Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Environ Res. 2020 Jul;186:109578. doi: 10.1016/j.envres.2020.109578. Epub 2020 Apr 28.
Carcinogens released from indoor burning of solid fuels are believed to enter the bloodstream and to be metabolized in breast and cervical tissues. Little evidence exists about the relationship of solid fuel use from heating with breast and cervical cancer.
To examine the association of solid heating fuel use with breast and cervical cancer mortality.
This study included female participants aged 30-79 years who were enrolled in the China Kadoorie Biobank during 2004-2008 from 10 diverse regions across China. During a 10.2-year median follow-up, 177 breast cancer deaths and 113 cervical cancer deaths were documented. Multivariable Cox regression models yielded adjusted hazard ratios (HRs) for the associations of self-reported long-term heating fuel exposure with two cancer deaths. Stratified analyses were used to assess effect modification.
We included 236,116 participants for breast cancer analyses and 228,795 for cervical cancer analyses. Compared with non-solid fuel use, the fully adjusted HRs of cervical cancer deaths were 1.75 (0.91-3.38) for wood use, 2.23 (1.09-4.59) for mixed fuel (coal and wood) use. No evident relationship was observed for breast cancer deaths. Cervical cancer risk increased with the duration of solid fuel use (P for trend = 0.041). Elevated cervical cancer risk was observed in post-menopausal women (HR 2.01, 1.01-4.03), not in pre-menopausal women (HR 0.77, 0.56-2.31) (P for heterogeneity = 0.004); and in those aged ≥50 years (HR 2.56, 1.17-5.86), not in those aged < 50 years (HR 0.69, 0.26-1.84) (P < 0.001).
Indoor solid fuel combustion for heating may be associated with a higher risk for cervical cancer death, but not for breast cancer. The strength of the association increased with the duration of exposure and was modified by age and menopause status.
室内燃烧固体燃料释放的致癌物据称会进入血液，并在乳腺和宫颈组织中代谢。关于固体燃料加热与乳腺癌和宫颈癌之间的关系，证据很少。
研究固体加热燃料使用与乳腺癌和宫颈癌死亡率的关系。
本研究纳入了年龄在 30-79 岁之间的女性参与者，她们于 2004-2008 年期间在中国 10 个不同地区参加了中国慢性病前瞻性研究。在中位随访 10.2 年期间，记录了 177 例乳腺癌死亡和 113 例宫颈癌死亡。多变量 Cox 回归模型得出了与自我报告的长期加热燃料暴露相关的两种癌症死亡的调整后危险比 (HR)。分层分析用于评估效应修饰。
我们纳入了 236116 名参与者进行乳腺癌分析，228795 名参与者进行宫颈癌分析。与非固体燃料使用相比，宫颈癌死亡的完全调整 HR 分别为木柴使用 1.75（0.91-3.38），混合燃料（煤和木柴）使用 2.23（1.09-4.59）。未观察到乳腺癌死亡的明显关系。宫颈癌风险随固体燃料使用时间的延长而增加（趋势 P 值=0.041）。绝经后妇女的宫颈癌风险升高（HR 2.01，1.01-4.03），而绝经前妇女的风险并未升高（HR 0.77，0.56-2.31）（异质性 P 值=0.004）；年龄≥50 岁的妇女的风险升高（HR 2.56，1.17-5.86），而年龄<50 岁的妇女的风险并未升高（HR 0.69，0.26-1.84）（P<0.001）。
室内固体燃料燃烧取暖可能与宫颈癌死亡风险增加有关，但与乳腺癌无关。暴露时间的延长与关联的强度增加有关，且受年龄和绝经状态的影响。
