Scheurer Michael E, Danysh Heather E, Follen Michele, Lupo Philip J
Department of Pediatrics, Section of Hematology-Oncology and Dan L, Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
Environ Health. 2014 Jun 13;13(1):52. doi: 10.1186/1476-069X-13-52.
Human papillomavirus (HPV) infection is a necessary cause in the development of cervical cancer; however, not all women infected with HPV develop cervical cancer indicating that other risk factors are involved. Our objective was to determine the association between exposure to ambient levels of common traffic-related air toxics and cervical dysplasia, a precursor lesion for cervical cancer.
The study sample consisted of women enrolled in a Phase II clinical trial to evaluate diagnostic techniques for cervical disease in Houston, Texas. The current assessment is a secondary data analysis in which cases were defined as women diagnosed with cervical dysplasia, while those without cervical dysplasia served as controls. Residential census tract-level estimates of ambient benzene, diesel particulate matter (DPM), and polycyclic aromatic hydrocarbons (PAHs) were used to assess exposure. Census tract-level pollutant estimates were obtained from the United States Environmental Protection Agency. Multivariable logistic regression was used to estimate prevalence odds ratios (aOR) and 95% confidence intervals (CI) adjusted for age, race/ethnicity, education, smoking status, and HPV status.
Women in the highest residential exposure categories for benzene and DPM had an increased prevalence of cervical dysplasia compared to the lowest exposure category (Benzene: aOR [95% CI] for high exposure = 1.97[1.07-3.62], very high exposure = 2.30[1.19-4.46]. DPM: aOR [95% CI] for high exposure = 2.83[1.55-5.16], very high exposure = 2.10[1.07-4.11]). Similarly, women with high residential exposure to PAHs had an increased prevalence of cervical dysplasia (aOR [95% CI] = 2.46[1.35-4.48]). The highest PAH exposure category was also positively associated with cervical dysplasia prevalence but was not statistically significant. Assessment of the combined effect of HAP exposure indicates that exposure to high levels of more than one HAP is positively associated with cervical dysplasia prevalence (p for trend = 0.004).
Traffic-related HAPs, such as benzene, DPM, and PAHs, are not as well-regulated and monitored as criteria air pollutants (e.g., ozone), underscoring the need for studies evaluating the role of these toxicants on disease risk. Our results suggest that exposure to traffic-related air toxics may increase cervical dysplasia prevalence.
人乳头瘤病毒（HPV）感染是宫颈癌发生的必要病因；然而，并非所有感染HPV的女性都会患宫颈癌，这表明还有其他风险因素。我们的目标是确定暴露于环境中常见的交通相关空气有毒物质与宫颈发育异常（宫颈癌的一种前驱病变）之间的关联。
研究样本包括参加德克萨斯州休斯顿一项评估宫颈疾病诊断技术的II期临床试验的女性。当前评估是一项二次数据分析，其中病例定义为被诊断为宫颈发育异常的女性，而无宫颈发育异常的女性作为对照。使用居住普查区层面的环境苯、柴油颗粒物（DPM）和多环芳烃（PAHs）估计值来评估暴露情况。普查区层面的污染物估计值来自美国环境保护局。采用多变量逻辑回归来估计患病率比值比（aOR）和经年龄、种族/族裔、教育程度、吸烟状况和HPV状态调整后的95%置信区间（CI）。
与最低暴露类别相比，居住环境中苯和DPM暴露类别最高的女性宫颈发育异常患病率增加（苯：高暴露的aOR [95% CI] = 1.97[1.07 - 3.62]，极高暴露 = 2.30[1.19 - 4.46]。DPM：高暴露的aOR [95% CI] = 2.83[1.55 - 5.16]，极高暴露 = 2.10[1.07 - 4.11]）。同样，居住环境中PAHs高暴露的女性宫颈发育异常患病率增加（aOR [95% CI] = 2.46[1.35 - 4.48]）。最高PAH暴露类别也与宫颈发育异常患病率呈正相关，但无统计学意义。对多种空气有毒物质（HAP）暴露综合效应的评估表明，暴露于高水平的一种以上HAP与宫颈发育异常患病率呈正相关（趋势p = 0.004）。
与交通相关的空气有毒物质，如苯、DPM和PAHs，不像标准空气污染物（如臭氧）那样受到严格监管和监测，这突出了评估这些有毒物质对疾病风险作用的研究的必要性。我们的结果表明，暴露于与交通相关的空气有毒物质可能会增加宫颈发育异常的患病率。
