Abstract
Introduction: Associations with smoking and occupational exposures indicate that air pollution could be associated with increased risk of gastric and upper aerodigestive tract (UADT) cancers. However, data from large cohort studies is lacking. We evaluate the association between long-term exposure to ambient air pollution and gastric and UADT cancer incidence in European adult populations. Methods: Baseline addresses of individuals were geocoded and air pollution was assessed by land-use regression models for particulate matter (PM) below 10 µm (PM10), below 2.5 µm (PM2.5), between 2.5-10 µm (PMcoarse), PM2.5absorbance in 12 cohorts and for nitrogen oxides in 15 cohorts, and two traffic indicators. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses. Combined estimates were determined with meta-analyses random effects models. Results: We included data on 305,319 individuals contributing 4,303,965 person-years at risk (average follow-up 14.1 years). 743 incident cases of gastric cancer and 927 of UADT cancer occurred. The hazard ratio for an increase of 5µg/m3 of PM2.5 was (1.39 (95%-CI 1.00;1.93) for gastric cancer and 1.06 (95%-CI 0.63;1.79) for UADT cancer. The corresponding HRs for PM10 were 1.07 (0.80-1.45) and 0.94 (0.65-1.36), respectively and for NO2 1.03 (0.92-1.15) and 0.95 (0.86-1.06), respectively. No statistically significant associations were found for any of the other exposure measures. Adjustment for the other pollutants and additional, mainly dietary, factors did not influence markedly the effect estimate for PM2.5 and gastric cancer. Restriction to study participants with stable addresses over follow-up resulted in a small increase of the effect estimate with a decrease in precision. Conclusion: This large multicentre study shows an association between exposure to PM2.5 and gastric cancer but not UADT cancer, suggesting that long- term air pollution could contribute to the risk of gastric cancer
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