Tagliabue Giovanna, Borgini Alessandro, Tittarelli Andrea, van Donkelaar Aaron, Martin Randall V, Bertoldi Martina, Fabiano Sabrina, Maghini Anna, Codazzi Tiziana, Scaburri Alessandra, Favia Imma, Cau Alessandro, Barigelletti Giulio, Tessandori Roberto, Contiero Paolo
Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
BMJ Open. 2016 Nov 14;6(11):e012580. doi: 10.1136/bmjopen-2016-012580.
Atmospheric fine particulate matter (PM) has multiple adverse effects on human health. Global atmospheric levels of PM increased by 0.55 μg/m/year (2.1%/year) from 1998 through 2012. There is evidence of a causal relationship between atmospheric PM and breast cancer (BC) incidence, but few studies have investigated BC mortality and atmospheric PM. We investigated BC mortality in relation to atmospheric PM levels among patients living in Varese Province, northern Italy.
We selected female BC cases, archived in the local population-based cancer registry, diagnosed at age 50-69 years, between 2003 and 2009. The geographic coordinates of each woman's place of residence were identified, and individual PM exposures were assessed from satellite data. Grade, stage, age at diagnosis, period of diagnosis and participation in BC screening were potential confounders. Kaplan-Meir and Nelson-Aalen methods were used to test for mortality differences in relation to PM quartiles. Multivariable Cox proportional hazards modelling estimated HRs and 95% CIs of BC death in relation to PM exposure.
Of 2021 BC cases, 325 died during follow-up to 31 December 2013, 246 for BC. Risk of BC death was significantly higher for all three upper quartiles of PM exposure compared to the lowest, with HRs of death: 1.82 (95% CI 1.15 to 2.89), 1.73 (95% CI 1.12 to 2.67) and 1.72 (95% CI 1.08 to 2.75).
Our study indicates that the risk of BC mortality increases with PM exposure. Although additional research is required to confirm these findings, they are further evidence that PM exposure is harmful and indicate an urgent need to improve global air quality.
大气细颗粒物（PM）对人类健康有多种不利影响。1998年至2012年期间，全球大气PM水平以每年0.55μg/m³（每年2.1%）的速度上升。有证据表明大气PM与乳腺癌（BC）发病率之间存在因果关系，但很少有研究调查BC死亡率与大气PM的关系。我们调查了意大利北部瓦雷泽省居民中BC死亡率与大气PM水平的关系。
我们选择了2003年至2009年期间在当地基于人群的癌症登记处存档的50至69岁女性BC病例。确定了每位女性居住地的地理坐标，并根据卫星数据评估个体PM暴露情况。分级、分期、诊断年龄、诊断时期和参与BC筛查是潜在的混杂因素。采用Kaplan-Meir和Nelson-Aalen方法检验与PM四分位数相关的死亡率差异。多变量Cox比例风险模型估计了与PM暴露相关的BC死亡的HR和95%CI。
在2021例BC病例中，到2013年12月31日随访期间有325例死亡，其中246例死于BC。与最低PM暴露四分位数相比，所有三个较高PM暴露四分位数的BC死亡风险均显著更高，死亡HR分别为：1.82（95%CI 1.15至2.89）、1.73（95%CI 1.12至2.67）和1.72（95%CI 1.08至2.75）。
我们的研究表明，BC死亡率风险随PM暴露增加。尽管需要更多研究来证实这些发现，但它们进一步证明了PM暴露是有害的，并表明迫切需要改善全球空气质量。
