TY - JOUR
T1 - Household fuel use and the risk of gastrointestinal cancers
T2 - The golestan cohort study
AU - Sheikh, Mahdi
AU - Poustchi, Hossein
AU - Pourshams, Akram
AU - Khoshnia, Masoud
AU - Gharavi, Abdolsamad
AU - Zahedi, Mahdi
AU - Roshandel, Gholamreza
AU - Sepanlou, Sadaf G.
AU - Fazel, Abdolreza
AU - Hashemian, Maryam
AU - Abaei, Behrooz
AU - Sotoudeh, Masoud
AU - Nikmanesh, Arash
AU - Merat, Shahin
AU - Etemadi, Arash
AU - Moghaddam, Siavosh Nasseri
AU - Islami, Farhad
AU - Kamangar, Farin
AU - Pharoah, Paul D.
AU - Dawsey, Sanford M.
AU - Abnet, Christian C.
AU - Boffetta, Paolo
AU - Brennan, Paul
AU - Malekzadeh, Reza
N1 - Funding Information:
This work was funded by the World Cancer Research Fund International (grant: WCRF 2016/1633, funding for this grant was obtained from Wereld Kanker Onderzoek Fonds (WKOF), as part of the World Cancer Research Fund International grant programme); Tehran University of Medical Sciences (grant: 81/15); Cancer Research UK (grant: C20/A5860); the Intramural Research Program of the U.S. National Cancer Institute, National Institutes of Health; and the IARC. The authors thank A. Feiz Sani and R. Shakeri from the Digestive Disease Research Institute of the Tehran University of Medical Sciences; the Golestan Cohort Study Center staff; the local health networks and health workers in the study area; and the Golestan University of Medical Sciences for their assistance and support.
Publisher Copyright:
© 2020, Public Health Services, US Dept of Health and Human Services. All rights reserved.
PY - 2020/6
Y1 - 2020/6
N2 - BACKGROUND: Three billion people burn nonclean fuels for household purposes. Limited evidence suggests a link between household fuel use and gastrointestinal (GI) cancers. OBJECTIVES: We investigated the relationship between indoor burning of biomass, kerosene, and natural gas with the subsequent risk of GI cancers. METHODS: During the period 2004–2008, a total of 50,045 Iranian individuals 40–75 years of age were recruited to this prospective population-based cohort. Upon enrollment, validated data were collected on demographics, lifestyle, and exposures, including detailed data on lifetime household use of different fuels and stoves. The participants were followed through August 2018 with <1% loss. RESULTS: During the follow-up, 962 participants developed GI cancers. In comparison with using predominantly gas in the recent 20-y period, using predominantly biomass was associated with higher risks of esophageal [hazard ratio (HR): 1.89; 95% confidence interval (CI): 1.02, 3.50], and gastric HR: 1.83; 95% CI: 1.01, 3.31) cancers, whereas using predominantly kerosene was associated with higher risk of esophageal cancer (HR: 1.84; 95% CI: 1.10, 3.10). Lifetime duration of biomass burning for both cooking and house heating (exclusive biomass usage) using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.14; 95% CI: 1.07, 1.21), esophageal (10-y HR: 1.19; 95% CI: 1.08, 1.30), gastric (10-y HR: 1.11; 95% CI: 1.00, 1.23), and colon (10-y HR: 1.26; 95% CI: 1.03, 1.54) cancers. The risks of GI cancers combined, esophageal cancer, and gastric cancer were lower when biomass was burned using chimney-equipped heating-stoves (strata difference p-values = 0:001, 0.003, and 0.094, respectively). Duration of exclusive kerosene burning using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.05; 95% CI: 1.00, 1.11), and esophageal cancer (10-y HR: 1.14; 95% CI: 1.04, 1.26). DISCUSSION: Household burning of biomass or kerosene, especially without a chimney, was associated with higher risk of some digestive cancers. Using chimney-equipped stoves and replacing these fuels with natural gas may be useful interventions to reduce the burden of GI cancers worldwide.
AB - BACKGROUND: Three billion people burn nonclean fuels for household purposes. Limited evidence suggests a link between household fuel use and gastrointestinal (GI) cancers. OBJECTIVES: We investigated the relationship between indoor burning of biomass, kerosene, and natural gas with the subsequent risk of GI cancers. METHODS: During the period 2004–2008, a total of 50,045 Iranian individuals 40–75 years of age were recruited to this prospective population-based cohort. Upon enrollment, validated data were collected on demographics, lifestyle, and exposures, including detailed data on lifetime household use of different fuels and stoves. The participants were followed through August 2018 with <1% loss. RESULTS: During the follow-up, 962 participants developed GI cancers. In comparison with using predominantly gas in the recent 20-y period, using predominantly biomass was associated with higher risks of esophageal [hazard ratio (HR): 1.89; 95% confidence interval (CI): 1.02, 3.50], and gastric HR: 1.83; 95% CI: 1.01, 3.31) cancers, whereas using predominantly kerosene was associated with higher risk of esophageal cancer (HR: 1.84; 95% CI: 1.10, 3.10). Lifetime duration of biomass burning for both cooking and house heating (exclusive biomass usage) using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.14; 95% CI: 1.07, 1.21), esophageal (10-y HR: 1.19; 95% CI: 1.08, 1.30), gastric (10-y HR: 1.11; 95% CI: 1.00, 1.23), and colon (10-y HR: 1.26; 95% CI: 1.03, 1.54) cancers. The risks of GI cancers combined, esophageal cancer, and gastric cancer were lower when biomass was burned using chimney-equipped heating-stoves (strata difference p-values = 0:001, 0.003, and 0.094, respectively). Duration of exclusive kerosene burning using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.05; 95% CI: 1.00, 1.11), and esophageal cancer (10-y HR: 1.14; 95% CI: 1.04, 1.26). DISCUSSION: Household burning of biomass or kerosene, especially without a chimney, was associated with higher risk of some digestive cancers. Using chimney-equipped stoves and replacing these fuels with natural gas may be useful interventions to reduce the burden of GI cancers worldwide.
UR - http://www.scopus.com/inward/record.url?scp=85087096143&partnerID=8YFLogxK
U2 - 10.1289/EHP5907
DO - 10.1289/EHP5907
M3 - Article
C2 - 32609005
AN - SCOPUS:85087096143
SN - 0091-6765
VL - 128
SP - 1
EP - 9
JO - Environmental Health Perspectives
JF - Environmental Health Perspectives
IS - 6
M1 - 067002
ER -