Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
Cancer Epidemiol. 2024 Oct;92:102630. doi: 10.1016/j.canep.2024.102630. Epub 2024 Aug 3.
Lead (Pb) is a toxic heavy metal and pervasive environmental contaminant, and a class 2 A carcinogen according to the IARC classification, yet its link with cancer at several body sites remains uncertain. Here, we aimed at summarizing the scientific evidence regarding its association with cancer risk and mortality, focusing on studies that carried out Pb measurements in biological samples.
We reviewed articles published in PubMed and EMBASE until January 2nd, 2024, that quantified the epidemiological association between Pb measured in blood, urine, nails, and other biological media, and cancer risk and mortality (overall and by cancer site/type).
We included 46 articles (out of 8022 screened) published in 1995-2023 and reporting on investigations conducted in fifteen countries. In terms of design, 20 were prospective, 24 were retrospective case-control studies, and 2 were cross-sectional. Pb levels were determined in blood in the majority of studies (n=28). The most consistent evidence was for the association of Pb with cancer of the gastrointestinal tract, particularly the oesophagus, stomach (RR ranging from 0.80 to 2.66), colon-rectum, and pancreas; and of the bladder and urinary tract (RR from 1.10 to 2.89). For other specific malignancies, the data were conflicting or too limited to draw reliable conclusions. Finally, increased Pb concentration in blood and urine was consistently associated with higher overall cancer incidence and mortality.
Lead is a widespread and highly persistent environmental pollutant associated with cancer at multiple body sites. Comprehensive primary prevention interventions aiming at reducing opportunities for Pb exposure need to be continuously promoted and implemented.
铅（Pb）是一种有毒重金属和普遍存在的环境污染物，根据 IARC 分类，属于 2A 类致癌物，但它与多个身体部位的癌症之间的联系仍不确定。在这里，我们旨在总结关于其与癌症风险和死亡率之间关联的科学证据，重点关注在生物样本中进行 Pb 测量的研究。
我们在 PubMed 和 EMBASE 上检索了截至 2024 年 1 月 2 日发表的文章，这些文章定量描述了血液、尿液、指甲和其他生物介质中测量的 Pb 与癌症风险和死亡率（总体和按癌症部位/类型）之间的流行病学关联。
我们共纳入了 46 篇文章（从 8022 篇筛选出的文章中），这些文章发表于 1995 年至 2023 年，报道了在 15 个国家进行的研究。就设计而言，其中 20 项为前瞻性研究，24 项为回顾性病例对照研究，2 项为横断面研究。大多数研究（n=28）中都测定了血液中的 Pb 水平。最一致的证据表明 Pb 与胃肠道癌，特别是食道癌、胃癌（RR 范围为 0.80 至 2.66）、结肠-直肠和胰腺；以及膀胱癌和泌尿道（RR 范围为 1.10 至 2.89）有关。对于其他特定的恶性肿瘤，数据存在矛盾或过于有限，无法得出可靠的结论。最后，血液和尿液中 Pb 浓度的增加与更高的总体癌症发病率和死亡率一致相关。
铅是一种广泛存在且高度持久的环境污染物，与多个身体部位的癌症有关。需要不断推广和实施旨在减少 Pb 暴露机会的综合初级预防干预措施。
