Indoor wood combustion, carcinogenic exposure and esophageal cancer in southwest Kenya
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Exposure to polycyclic aromatic hydrocarbons (PAHs) is a risk factor for esophageal squamous cell carcinoma (ESCC) in high-incidence areas of China, Iran and Brazil, but PAH assessments have not been conducted in East Africa, another ESCC hot spot.
Objective
To evaluate demographic or lifestyle factors associated with the PAH biomarker concentrations in the study population, and whether PAH metabolite concentrations showed any associations with esophageal precancerous lesions.
Methods
We recruited a community-based sample of 289 asymptomatic adults from a rural area of Kenya and performed Lugol’s chromoendoscopy to detect esophageal squamous dysplasia (ESD); participants completed a questionnaire and provided a spot urine specimen. We analyzed urine for seven hydroxylated metabolites of naphthalene, fluorene, phenanthrene, and pyrene at the U.S. National Center for Environmental Health, and compared creatinine-corrected PAH metabolite concentrations with questionnaire data and the presence of ESD.
Results
PAH metabolite concentrations among never tobacco users in these rural Kenya residents were 2.4–28.1 times higher than those reported from never tobacco users in Iran, Brazil and the USA. Female sex, cooking indoors, having no post-primary education, and age <50, but not tobacco use, were positively and significantly associated with PAH metabolite concentrations. Almost all participants used wood as cooking fuel. Nine participants had advanced ESD. Adjusted logistic regression showed a significant association between 2-hydroxynaphthalene (OR = 4.19, 95%CI: 1.01–17.47) and advanced ESD. All other PAH metabolites had positive but non-significant associations with advanced ESD.
Conclusions
Urinary PAH metabolite concentrations among never tobacco users are markedly higher in this group from Kenya than in other populations and are associated with indoor cooking with wood on open, unvented stoves. These metabolite concentrations were also associated with the presence of advanced esophageal dysplasia. Our findings underline the importance of assessing alternative cooking conditions to reduce PAH exposure in this population.
Exposure to polycyclic aromatic hydrocarbons (PAHs) is a risk factor for esophageal squamous cell carcinoma (ESCC) in high-incidence areas of China, Iran and Brazil, but PAH assessments have not been conducted in East Africa, another ESCC hot spot.
Objective
To evaluate demographic or lifestyle factors associated with the PAH biomarker concentrations in the study population, and whether PAH metabolite concentrations showed any associations with esophageal precancerous lesions.
Methods
We recruited a community-based sample of 289 asymptomatic adults from a rural area of Kenya and performed Lugol’s chromoendoscopy to detect esophageal squamous dysplasia (ESD); participants completed a questionnaire and provided a spot urine specimen. We analyzed urine for seven hydroxylated metabolites of naphthalene, fluorene, phenanthrene, and pyrene at the U.S. National Center for Environmental Health, and compared creatinine-corrected PAH metabolite concentrations with questionnaire data and the presence of ESD.
Results
PAH metabolite concentrations among never tobacco users in these rural Kenya residents were 2.4–28.1 times higher than those reported from never tobacco users in Iran, Brazil and the USA. Female sex, cooking indoors, having no post-primary education, and age <50, but not tobacco use, were positively and significantly associated with PAH metabolite concentrations. Almost all participants used wood as cooking fuel. Nine participants had advanced ESD. Adjusted logistic regression showed a significant association between 2-hydroxynaphthalene (OR = 4.19, 95%CI: 1.01–17.47) and advanced ESD. All other PAH metabolites had positive but non-significant associations with advanced ESD.
Conclusions
Urinary PAH metabolite concentrations among never tobacco users are markedly higher in this group from Kenya than in other populations and are associated with indoor cooking with wood on open, unvented stoves. These metabolite concentrations were also associated with the presence of advanced esophageal dysplasia. Our findings underline the importance of assessing alternative cooking conditions to reduce PAH exposure in this population.
Date Issued
2021-07-01
Date Acceptance
2021-02-23
Citation
Environment International, 2021, 152
ISSN
0160-4120
Publisher
Elsevier
Journal / Book Title
Environment International
Volume
152
Copyright Statement
© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33689906
PII: S0160-4120(21)00110-0
Subjects
DYSPLASIA
EMISSION FACTORS
Environmental Sciences
Environmental Sciences & Ecology
Esophageal neoplasms
FUEL
HIGH-RISK
Kenya
Life Sciences & Biomedicine
LINXIAN
METABOLITES
Polycyclic aromatic hydrocarbons
POLYCYCLIC AROMATIC-HYDROCARBONS
Science & Technology
SQUAMOUS-CELL CARCINOMA
URINE
Publication Status
Published
Coverage Spatial
Netherlands
Article Number
106485
Date Publish Online
2021-03-06