Tenwek Hospital, Bomet, Kenya.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Environ Int. 2021 Jul;152:106485. doi: 10.1016/j.envint.2021.106485. Epub 2021 Mar 6.
Exposure to polycyclic aromatic hydrocarbons (PAHs) is a risk factor for esophageal squamous cell carcinoma (ESCC) in high-incidence areas of China, Iran and Brazil, but PAH assessments have not been conducted in East Africa, another ESCC hot spot.
To evaluate demographic or lifestyle factors associated with the PAH biomarker concentrations in the study population, and whether PAH metabolite concentrations showed any associations with esophageal precancerous lesions.
We recruited a community-based sample of 289 asymptomatic adults from a rural area of Kenya and performed Lugol's chromoendoscopy to detect esophageal squamous dysplasia (ESD); participants completed a questionnaire and provided a spot urine specimen. We analyzed urine for seven hydroxylated metabolites of naphthalene, fluorene, phenanthrene, and pyrene at the U.S. National Center for Environmental Health, and compared creatinine-corrected PAH metabolite concentrations with questionnaire data and the presence of ESD.
PAH metabolite concentrations among never tobacco users in these rural Kenya residents were 2.4-28.1 times higher than those reported from never tobacco users in Iran, Brazil and the USA. Female sex, cooking indoors, having no post-primary education, and age <50, but not tobacco use, were positively and significantly associated with PAH metabolite concentrations. Almost all participants used wood as cooking fuel. Nine participants had advanced ESD. Adjusted logistic regression showed a significant association between 2-hydroxynaphthalene (OR = 4.19, 95%CI: 1.01-17.47) and advanced ESD. All other PAH metabolites had positive but non-significant associations with advanced ESD.
Urinary PAH metabolite concentrations among never tobacco users are markedly higher in this group from Kenya than in other populations and are associated with indoor cooking with wood on open, unvented stoves. These metabolite concentrations were also associated with the presence of advanced esophageal dysplasia. Our findings underline the importance of assessing alternative cooking conditions to reduce PAH exposure in this population.
多环芳烃（PAHs）暴露是中国、伊朗和巴西高发地区食管鳞状细胞癌（ESCC）的一个危险因素，但在另一个 ESCC 高发地区东非，尚未对 PAH 进行评估。
评估与研究人群中 PAH 生物标志物浓度相关的人口统计学或生活方式因素，以及 PAH 代谢物浓度是否与食管癌前病变存在任何关联。
我们从肯尼亚一个农村地区招募了一个基于社区的 289 名无症状成年人样本，并进行了卢戈氏染色内镜检查以检测食管鳞状上皮不典型增生（ESD）；参与者完成了一份问卷并提供了一份尿样。我们在美国国家环境卫生中心分析了尿液中萘、芴、菲和芘的七种羟基化代谢物，并将肌酐校正后的 PAH 代谢物浓度与问卷数据和 ESD 的存在进行了比较。
这些肯尼亚农村地区从不吸烟的居民的 PAH 代谢物浓度比来自伊朗、巴西和美国从不吸烟的居民高 2.4-28.1 倍。女性、室内烹饪、未接受过中学后教育和年龄<50 岁，但不吸烟与 PAH 代谢物浓度呈正相关且具有显著意义。几乎所有参与者都使用木材作为烹饪燃料。9 名参与者患有晚期 ESD。调整后的逻辑回归显示，2-羟基萘（OR=4.19，95%CI：1.01-17.47）与晚期 ESD 之间存在显著关联。其他所有 PAH 代谢物与晚期 ESD 均呈正相关但无统计学意义。
与其他人群相比，该肯尼亚人群中从不吸烟的人尿液中的 PAH 代谢物浓度明显更高，且与在无通风的敞开式炉灶上用木材进行室内烹饪有关。这些代谢物浓度也与晚期食管上皮不典型增生的存在相关。我们的研究结果强调了评估替代烹饪条件以减少该人群中 PAH 暴露的重要性。
