Arsenic and Nonmelanoma Skin Cancer in Slovakia - PowerPoint PPT Presentation

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Arsenic and Nonmelanoma Skin Cancer in Slovakia

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Historical As exposure. Air pollution modelling (Colvile et al. 2001) ... Comparative Incidence Figures (CIF) Prievidza district versus. Slovakia 1975-84 ... – PowerPoint PPT presentation

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Title: Arsenic and Nonmelanoma Skin Cancer in Slovakia


1
Arsenic and Nonmelanoma Skin Cancer in Slovakia
  • Beate Pesch
  • Environmental Health Research Institute, Germany

2
Part of the EU-funded Project EXPASCAN
Exposure to Arsenic and Cancer in Central
Eastern Europe
  • www.icconsultants.co.uk/EXPASCAN.html

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
4
Objective
  • Estimation of the risk of environmental arsenic
    exposure from power plant emissions for
    non-melanoma skin cancer (NMSC)

5
Estimation of the risk of environmental arsenic
exposure
  • Choose study design(s)
  • Assess exposure
  • Estimate risk
  • Discuss confounders

6
Arsenic and arsenic compounds
  • Environmental Health Criteria (EHC) 2nd
    edition, 224 2001
  • WHO, Geneva
  • www.inchem.org

7
Estimate by Distance to the Power Plant
  • Environmental As exposure
  • NMSC incidence
  • Associate As exposure with NMSC risk control
    for covariates

8
ENO Power Plant (Slovakia)
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)

10
Arsenic Emissions (tons/year) of the ENO Power
Plant, Slovakia
200
As t/a
100
0
1953
1960
1970
1980
1990
1999
Year
11
(No Transcript)
12
Arsenic (mg/g) in soil 1999 by distance from the
plant Distance N Median Min Max lt 5 km
40 41 14 134 5-10 km 102 23 9
139 gt10 km 68 20 10 53
13
(No Transcript)
14
(No Transcript)
15
Cancer Incidence Analysis
  • Prievidza district versus Slovakia
  • Within Prievidza district by distance to the
    plant

16
Comparative Incidence Figures (CIF) Prievidza
district versus Slovakia 1975-84
  • All malignancies 1.1
  • NMSC 1.6
  • Lung cancer 1.0
  • Bladder cancer 0.9

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

18
SIR NMSC (1996-1999)by Distance to the Plant
  • lt5km 5-10 km gt10km
  • Reference
  • District 1.2 1.1 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

19
Population-based Case-Control Study
  • 264 NMSC cases (1996-99)response rate 80
  • 286 population controls
  • response rate 72
  • Matching by sex, age

20
Statistical Power
  • ? 5 one-sided
  • ? 20 (power 80)
  • controls exposed to As10
  • N cases 264
  • N controls 286
  • RR to be detected gt 1.9

21
NMSC Risk Estimation
  • Logistic regression
  • conditional on age, genderOdds Ratio (OR),
    95 CI
  • Potential confounders occupational As exposure
  • smoking

22
Occupational As exposure (Job-Exposure Matrix)
23
Cigarette Smoking
24
Skin Type UV Exposure
25
Fresh Vegetables Fruits
26
Exposure Assessment and Risk Estimationfor
Environmental Arsenic
  • Dietary habits
  • Residential history

27
Arsenic Exposurefrom Dietary Habits
  • AsNut1 S 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

28
Arsenic Exposure with Dietary Habits
29
As Exposurefrom Residential Data
  • AsRes1 S E(t) w(d(t),t)
  • for all places of residenceE(t) annual
    emissionw(d(t),t) immission weight

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
    R800 re-sampled groups

31
Arsenic Exposure with Residential Data
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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