma. Finally, the male seafarers had an increased risk of lip cancer. CONCLUSIONS: The majority of cancers among seafarers continue to be lifestyle-related. However, occupational exposure to asbestos and ultraviolet radiation seems to affect the cancer pattern among the male seafarers as well.

[Clinical analysis of 138 multiple primary cancers diagnosed of digestive system malignant tumor initially].

Objective: To study the clinical characteristics, strategy of treatment and prognosis of multiple primary cancers(MPC) diagnosed of digestive system malignant tumor firstly. Methods: From January, 2000 to December, 2015, the clinical, follow-up and prognostic data of 138 MPC patients diagnosed of digestive system malignant tumor firstly were retrospectively analyzed. Results: 138 cases were found in 10 580 cases with malignant tumors, and the incidence was 1.30%. There were 129 cases of duplex primary cancers, 8 cases of triple primary cancers and 1 case of quintuple primary cancers. The repetitive primary cancer was occurred in digestive system (61cases, 44.2%) most frequently, with the next in respiratory system (46 cases, 33.3%). 52.2% (72 cases) suffered second primary cancer in 2 years after first primary cancer diagnosed, and 75.4% (104 cases) in 5 years. The median overall survival in patients with all cancer lesions radically treated was 168 months, better than any other treatment (68 months, P<0.05). Conclusions: The second primary cancers of MPC cases initially diagnosed of digestive system malignant tumor most frequently occurred in the digestive system and respiratory system. More concern should be attracted in follow-up, especially in the first 5 years. The key to improve patient' prognosis was radical treatment to every primary cancer.

[Tobacco cultivationin Salento (Apulia Region, Southern Italy) from 1929 to 1993: possible health implications]. / La tabacchicoltura nel Salento dal 1929 al 1993: possibili implicazioni sanitarie.

The Province of Lecce (Apulia Region, Southern Italy) is one of the Italian areas where the prevalence of respiratory disease and cancer of the respitartory tract is very high. Through a descriptive analysis of the historical series of tobacco culture indicators, a historical reconstruction of the development of tobacco cultivation in Salento (the area where the Province of Lecce is located) is here presented, in order to provide an additional element of knowledge on potential risk factors for respiratory diseases and cancers. Data regarding extensions in hectares and crop productions in the province of Lecce, in Apulia, and in Italy are from the Chamber of commerce of Lecce province and from the Italian National Institute of Statistics (Istat). From 1929 to 1993, the province of Lecce provided between 75% and 94% of the tobacco cultivated in Apulia Region and 25% of the national tobacco until 1945. Since the late Sixties, a growing increase in annual average production was observed, reaching 21.5 quintals per hectare in 1991 in Salento. This large tobacco production, associated with intensive use of pesticides, could be an element to be observed in analytical studies as a determining potential for the high prevalence of respiratory diseases and pulmonary cancers in the male population of the province of Lecce.

Second primary cancer after major salivary gland carcinoma.

BACKGROUND: We investigated the risk of second primary cancers after major salivary gland carcinoma in Finland, with a population of 5.5 million. METHODS: Nationwide cancer registry data were used to identify patients with major salivary gland carcinoma diagnosed between 1953 and 2014. Standardized incidence ratios (SIRs) were estimated to compare their second primary cancer risk with the respective site-specific cancer risk in the general population. RESULTS: There were 1727 patients with major salivary gland carcinomas and 222 second primary cancers had been diagnosed in these patients (SIR 1.43). The risk was increased for cancers of the thyroid (SIR 5.12), breast (SIR 1.63), respiratory organs (SIR 1.63), male genital organs (SIR 1.48), melanoma of the skin (SIR 3.35), and nonmelanoma skin cancer (SIR 2.50). The risk was high during the first 5 years and after 20 years of diagnosis. CONCLUSION: Second primary cancers can occur among patients with major salivary gland carcinoma even after a long time period. This needs to be recognized in the follow-up of these patients.

Mortality among Coast Guard Shipyard workers: A retrospective cohort study of specific exposures.

In a previous analysis of a cohort of shipyard workers, we found excess mortality from all causes, lung cancer, and mesothelioma for longer work durations and in specific occupations. Here, we expand the previous analyses by evaluating mortality associated with 5 chemical exposures: asbestos, solvents, lead, oils/greases, and wood dust. Data were gathered retrospectively for 4,702 workers employed at the Coast Guard Shipyard, Baltimore, MD (1950-1964). The cohort was traced through 2001 for vital status. Associations between mortality and these 5 exposures were calculated via standardized mortality ratios (SMRs). We found all 5 substances to be independently associated with mortality from mesothelioma, cancer of the respiratory system, and lung cancer. Findings from efforts to evaluate solvents, lead, oils/greases, and wood dust in isolation of asbestos suggested that the excesses from these other exposures may be due to residual confounding from asbestos exposure.

Câncer e poluição do ar relacionada ao tráfego veicular no município de São Paulo: análise espacial em pequenas áreas / Cancer and traffic-related air pollution in São Paulo spatial analysis in small areas units

Introdução: A poluição do ar relacionada ao tráfego veicular é um grave problema nos centros urbanos, expondo parcela considerável da população ao risco de efeitos adversos à saúde. Estudos epidemiológicos e toxicológicos têm encontrado evidências que associam a exposição aos poluentes do tráfego veicular e a incidência de câncer. Objetivo: Realizar uma análise espacial dos casos de cânceres do trato respiratório e hematológico e de sua relação com a densidade de tráfego veicular no município de São Paulo. Métodos: Foram utilizados os dados de três bases distintas: dados de incidência de câncer do Registro de Câncer de Base Populacional do Município de São Paulo (RCBP) de 2002 a 2011; dados de internações hospitalares por câncer do sistema público e particular de 2004 a 2006; dados de mortalidade por neoplasias do Sistema de Informação de Mortalidade de 2002 a 2013, da Secretaria Municipal de Saúde. Para a avaliação da exposição foi utilizada a densidade de tráfego veicular e, como indicador de status socioeconômico, o Índice de Desenvolvimento Humano Municipal (IDHM). Foram utilizadas como unidade espacial as áreas de ponderação do Censo 2010 e uma grade de 500m x 500m. Mediante um modelo ecológico de Besag-York-Mollié foi avaliada a variabilidade espacial do risco de incidência, internação hospitalar e mortalidade por câncer do aparelho respiratório e hematológico, sendo os resultados expressos em termos de risco relativo (RR). Utilizou-se também um modelo de regressão Binomial Negativo e Poisson para quantificar a associação do desfecho estudado às categorias crescentes de exposição à densidade de tráfego obtendo-se estimativas da razão da taxa de incidência (IRR). Resultados: A variabilidade espacial do risco foi influenciada pelas covariáveis padronizadas: densidade de tráfego veicular e IDHM. Para cada aumento de um desvio padrão da densidade de tráfego obteve-se um RR= 1,07 (IC 95%: 1,02-1,13), RR= 1,09 (CI 95%: 1,02-1,15) e RR= 1,04 (CI 95%: 0,99-1,09), para incidência, internação hospitalar e mortalidade por câncer do aparelho respiratório para indivíduos > 20 anos de idade, respectivamente. Para a incidência de câncer hematológico em jovens obteve-se um RR= 1,09 (IC 95%: 1,00-1,18) para este mesmo aumento da densidade de tráfego. A avaliação da exposição por categorias crescentes de densidade de tráfego evidenciou um claro e significante gradiente de exposição-resposta para incidência e mortalidade por câncer respiratório em regiões com baixo IDHM, independente do sexo analisado. Na categoria mais alta de densidade de tráfego, homens de regiões com baixo IDHM apresentaram IRR= 3,29 (IC 95%: 2.34-4,64) comparado a IRR= 1,18 (IC 95%: 1,03-1,36) referente aos homens de regiões com alto IDHM. Conclusões: Os resultados mostraram uma associação positiva significante entre residir em áreas com alta densidade de tráfego e incidência, internação hospitalar e mortalidade por câncer respiratório em > 20 anos e incidência de câncer hematológico em indivíduos jovens. As pessoas de baixo status socioeconômico, embora não residam em áreas de maior exposição aos poluentes do tráfego, sofreram mais os efeitos da poluição do ar, provavelmente devido a fatores de vulnerabilidade

Introduction: Traffic-related air pollution is a serious problem in urban centers, exposing a considerable part of the population to the risk of adverse health effects. Epidemiological and toxicological studies have found evidence associating exposure to traffic pollutants and the incidence of cancer. Objective: To perform a spatial analysis of cases of respiratory and hematological cancers and its relation with traffic density in the city of São Paulo. Methods: Data from three different databases were used: cancer incidence data from the Population- Based Cancer Registry of the Municipality of São Paulo (RCBP) from 2002 to 2011; data from hospital admissions for cancer of the public and private system from 2004 to 2006; mortality data from the Mortality Information System (SIM) from 2002 to 2013, from the Municipal Health Department. The traffic density was used for exposure assessment, and the Municipal Human Development Index (MHDI) as an indicator of socioeconomic status. As a spatial unit, the weighting areas of the 2010 Census and a grid of 500 m x 500 m were used. The spatial variability of risk for incidence, hospital admission and mortality from respiratory and hematological cancers was assessed using an ecological model from Besag-York-Mollie. The results were expressed in terms of relative risk (RR). A Negative Binomial and Poisson regression model was used to quantify the association of the endpoint studied with the increasing categories of exposure to traffic density, obtaining estimates of the incidence rate ratio (IRR). Results: The spatial variability of the risk was influenced by the standardized covariates: traffic density and MHDI. For each increase of a standard deviation of the traffic density was obtained an RR = 1.07 (95% CI: 1.02-1.13), RR = 1.09 (95% CI: 1.02-1, 15) and RR = 1.04 (CI 95%: 0.99-1.09), for incidence, hospital admission and mortality from respiratory cancer, respectively, among individuals over 20 years of age. The RR = 1.09 (95% CI: 1.00-1.18) for this same increase in traffic density was obtained for the incidence of hematological cancer in youngsters. The exposure assessment by increasing categories of traffic density evidenced a clear and significant exposure-response gradient for incidence and mortality from respiratory cancer in regions with low MHDI, regardless of the sex analyzed. In the highest category of traffic density, men from regions with low MHDI regions presented IRR = 3.29 (95% CI: 2.34-4.64) compared to IRR = 1.18 (95% CI: 1.03-1, 36) for men from regions with high MHDI. Conclusions: The results showed a significant positive association between residing in areas with high traffic density and incidence, hospital admission and mortality from respiratory cancers in individuals over 20 years, and the incidence of hematological cancer in young individuals. People with low socioeconomic status, although not residing in areas of greater exposure to traffic pollutants, have been more affected by air pollution, probably due to vulnerability factors

[Respiratory cancers attributable to occupational exposures: what is the cost to society in France]. / Cancers des voies respiratoires attribuables aux expositions professionnelles : quels coûts pour la société française ?

OBJECTIVE: To estimate the social cost of respiratory cancers attributable to occupational risk factors in France in 2010. METHODS: We estimated the number of cases of respiratory cancers attributable to each identified occupational risk factor according to the attributable fractions method. We also estimated direct (costs of hospital stays, drugs, outpatient care) and indirect costs (production losses) related to morbidity (absenteeism and presenteeism) and mortality (years of lost production). Production losses for paid work and unpaid domestic activities were taken into account. RESULTS: The social cost of respiratory cancers (lung, larynx, sinonasal, pleural mesothelioma) attributable to exposure to asbestos, chromium, diesel engine exhaust, polycyclic aromatic hydrocarbons, painting occupations (unidentified carcinogen), crystalline silica, wood and leather dust in France in 2010 was estimated to be between €960 and 1,866 million. The cost of lung cancer represents between €804 and 1,617 million. The three risk factors with the greatest impact are asbestos (€530 to 890 million), diesel engine exhaust (€227 to 394 million), and crystalline silica (€116 to 268 million). CONCLUSION: These results provide a conservative estimate of the public health and economic burden of respiratory cancers attributable to occupational risk factors from a societal perspective.

Increased incidence of respiratory tract cancers in people living near Portland cement plants in Korea.

PURPOSE: Portland cement contains carcinogens such as chromium and free silica, and hence, inhalation of cement dust can cause respiratory tract cancers. The purpose of this study was to determine whether living near a cement plant increases the risk of respiratory tract cancers. METHODS: The study population consisted of 341,793 people, all of whom lived in administrative districts within 3-km radius of ten cement plants in Korea. The respiratory tract cancer incidence data (International Classification of Diseases, ten revision code C00-C14 and C30-C34) for 2008-2012 were obtained from regional cancer registries. Standardized incidence ratios (SIRs) for each cancer site in the respiratory tract were calculated using an indirect standardization method. RESULTS: Compared with the general Korean population, the incidence of lung and bronchus cancer (C33-C34) was significantly higher in all subjects [SIR 1.15, 95% confidence interval (CI) 1.02-1.29] and especially in the men subjects (SIR 1.47, 95% CI 1.29-1.68) in our study population. In addition, the incidence of larynx cancer in men (SIR 1.64, 95% CI 0.97-2.59) and salivary gland cancer in women (SIR 3.03, 95% CI 0.98-7.07) living near cement plants was marginally increased. CONCLUSIONS: These results suggest that environmental exposure to Portland cement dust is a risk factor for respiratory tract cancers.

The association of remotely sensed outdoor fine particulate matter with cancer incidence of respiratory system in the USA.

This study aimed to assess the association between exposure to fine particulate matter (PM2.5) and respiratory system cancer incidence in the US population (n = 295,404,580) using a satellite-derived estimate of PM2.5 concentrations. Linear and logistic regression analyses were performed to determine whether PM2.5 was related to the odds of respiratory system cancer (RSC) incidence based on gender and race. Positive linear regressions were found between PM2.5 concentrations and the age-adjusted RSC incidence rates for all groups (Males, Females, Whites, and Blacks) except for Asians and American Indians. The linear relationships between PM2.5 and RSC incidence rate per 1 µg/m3 PM2.5 increase for Males, Females, Whites, Blacks, and all categories combined had slopes of, respectively, 7.02 (R2 = 0.36), 2.14 (R2 = 0.14), 3.92 (R2 = 0.23), 5.02 (R2 = 0.21), and 4.15 (R2 = 0.28). Similarly, the logistic regression odds ratios per 10 µg/m3 increase of PM2.5 were greater than one for all categories except for Asians and American Indians, indicating that PM2.5 is related to the odds of RSC incidence. The age-adjusted odds ratio for males (OR = 2.16, 95% CI = 1.56-3.01) was higher than that for females (OR = 1.50, 95% CI = 1.09-2.06), and it was higher for Blacks (OR = 2.12, 95% CI = 1.43-3.14) than for Whites (OR = 1.72, 95% CI = 1.23-2.42). The odds ratios for all categories were attenuated with the inclusion of the smoking covariate, reflecting the effect of smoking on RSC incidence besides PM2.5.

Respiratory cancer mortality and incidence in an updated cohort of Canadian nickel production workers.

Respiratory cancer mortality and incidence were examined in an updated cohort of >56,000 Canadian nickel mining and refining workers. There was little evidence to suggest increased lung cancer risk in workers who had no experience in high-risk sintering operations that were closed by 1972, apart from that which would be expected from probable increased smoking prevalence relative to the comparison population. There was no substantive evidence of increased laryngeal cancer risk in the cohort, nor was there evidence of increased pharyngeal cancer risk in nonsinter workers. Nasal cancer incidence was elevated in nonsinter workers, but excess risks appeared to be confined to those hired prior to 1960. These findings lead us to tentatively conclude that occupationally-related respiratory risks in workers hired over the past 45 years are either very low or nonexistent.

Space-time variation of respiratory cancers in South Carolina: a flexible multivariate mixture modeling approach to risk estimation.

PURPOSE: Many types of cancer have an underlying spatiotemporal distribution. Spatiotemporal mixture modeling can offer a flexible approach to risk estimation via the inclusion of latent variables. METHODS: In this article, we examine the application and benefits of using four different spatiotemporal mixture modeling methods in the modeling of cancer of the lung and bronchus as well as "other" respiratory cancer incidences in the state of South Carolina. RESULTS: Of the methods tested, no single method outperforms the other methods; which method is best depends on the cancer under consideration. The lung and bronchus cancer incidence outcome is best described by the univariate modeling formulation, whereas the "other" respiratory cancer incidence outcome is best described by the multivariate modeling formulation. CONCLUSIONS: Spatiotemporal multivariate mixture methods can aid in the modeling of cancers with small and sparse incidences when including information from a related, more common type of cancer.

Re-evaluation of the WHO (2010) formaldehyde indoor air quality guideline for cancer risk assessment.

In 2010, the World Health Organization (WHO) established an indoor air quality guideline for short- and long-term exposures to formaldehyde (FA) of 0.1 mg/m3 (0.08 ppm) for all 30-min periods at lifelong exposure. This guideline was supported by studies from 2010 to 2013. Since 2013, new key studies have been published and key cancer cohorts have been updated, which we have evaluated and compared with the WHO guideline. FA is genotoxic, causing DNA adduct formation, and has a clastogenic effect; exposure-response relationships were nonlinear. Relevant genetic polymorphisms were not identified. Normal indoor air FA concentrations do not pass beyond the respiratory epithelium, and therefore FA's direct effects are limited to portal-of-entry effects. However, systemic effects have been observed in rats and mice, which may be due to secondary effects as airway inflammation and (sensory) irritation of eyes and the upper airways, which inter alia decreases respiratory ventilation. Both secondary effects are prevented at the guideline level. Nasopharyngeal cancer and leukaemia were observed inconsistently among studies; new updates of the US National Cancer Institute (NCI) cohort confirmed that the relative risk was not increased with mean FA exposures below 1 ppm and peak exposures below 4 ppm. Hodgkin's lymphoma, not observed in the other studies reviewed and not considered FA dependent, was increased in the NCI cohort at a mean concentration ≥0.6 mg/m3 and at peak exposures ≥2.5 mg/m3; both levels are above the WHO guideline. Overall, the credibility of the WHO guideline has not been challenged by new studies.