Household fuel use and the risk of gastrointestinal cancers: The golestan cohort study

Mahdi Sheikh, Hossein Poustchi, Akram Pourshams, Masoud Khoshnia, Abdolsamad Gharavi, Mahdi Zahedi, Gholamreza Roshandel, Sadaf G. Sepanlou, Abdolreza Fazel, Maryam Hashemian, Behrooz Abaei, Masoud Sotoudeh, Arash Nikmanesh, Shahin Merat, Arash Etemadi, Siavosh Nasseri Moghaddam, Farhad Islami, Farin Kamangar, Paul D. Pharoah, Sanford M. DawseyChristian C. Abnet, Paolo Boffetta, Paul Brennan, Reza Malekzadeh

    Research output: Contribution to journalArticlepeer-review

    21 Scopus citations

    Abstract

    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.

    Original languageEnglish
    Article number067002
    Pages (from-to)1-9
    Number of pages9
    JournalEnvironmental Health Perspectives
    Volume128
    Issue number6
    DOIs
    StatePublished - Jun 2020

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