Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
Ann Glob Health. 2014 Sep-Oct;80(5):393-411. doi: 10.1016/j.aogh.2014.10.002.
Over the past few decades, there has been a decline in cancers attributable to environmental and occupational carcinogens of asbestos, arsenic, and indoor and outdoor air pollution in high-income countries. For low- to middle-income countries (LMICs), however, these exposures are likely to increase as industrialization expands and populations grow.
The aim of this study was to review the evidence on the cancer risks and burdens of selected environmental and occupational exposures in less-developed economies.
A causal association has been established between asbestos exposure and mesothelioma and lung cancer. For arsenic exposure, there is strong evidence of bladder, skin, lung, liver, and kidney cancer effects. Women are at the highest risk for lung cancer due to indoor air pollution exposure; however, the carcinogenic effect on the risk for cancer in children has not been studied in these countries. Cancer risks associated with ambient air pollution remain the least studied in LMICs, although reported exposures are higher than World Health Organization, European, and US standards. Although some associations between lung cancer and ambient air pollutants have been reported, studies in LMICs are weak or subject to exposure misclassification. For pulmonary cancers, tobacco smoking and respiratory diseases have a positive synergistic effect on cancer risks.
A precise quantification of the burden of human cancer attributable to environmental and occupational exposures in LMICs is uncertain. Although the prevalence of carcinogenic exposures has been reported to be high in many such countries, the effects of the exposures have not been studied due to varying country-specific limitations, some of which include lack of resources and government support.
在过去几十年中，由于高收入国家中石棉、砷以及室内外空气污染等环境和职业致癌物的减少，归因于这些因素的癌症病例有所减少。然而，对于中低收入国家（LMICs）而言，随着工业化的扩张和人口的增长，这些暴露的情况可能会增加。
本研究旨在回顾有关欠发达经济体中特定环境和职业暴露致癌风险和负担的证据。
石棉暴露与间皮瘤和肺癌之间存在因果关系。对于砷暴露，有强有力的证据表明膀胱癌、皮肤癌、肺癌、肝癌和肾癌。由于室内空气污染暴露，女性患肺癌的风险最高；然而，在这些国家，尚未研究儿童癌症风险的致癌作用。与环境空气污染相关的癌症风险在 LMICs 中研究最少，尽管报告的暴露量高于世界卫生组织、欧洲和美国的标准。尽管已经报道了一些与环境空气污染物相关的肺癌之间的关联，但在 LMICs 中的研究仍然很薄弱或存在暴露分类错误。对于肺癌，吸烟和呼吸道疾病对癌症风险有积极的协同作用。
无法准确量化 LMICs 中归因于环境和职业暴露的人类癌症负担。尽管许多此类国家报告了致癌暴露的高发率，但由于各国具体的限制因素，包括资源和政府支持的缺乏，尚未研究这些暴露的影响。
