Risk of gastric cancer in the environs of industrial facilities in the MCC-Spain study☆
Graphical abstract
Introduction
Gastric cancer is the fourth leading cause of cancer death and the fifth most frequent cancer worldwide, with 1.09 million new cases in both sexes in 2020 (International Agency for Research on Cancer, 2020). In Spain, 6981 new cases of gastric cancer were estimated in the same year (2.5% of all malignant tumors) (International Agency for Research on Cancer, 2020). Gastric cancer incidence has been decreasing during the last decades in Spain (Galceran et al., 2017); however, survival rates are still among the lowest of all cancer sites, with an estimated age-standardized 5-year net survival for the period 2010–2014 of 27.6% (Allemani et al., 2018). Moreover, this tumor presents a marked geographic variability in its incidence, both worldwide and among Spanish regions (Galceran et al., 2017).
With respect to the etiology of gastric cancer, the strongest risk factor for the most frequent type (the non-cardia gastric cancer) is the infection with the bacterium Helicobacter pylori (De Martel and Parsonnet, 2018; Fernández de Larrea-Baz et al., 2017). Apart from genetic predisposition, other suggested or alleged risk factors include the Epstein-Barr virus, smoking, alcohol consumption, consumption of salt-preserved foods, low fruit and vegetable intake, obesity, and ionizing radiation (Aragonés et al., 2019; De Martel and Parsonnet, 2018; Poorolajal et al., 2020; Rawla and Barsouk, 2019; WCRF/AICR, 2018), although they account for up to 3/4 of all cases (Charafeddine et al., 2017; Ko et al., 2018; Parkin et al., 2011; Poirier et al., 2019). Therefore, epidemiologic research focused on other potential risk factors, especially environmental causes, seems to be advisable.
With regard to environmental exposures, some authors have found associations between exposure to certain endocrine disrupting chemicals (EDCs), such as organophosphate esters (Li et al., 2020) or phthalate plasticizers (Wong et al., 2019), and gastrointestinal cancers. On the other hand, recent studies have suggested associations between air pollution and risk of gastric cancer, both incidence and mortality, due to particulate matter (PM), such as PM2.5 and PM10 (Ethan et al., 2020; Guo et al., 2020; Nagel et al., 2018; Weinmayr et al., 2018; Yin et al., 2020). PM is released by industrial installations, which also emit numerous potential carcinogens suspected of being related to gastric cancer, such as some heavy metals (e.g.: arsenic and lead) and polycyclic aromatic hydrocarbons (PAHs) (Deng et al., 2019; Liao et al., 2014; Núñez et al., 2016; Zhao et al., 2014). A recent systematic review of ecological studies revealed positive associations between proximity to certain industrial facilities and stomach cancer mortality and incidence (Khazaei et al., 2020). Moreover, industrial facilities generate hazardous waste, including metalworking fluids and materials containing asbestos, which have also been associated with gastric cancer risk (Di Ciaula, 2017; Park, 2001; Peng et al., 2015; Zhao et al., 2005). Accordingly, it is necessary to carry out epidemiological studies to ascertain whether residing close to industrial pollution sources might increase the incidence of gastric cancer.
The aim of the present paper was to assess the possible association between gastric cancer risk (by histological type and tumor site) and residential proximity to industrial installations, according to categories of industrial groups and specific pollutants released by the plants, in the context of a population-based multicase-control study of common tumors in Spain (MCC-Spain). Our study presents the novelty of being able to analyze the risk of gastric cancer associated with the proximity to industrial pollution sources using individual data, an area of research that has been deserted for many years in relation to gastric cancer. The results of the paper will allow to identify the existence, or not, of potential industrial sectors and specific pollutants possibly related to an increased risk of gastric cancer.
Section snippets
Study population and data collection
The design of the MCC-Spain study and the overall methodology carried out to analyze the proposed objectives have been previously described (Castaño-Vinyals et al., 2015; García-Pérez et al., 2018). In brief, among the five types of tumors (breast, colorectal, leukemias, prostate, and gastric) included in the MCC-Spain study, a total of 459 histologically confirmed incident gastric cancer cases (codes C15.5, C16, and D00.2, according to the International Classification of Diseases-10th),
Characteristics of the study population
The final study population (participants with no missing values in any of the potential confounders) comprised 2664 controls and 137 cases, whose main characteristics are listed in Table 1. In general, controls were slightly younger and had a higher educational level than cases.
Results of the analysis 1
ORs of gastric cancer, by histological type and tumor site, in the environs of industrial facilities as a whole are included in Table 2 (analysis with all of the individuals). No excess risk was observed for any of the
Discussion
To the best of our knowledge, this paper represents the first attempt to analyze the risk of gastric cancer, by histological type and tumor site, in the proximity of industrial facilities in Spain using individual data. Our results suggest no association between risk of this tumor and proximity to the industries as a whole. However, some specific statistically significant associations, especially with non-cardia tumors, have been found with proximity to industries belonging to the chemical
Conclusions
Our results suggest no association between the risk of gastric cancer and living in the proximity to the industrial facilities as a whole. However, some associations, especially with non-cardia tumors, have been found with proximity to a few industrial sectors (chemical, food/beverage, and surface treatment using organic solvents) and plants releasing specific pollutants (nonylphenol, phenols, and antimony). Further studies in the environs of industrial facilities are recommended to improve our
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
The authors thank all those who took part in this study by providing questionnaire data. This study was funded by: Scientific Foundation of the Spanish Association Against Cancer (Fundación Científica de la Asociación Española Contra el Cáncer (AECC) – grants EVP-1178/14 and GCTRA18022MORE); “Acción Transversal del Cáncer”, approved on the Spanish Ministry Council on October 11, 2007; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP); Spain’s Health Research Fund (
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This paper has been recommended for acceptance by Payam Dadvand.