López-Abente Gonzalo, Aragonés Nuria, Pérez-Gómez Beatriz, Ramis Rebeca, Vidal Enrique, García-Pérez Javier, Fernández-Navarro Pablo, Pollán Marina
Cancer and Environmental Epidemiology Area, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
BMC Cancer. 2008 Oct 9;8:293. doi: 10.1186/1471-2407-8-293.
Since the second half of the 1990s, kidney cancer mortality has tended to stabilize and decline in many European countries, due to the decrease in the prevalence of smokers. Nevertheless, incidence of kidney cancer is rising across the sexes in some of these countries, a trend which may possibly reflect the fact that improvements in diagnostic techniques are being outweighed by the increased prevalence of some of this tumor's risk factors. This study sought to: examine the geographic pattern of kidney cancer mortality in Spain; suggest possible hypotheses that would help explain these patterns; and enhance existing knowledge about the large proportion of kidney tumors whose cause remains unknown.
Smoothed municipal relative risks (RRs) for kidney cancer mortality were calculated in men and women, using the conditional autoregressive model proposed by Besag, York and Molliè. Maps were plotted depicting smoothed relative risk estimates, and the distribution of the posterior probability of RR>1 by sex.
Municipal maps displayed a marked geographic pattern, with excess mortality in both sexes, mainly in towns along the Bay of Biscay, including areas of Asturias, the Basque Country and, to a lesser extent, Cantabria. Among women, the geographic pattern was strikingly singular, not in evidence for any other tumors, and marked by excess risk in towns situated in the Salamanca area and Extremaduran Autonomous Region. This difference would lead one to postulate the existence of different exposures of environmental origin in the various regions.
The reasons for this pattern of distribution are not clear, and it would thus be of interest if the effect of industrial emissions on this disease could be studied. The excess mortality observed among women in towns situated in areas with a high degree of natural radiation could reflect the influence of exposures which derive from the geologic composition of the terrain and then become manifest through the agency of drinking water.
自20世纪90年代后半期以来，由于吸烟者患病率下降，许多欧洲国家的肾癌死亡率趋于稳定并有所下降。然而，在其中一些国家，肾癌的发病率在男女中均呈上升趋势，这一趋势可能反映出，某些该肿瘤风险因素患病率的增加超过了诊断技术的进步。本研究旨在：研究西班牙肾癌死亡率的地理分布模式；提出有助于解释这些模式的可能假设；并增进对很大一部分病因不明的肾肿瘤的现有认识。
采用贝萨格、约克和莫利耶提出的条件自回归模型，计算男性和女性肾癌死亡率的平滑市级相对风险（RRs）。绘制地图，描绘平滑后的相对风险估计值，以及RR>1的后验概率按性别分布情况。
市级地图显示出明显的地理分布模式，男女死亡率均过高，主要集中在比斯开湾沿岸城镇，包括阿斯图里亚斯地区、巴斯克地区，以及程度稍轻的坎塔布里亚地区。在女性中，这种地理分布模式极为独特，在其他任何肿瘤中都未出现，其特点是萨拉曼卡地区和埃斯特雷马杜拉自治区的城镇风险过高。这种差异使人推测不同地区存在不同的环境源性暴露。
这种分布模式的原因尚不清楚，因此研究工业排放对该疾病的影响将很有意义。在自然辐射程度高的地区的城镇中，女性观察到的过高死亡率可能反映了源于地形地质构成的暴露影响，然后通过饮用水的媒介显现出来。
