Outdoor particulate matter (PM(10)) exposure and lung cancer risk in the EAGLE study

OBJECTIVE: Cohort studies in Europe, but not in North-America, showed an association between exposure to outdoor particulate matter with aerodynamic diameter ≤10 μm (PM(10)) and lung cancer risk. Only a case-control study on lung cancer and PM(10) in South Korea has so far been performed. For the first time in Europe we analyzed quantitatively this association using a case-control study design in highly polluted areas in Italy. METHODS: The Environment And Genetics in Lung cancer Etiology (EAGLE) study, a population-based case-control study performed in the period 2002–2005 in the Lombardy Region, north-west Italy, enrolled 2099 cases and 2120 controls frequency-matched for area of residence, gender, and age. For this study we selected subjects with complete active and passive smoking history living in the same municipality since 1980 until study enrollment. Fine resolution annual PM(10) estimates obtained by applying land use regression modeling to satellite data calibrated with fixed site monitor measurements were used. We assigned each subject the PM(10) average estimates for year 2000 based on enrollment address. We used logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI) adjusted for matching variables, education, smoking, and dietary and occupational variables. RESULTS: We included 3473 subjects, 1665 cases (1318 men, 347 women) and 1808 controls (1368 men, 440 women), with PM(10) individual levels ranging from 2.3 to 53.8 μg/m(3) (mean: 46.3). We found increasing lung cancer risk with increasing PM(10) category (P-value for trend: 0.04). The OR per 10 μg/m(3) was 1.28 (95% CI: 0.95–1.72). The association appeared stronger for squamous cell carcinoma (OR 1.44, 95% CI: 0.90–2.29). CONCLUSION: In a population living in highly polluted areas in Italy, our study added suggestive evidence of a positive association between PM(10) exposure and lung cancer risk. This study emphasizes the need to strengthen policies to reduce airborne pollution.