Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Respirology. 2012 Jan;17(1):20-31. doi: 10.1111/j.1440-1843.2011.02088.x.
It is estimated that about 2.4 billion people around the world, or about 40% of the world's population, depend on biomass fuels (wood, charcoal, dung, crop residue) to meet their energy needs for cooking and heating. The burden is especially high in Asia. Studies suggest that levels of pollutants including particulate matter <10 µm and polycyclic aromatic hydrocarbons indoors in homes where biomass fuels are used far exceed levels recommended as safe. While in vitro and in vivo studies in animal models suggest that wood smoke emission extracts are mutagenic and carcinogenic, epidemiologic studies have been inconsistent. In this review, we discuss possible carcinogenic mechanisms of action of biomass fuel emissions, summarize the biological evidence for carcinogenesis, and review the epidemiologic evidence in humans of biomass fuel emissions as a risk factor for lung cancer. Finally, we highlight some issues relevant for interpreting the epidemiologic evidence for the relationship between biomass fuel exposure and lung cancer: these include methodologic considerations and recognition of possible effect modification by genetic susceptibility, smoking status, age of exposure and histologic type.
据估计，全球约有 24 亿人，即约占世界人口的 40%，依赖生物质燃料（木材、木炭、粪便、农作物残余物）来满足烹饪和取暖的能源需求。亚洲的负担尤其沉重。研究表明，在使用生物质燃料的家庭中，室内的污染物水平，包括 <10 µm 的颗粒物和多环芳烃，远远超过了建议的安全水平。虽然动物模型的体外和体内研究表明木烟排放提取物具有致突变性和致癌性，但流行病学研究一直不一致。在这篇综述中，我们讨论了生物质燃料排放物可能的致癌作用机制，总结了生物致癌证据，并回顾了人类流行病学证据，证明生物质燃料排放物是肺癌的一个危险因素。最后，我们强调了一些与解释暴露于生物质燃料与肺癌之间关系的流行病学证据有关的问题：这些问题包括方法学考虑因素，以及认识到遗传易感性、吸烟状况、暴露年龄和组织学类型等因素可能产生的影响修饰作用。
