Fine Particulate Matter Pollution Associated with Mortality in Pediatric and AYA Patients

A study published in Cancer Epidemiology, Biomarkers & Prevention found that fine particulate matter pollution was associated with mortality in pediatric, adolescent, and young adult patients with specific cancers.¹

The study authors indicated that findings such as this could lead to patient recommendations to reduce their personal exposure to air pollution through home-based or behavioral interventions. 

“It is estimated that roughly 40% of Americans live in communities with unhealthy levels of air pollution,” corresponding author Judy Ou, PhD, research scientist at the Huntsman Cancer Institute at the University of Utah, said in a press release.²  "Currently, there are no guidelines for long-term cancer survivors that advise reducing exposure to air pollution, nor are (patients with cancer) considered a population vulnerable to mortality or illness from air pollution. Our results suggest that limiting exposure to fine particulate matter may be important for the survival of younger (patients) with specific cancers.”

Using data from the Utah Population Database and Utah Cancer Registry, researchers followed 2,444 pediatric (ages 0 to 14) and 13,459 young adult and adolescent (ages 15 to 39) patients diagnosed with cancer while living in Utah from 1986 to 2015. Notably, these patients were followed from diagnosis to clinically relevant time points of 5 and 10 years after diagnosis. 

In order to estimate cumulative exposure to fine particulate matter pollution, data was used from stationary monitors provided by the Environmental Protection Agency (EPA). Moreover, researchers used this to model the association between cumulative exposure and mortality from cancer and all-causes. The exposure to fine particulate matter was measured continuously (in increments of 5 micrograms per cubic meter of air; µg/m³) and categorically (if exposure was equal to/exceeded the EPA annual standard of 12 µg/m³, based on the 3 year average of annual mean concentration of fine particulate matter) for these models.

Of the patients with pediatric cancer studied, exposure to fine particulate matter pollution was found to be correlated with an increased risk of death for the following cancer types:

• Lymphomas saw increased cancer mortality and all-cause mortality at both time points  when exposure was measured continuously. 

• Central nervous system and intracranial/spinal neoplasms were found to have increased cancer mortality and all-cause mortality at both time points when exposure was measured continuously. 

• Lymphoid leukemias had increased all-cause mortality 5 years after diagnosis when exposure was measured both continuously and categorically.

• Hepatic tumors saw increased all-cause mortality 10 years after diagnosis when exposure was measured continuously.

Among adolescent and young adult patients, exposure to fine particulate matter pollution was correlated with an increased risk of death for the following cancer types:

• Central nervous system and intracranial/spinal neoplasms were found to have increased cancer mortality and all-cause mortality at both time points when exposure was measured both continuously and categorically.

• Skin melanomas had increased cancer mortality 5 years after diagnosis when exposure was measured categorically, and increased all-cause mortality at both time points when exposure was measured categorically.

• Carcinomas, excluding skin, when collectively analyzed saw increased cancer mortality and all-cause mortality at both time points when exposure was measured either continuously or categorically. 

• Lymphomas were found to have increased all-cause mortality 5 years after diagnosis when exposure was measured categorically.

According to the researchers, current changes in policies and protocols have reduced the ability of regulatory bodies to enforce standards for fine particulate matter pollution and other pollutants. With this knowledge, the authors indicated that studies are needed to support existing policies and further advocate for protections of vulnerable populations who may be at greater risk for illness and death due to these preventable exposures. 

“Exposure to air pollution is preventable to a degree on an individual level, but the responsibility ultimately lies with government policy to protect the public from this major health hazard,” said Ou. “We need patients and their caregivers to become informed advocates to support enforcing air quality policies at the local, state, and federal levels.”

References:

1. Ou JY, Hanson HA, Ramsay JM, et al. Fine Particulate Matter Air Pollution and Mortality Among Pediatric, Adolescent, and Young Adult Cancer Patients. Cancer Epidemiol Biomarkers Prev. doi:10.1158/1055-9965.EPI-19-1363. 

2. Exposure to Fine Particulate Matter May Increase Mortality Among Young Patients with Certain Cancers [news release]. Utah. Published May 11, 2020. Accessed May 12, 2020.