Air pollution affects lung cancer survival time

Exposure to higher levels of air pollution shortens survival after lung cancer diagnosis

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Exposure to air pollution has many impacts across the lifespan and has now been linked to survival of patients after being diagnosed with lung cancer. Lung cancer has been the most commonly diagnosed cancer over the past several decades. Patterns of lung cancer incidence and mortality have been closely tied to exposure to tobacco smoke across time and place. There is also a growing body of evidence that shows that air pollution exposures are associated with lung cancer incidence and mortality but, since survival times after lung cancer diagnosis can be quite short, few studies have attempted to disentangle the two. In addition, the International agency for Research on Cancer (IARC) recently classified ambient air pollution as carcinogenic.

“We thought that if ambient air pollution is a carcinogen that can drive lung cancer development, then exposure to air pollution in patients already diagnosed with lung cancer could promote the progression of their disease through the same biological pathways.” said Sandrah Eckel, PhD, assistant professor of Preventive Medicine at the Keck School of Medicine and lead author of the research. Therefore, Dr. Eckel and colleagues at the Keck School of Medicine at the University of Southern California decided to more closely explore the question of whether lung cancer survival times might be affected by air pollution.

The research, published this month in Thorax, shows that the length of time that lung cancer patients live after diagnosis varies depending on their exposures to regional pollution. Researchers found that the median survival for people diagnosed with early stage lung cancers who lived in areas with high levels of regional pollution was approximately 3 years shorter than for people who lived in areas with lower levels of pollution. “We focused on California, since there are a wide range of air pollution levels here and one of the largest and longest running air quality monitoring networks and cancer registry system in the US,” said Eckel.

Dr. Eckel and her team of researchers looked at lung cancer data from over 350,000 patients in the California Cancer Registry who were diagnosed with lung cancer between 1988-2009. From the extensive and detailed dataset, the team assigned air pollution exposure levels based on the average exposure at the patient’s residence at diagnosis. The pollutants that were used included: nitrogen dioxide (NO2, ppb), ozone (O3, ppb), and particulate matter with diameter <10 μm (PM10, mg/m3) and 2.5 μm (PM2.5, mg/m3). “This study is unique in that it looks at another modifiable risk factor, besides smoking, that can impact lung cancer survival after diagnosis. The California Cancer Registry data provided a large, population-based sample of all lung cancer cases diagnosed in California over the last 20 years, minimizing the biases often encountered in other types of study designs,” said Dr. Eckel.

In general, the stage of cancer at diagnosis is a major determinant of survival, with patients diagnosed with earlier stage cancer living longer. As expected, the impacts of air pollution on survival were most evident in patients diagnosed at an early stage, when their cancer was localized to only their lungs. The median survival in patients with localized cancer at diagnosis living in areas with higher levels of fine particulate matter (PM2.5) was only 2.4 years as compared to 5.7 years in patients living in areas with lower levels of PM2.5. Patients whose cancer had spread to other parts of their bodies had shorter survival times overall and showed little difference in survival time whether they had high or low exposures to air pollution. These patterns of association persisted even after adjusting for numerous socio-demographic characteristics and type of cancer treatment.

The study’s findings are intriguing, but additional research is needed to determine the causality of the association between air pollution and lung cancer survival rates. Even so, these findings suggest that newly diagnosed lung cancer patients might want to consider taking precautions to reduce their own exposures to air pollution. As we continue to see increased emphasis on lung cancer screening, we will see more and more patients diagnosed with lung cancer at early stages and these are the patients that could potentially benefit the most from reduced air pollution exposures.

What can lung cancer patients with a locally diagnosed cancer do to take action that may effectively extend their survival times? Dr. Frank Gilliland, senior investigator on the study said, “In the short-term, common-sense precautions to reduce personal exposure to air pollution exposures include avoidance of places and times with high air pollution levels and using indoor home filtration systems. In the long-term, air quality standards should be evaluated to consider whether they are adequately protecting human health.”

The article, “Air pollution affects lung cancer survival time” by Sandrah P Eckel, Myles Cockburn, Yu-Hsiang Shu, Huiyu Deng, Frederick W Lurmann, Lihua Liu, and Frank D Gilliland. (http://dx.doi.org/10.1136/thoraxjnl-2015-207927) appears in Thorax, Published Online First (August 4, 2016)

Related links: 
Article
Editorial by Dr. Jamie E. Hart, Harvard
Podcast interview with Dr. Hart

This work was supported by the Southern California Environmental Health Sciences Center (grant 5P30ES007048) funded by the National Institute of Environmental Health Sciences; the Hastings Foundation; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health.

 

Event update: The air out there: Traffic, pollution and children’s health

View event video, live tweet feed, questions, answers and more about air pollution and children’s health.

On Sunday April 24, 2016 the SC-CEHC co-sponsored the event: The air out there: Traffic, pollution and children’s health with southern california public radio station KPCC. USC Keck Professor Jim Gauderman participated in the panel discussion lead by KPCC Early Childhood Development correspondent Deepa Fernandez. This time provided many great questions and insights into the health effects of air pollution as well as community perspectives and experiences as awareness about how pollution affects health continues to grow in the Southern California region.

KPCC live tweeted the event via @KPCCInPerson. The event can be viewed in full below, including a question/answer session from the audience.

 

SCEHSC Seminar May 6: Field and Laboratory Evaluation of ‘Low-Cost’ Air Quality Sensors

The SCEHSC Seminar Series presents

“Field and Laboratory Evaluation of ‘Low-Cost’ Air Quality Sensors”

Andrea Polidori, PhD

Quality Assurance Manager
Science & Technology Advancement
South Coast Air Management Quality District
Diamond Bar, CA

Friday, May 6, 2016
11:45 a.m.-1:00 p.m.

Soto Street Building, Room 115
2001 North Soto Street
Los Angeles, CA 90032

To sign up for the FREE seminar, please email jacy@usc.edu.

Dr. Andrea Polidori is the Quality Assurance Manager for Science & Technology Advancement at SCAQMD and is responsible for the development and implementation of quality assurance control methods, plans, procedures, and programs. He is also involved in the analysis of data collected from numerous field activities and air monitoring projects, and is currently leading the design, development and implementation of AQ-SPEC and of SCAQMD’s fenceline monitoring program.

Prior to joining the SCAQMD, he was a Research Assistant Professor at the University of Southern California, Los Angeles where he taught courses and conducted extensive research on the relationships between indoor and outdoor air pollutants, and the health impacts caused by exposure to air toxics. He has authored more than 40 peer-reviewed journal publications and one book chapter.

Visitor parking at the Soto Street Building is limited. If you are planning to park at the Soto building during the seminar please contact Marissa Jacy for more information. If you are a USC employee, please plan to take the free USC shuttle to our seminars whenever possible. Information about the USC shuttle can be found at http://transet.usc.edu/index.php/bus-map-schedules.


Location:

New Research published from the CHS: Less pollution = improvement in children’s respiratory health

Bronchitic symptoms on the decline as pollution levels drop in Los Angeles region over the past two decades  #CleanAir

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A USC study that tracked Southern California children over a 20 year period has found they now have significantly fewer respiratory symptoms as a result of improved air quality.

The finding expands on the landmark USC Children’s Health Study, which a year ago reported that kids’ lungs had grown stronger over the past 20 years as pollution levels in the Los Angeles Basin declined. In the current study, USC researchers examined a health issue that makes many parents anxious while pulling at their pocketbooks: bronchitic symptoms that could land otherwise healthy children in a doctor’s office or hospital.

The research appears in the April 12, 2016 issue of the Journal of the American Medical Association.

To assess respiratory symptoms, USC scientists studied children in eight California communities and defined bronchitic symptoms over the preceding year as a daily cough for at least three consecutive months, congestion or phlegm not related to a cold, or inflammation of the mucous membranes, according to Kiros Berhane, lead author and a professor of preventive medicine at the Keck School of Medicine of USC.

“This is one of the few times that we have been able to report good news, and this is very likely a direct result of the science-­‐‑based policies that have been put in place,” Berhane said. “The message that clean air leads to better health in children should be taken seriously because it has implications for how we live and how productive we become.”

The study, published April 12 in the Journal of the American Medical Association, followed 4,602 children in three cohorts as they aged from 5 to 18. During 1993 to 2012, children and their parents from Long Beach, San Dimas, Upland, Riverside, Mira Loma, Lake Elsinore, Alpine and Santa Maria answered questionnaires about children’s health. Air quality was continuously monitored in each community.

“Because of the wide variations in ambient pollution levels among the eight California communities we analyzed, these findings are applicable to other parts of the United States and maybe other parts of the world as well,” Berhane said, adding the results could help with asthma management and the overall respiratory health of children.

How much children’s respiratory health improved

Because bronchitic symptoms are usually about four times higher in children with asthma, the scientists examined associations of air pollution reduction with bronchitic symptoms separately for kids with and without asthma. Researchers also adjusted their analyses for age, gender, race or ethnicity, secondhand tobacco smoke and presence of cockroaches in the home.

“It is important to note that while reductions in bronchitic symptoms were larger in children with asthma, they were still substantial and significant in children without asthma as well — indicating that all children have benefited from the improvement in air quality over the past 20 years,” Berhane said.

The study found that tiny particles called particulate matter 2.5 (PM 2.5) — which can penetrate deep into lungs and cause serious health problems — dropped by 47 percent from 1992 to 2011 in the study region. USC researchers were able to associate cleaner air with improved children’s respiratory health. Kids with asthma were 32 percent less likely to suffer from bronchitic symptoms, and children without asthma experienced a 21 percent reduction in these respiratory problems.

Moreover, nitrogen dioxide, which can reduce resistance to respiratory infections, decreased by 49 percent in the same two decades. USC researchers linked the drop in nitrogen dioxide with a 21 percent decrease of bronchitic symptoms in children with asthma and a 16 percent decline of bronchitic symptoms in kids without asthma.

“This type of data is important for policymaking and for how clinicians would advise their patients,” Berhane said.

The cost of asthma and sick children

About 1 in 10 children in the United States had asthma in 2009, according to the Centers for Disease Control and Prevention. Medical expenses associated with asthma amounted to $50.1 billion in 2007 and cost the nation about $3,300 per person each year.

“Changes in children’s respiratory health have a ripple effect,” Berhane said. “A child may stay home because of severe bronchitic symptoms. That could mean parents have to call in sick or arrange for a caregiver. Beyond quality of life, childhood asthma and bronchitic symptoms take a toll on children’s school attendance, parental productivity and society in general.”

Asthma is the cause for almost 2 million emergency room visits each year, according to the Asthma and Allergy Foundation of America. Each year, this respiratory condition is the reason for more than 14 million doctor visits and about 439,000 hospital stays.

Frank Gilliland, senior author and a professor of preventive medicine at Keck Medicine of USC, said the USC Children’s Health Study is a unique examination because it has been able to follow children for so many years.

“Asthma is the most common chronic disease of childhood, so the reduction of these symptoms by 16 to 32 percent is a big deal,” Gilliland said. “We studied longitudinal cohorts of children for 20 years using consistent methods and found that decreased levels of air pollutants were associated with a marked decrease in bronchitic-­‐‑related symptoms in children both with and without asthma. No other study has been able to accomplish this.”

Pollution and policy

California cities have consistently topped the American Lung Association’s annual list of most polluted cities by ozone or particulate matter pollution. Historically, Southern California has reported high levels of ambient air pollution because of emissions from vehicles, industrial sources and two of the nation’s largest ports.

“While the reduction in ambient air pollution has been observed during the past 20 years, it was most marked after 2000 and is very likely due to policies that were put in place,” Berhane said. “Even though this is very encouraging, there is still room for improvement. We must recognize that in some cases, the ozone and particulate matter levels in Southern California are still in violation of federal standards.”

Some California regulatory policies that have been implemented include the Low-Emission Vehicle Program, a risk-reduction plan for diesel fueled engines and vehicles, and pollution controls at the ports of Los Angeles and Long Beach.

For many years, environmental epidemiologists have reported adverse health effects associated with increasingly polluted air. So the ability to report that Southern California has been on the path to cleaner air and that this reduction in air pollution has led to significant improvement in children’s health is a welcome change, Gilliland said.

Berhane added: “But we must not get complacent. We expect more cars on the road, more ships at our ports and more economic activities in the region. Even if we maintain the current policies and practices in environmental protection, pollution levels could start to rise again because of more cars and economic activities. We have to stay vigilant so that we do not lose current gains in air quality and the associated improvements in our children’s health.”

USC strives to conduct research that could have a global impact. This study was supported by the National Institute of Environmental Health Sciences, the Health Effects Institute and the California Air Resources Board.

Press Release: by Zen Vuong, USC Media Relations

# # #
Kiros Berhane, PhD; Chih-Chieh Chang, PhD; RobMcConnell, MD;W. James Gauderman, PhD; Edward Avol, MS; Ed Rapapport, MPH; Robert Urman, PhD; Fred Lurmann, MS; Frank Gilliland, MD, PhD. Association of Changes in Air Quality With Bronchitic Symptoms in Children in California, 1993-2012. JAMA. 2016;315(14):1491-1501. doi:10.1001/jama.2016.3444

KPCC documents community monitoring work on “invisible problem” of traffic pollution

A KPCC story today documents the work of health advocates and collaborations to implement community air monitoring of traffic pollution.  Center faculty and staff provided information for this ongoing series by Deepa Fernandes, which raises awareness about the health effects of going to school near busy roads and freeways.  The Community Outreach program partners with organizations who are interested in knowing what they are breathing at the neighborhood level.  The monitors are a valuable tool to understand more about air pollution and research.  Working with youth is also a strategy to encourage interest in science, health, and environmental issues. Continue reading “KPCC documents community monitoring work on “invisible problem” of traffic pollution”

Children’s Health Center to co-sponsor forum on health and air pollution

The Community Outreach team of the Southern California Children’s Environmental Health Center is co-sponsoring an event with local radio station KPCC on Sunday, April 24, 2016. The expert panel that has been assembled will include Jim Gauderman and community partners that the Community Outreach team has worked with over the years: Scott Chan and Elisa Nicholas.

The Outreach team will be publicizing the event and have a booth with resources at the event. Continue reading “Children’s Health Center to co-sponsor forum on health and air pollution”

Center Member Avol Featured in USC Trojan Family Magazine

Keck Medicine of USC’s Ed Avol wants to help Angelenos breathe easy

Katharine Gammon, Spring 2016

ED AVOL DIDN’T start out trying to change Los Angeles. After he earned his master’s degree from Caltech in 1974, the engineer used his chemistry and physics background to measure air pollution. Fairly quickly, though, he became interested in the health aspects of the air we breathe. As a Keck School of Medicine of USC professor, Avol has been instrumental in USC’s influential studies on the relationship between air quality and children’s lung health. Despite his knowledge about smog, Avol has also been an avid runner and running coach in LA for decades. Science writer Katharine Gammon recently caught up with him to talk about his personal experiences in environmental health research.

Click here to read the full story on the USC Trojan Family Magazine website.