The Relationship Between Indoor Air Pollution And Lung Cancer

Introduction

Lung-cancer still continues to lead in terms cancer-related mortality. Globally, out of the total cancer-related deaths, 17% are as a result of lung cancer. For the longest time, cigarette smoke has been the main culprit and seen by experts as a principal risk factor that is responsible for causing lung cancer among male subjects. Recently, a new group of lung cancer patients has come into being. These are the “never-smokers” who only constitute a minute proportion of Individuals who are suffering from lung cancer. During the formative years of research that had the sole intention of explaining why never-smokers would get lung cancer, reports were initially of the opinion that receptor-tyrosine kinase inhibitors would increase a non-smoker’s epidermal growth factor thus causing lung cancer (Houlihan and Tyson, 2012). Conclusive research has led to the identification of individual molecular changes that are unique and specific to the type of lung cancer affliction among never-smokers, generating further interest in the inner workings of this disease. Such findings have the potential of enhancing the specialist’s knowledge of the biology of lung cancer and at the same time lead to various developments on effective treatment methods for never-smokers with lung cancer.

Studies on cancer patients and the causative agents of cancer demonstrate that 53% of cancer patients of the female gender in five continents did not get cancer as a result of smoking. Epidemiological studies suggest that the morbidity of lung cancer among women who were never smokers was in actual sense significantly higher about that of male subjects. Prominent clinical, pathological and epidemiological differences that experts find among the assortment of lung cancers have been brought to light, especially among heavy smokers and lifetime never smokers. The rise in lung cancer among never smokers of the female gender is said to be as a result of indoor housing characteristics, indoor air pollution, exposure to passive smoke at home, exposure to fumes from cooking oil. (Leary, 2012, p. 78) Additionally, after numerous studies on practical ways to lower the chances of developing cancer, the daily intake of vegetables and fruits has been said to lower the risk of developing certain cancers (mostly those that affect the digestive tract). It is, however, important to note that that the risks and the complex epidemiological nature of lung cancer affecting non-smokers have not been well understood by many. The purpose of this essay is to bring to light and elaborate on how cooking smoke has can significantly increase the chances of individuals developing lung cancer.

Indoor Air Pollution as a Causative Agent

Oncologists have made it their life’s work to inform the general public about the relationship that exists between exposure to various environmental risks and the nascent development of chronic lung cancer among non-smokers. An individuals’ susceptibility to succumbing to lung cancer often differs while in the same environment mainly due to one’s genetic susceptibility. In scientific terms, the microRNA is particularly important as it plays a vital role in a majority of biological processes which may include apoptosis, differentiation, proliferation and the quick progression of a host of diseases (which also include cancer). Of particular concern is the exposure of the lungs to carcinogenic polycyclic aromatic hydrocarbons. These are harmful compounds that are mainly found in fumes that emanate from cooking oil and are responsible for oxidative DNA damage together with lipid peroxidation (Bardana & Montanaro, 2012, p. 16). Fumes from cooking oil are also responsible for an increase in the oxidative and endoplasmic reticulum strain that leads to apoptosis and cytotoxicity in the alveolar epithelial cells (AEC). A wide range of studies on this subject demonstrates that carcinogens and mutagens have their origin in fumes from heating cooking oils. Biological experiments on the adenocarcinoma cells in the human lung have had results that indicate the presence of various compounds that are mutagenic in nature, courtesy of oil fumes and which lead to the oxidative damage of lung cells and the lungs the DNA.

Indoor air pollution is quickly becoming a serious public health debacle in both developing and the developing countries. Combustion by-products that are cooking oils release during cooking and heating are among the main sources of this indoor air pollution crisis. The difference in cooking and heating technologies often implies that there will be different levels and types of indoor pollution. Coal and wood stoves are among some of the “dirtiest” types of cooking and heating systems, especially if they are near living areas. In the run up to the second half of the 20th Century, coal and wood were the main sources of fuel for the presently dominant developed countries such as France, the United Kingdom and the United States of America (U.S.A). Presently, there are areas around the globe that still find the use of coal and wood useful as there is no other reliable source of fuel. In modern times, these fuels lost their dominance in developed countries, but at the same time, their usage has seen a steady increase in the past decades as a supplementary system for cooking and heating. The combustion of these particular fuels has been known to emit a plethora of pollutants. Experts in oncology have often had speculations that some of the pollutants that come about as a result of combustion are carcinogenic.

It is true that in many developing countries, the cooking facilities that are present in homes consist mostly of fireplaces that are of the open-hearth fashion. These fireplaces are typically left smoking for a substantial amount of time and end up producing a considerable level of indoor pollution. Women in Asia living in households that use such facilities four cooking and heating are at a higher risk of developing lung cancer. An epidemiological investigation on non-smoking Chinese women seems to indicate that a certain degree of exposure to fumes from cooking oil might in a way increase their risk of lung cancer (Wild, Stewart, Danmark, & World Health Organization, 2014, p. 34). Exposure to fumes from cooking oil has been a major cause of lung cancer especially when a fume ventilator or extractor is missing. Recent studies into home appliances have shown that the improvement of the household stove significantly reduces the risk of developing lung cancer in the People’s Republic of China (Kaminsky, Netter, & Machado, 2011, p. 45). The style of cooking that the Chinese use has also been thought to be a culprit in the increase of developing lung cancer among women who are non-smokers.

Concern over the use of polluting cooking and heating sources has also been on the rise in developed countries as it could pose a threat to the health of individuals and at the same time be responsible for an increase in cases of lung cancer. Architects in North America are increasingly building homes that are airtight in an attempt to reduce the rates of ventilation. Additionally, most North Americans are known to spend a huge chunk of their time in their houses. While it is a good thing to spend time in your home, there is little information about the risk of developing cancer from living in an environment that has fumes emanating from traditional forms of fuel in these developed countries. Let us take the example of Montreal, Canada. It commonly has a period of cold climate that usually lasts for roughly six months every year. During this cold spell, most inhabitants of this Canadian city require home heating. Traditional sources of cooking and heating had been previously largely put to use since the start of the 1950s, but electricity soon became the primary source for cooking and heating in nearly half of all the households in this region. Other forms of energy that have been useful to these people are oil and natural gas.

A blowback that was as a result of the use of the use of traditional forms of fuel for cooking and heating was individuals with an experience from a young age (mostly those who were brought up in rural settings) are presently in the age range that is at risk of being the victims of lung cancer. In modern times, the resurgence of carcinogenic fuels such as wood for the purpose of heating and gas for cooking has been on the rise, prompting experts to determine whether exposure to fumes from these fuel sources would lead an increase in cancer risks (Mahjub H & Sadri GH, 2012, p. 12). Experts in oncology had a golden opportunity to address this pertinent issue by conducting a case-control study in Montreal. The subjects that were to provide information to the interviewers gave their accounts between the year1996 to 2001. The study had a primary goal of proving whether it was occupational exposures had a possible role in cancer etiology. Data collection mainly had as its epicenter the subject’s level of exposure to traditional cooking and heating sources together with a host of other environmental, socio-demographical, occupational, and medical characteristics.

Materials and Methods Used In the Montreal Study

The study took place in the city of Montreal, Canada, and its immediate surrounding suburbs. The area had a population of about 3.1 million residents in the year 1996. It would include both male and females between the ages of 35-75 years who were all legitimate Canadian citizens that were residing in those environs.

 Case Ascertainment

The ascertainment of all the cases in the study took place in the eighteen of largest hospitals in and around the metropolitan area. The hospitals in that area had records of over 98% of lung cancer cases whose diagnosis was complete. The hospitals had comprehensive tumor registries, and through active monitoring of the records in the pathology department, the ascertaining of cases became an easy task. In the list were historically proven cases whose diagnosis had taken place between the year 1996 and December 1997. Only a total of 1,434 cases were eligible. Fruitful attempts were made to conduct personal interviews on the subject and in cases where the subject was deceased; they’re next of kin was then responsible for providing the much-needed information. A total of 1,205 cases came under review which represents an 84% response rate among the respondents. Regarding averages, the interval that exists between the interview and the diagnosis of lung cancer happens to be one year. It is, however, important to note that the proxies were similar to those self-respondents regarding socio-economic status, schooling, and ethnicity.

Control Selection

The controls, in this case, were as a result of random sampling using a population-based form of an electoral list that was in various stratifications (age and the sex to case distribution). The compilation of the Canadian electoral list is as result of an active door-to-door enumeration process that offers a listing of citizens that is virtually complete. Out of the eligible control subjects (2,182), there was a 71%response rate (1,541). Proxy interviews were also put in place (7.8%) that would occur if an interviewee happens to be unavailable owing to travel, illness or communication difficulties.

Data Collected

After obtaining consent, the interviews took place. They were under the coordination of bilingual (French and English) interviewers who would then use structured questionnaires. The collection of information included residential history, socio-demographic characteristics, housing characteristic, smoking history, medical history, dietary intake, occupational history and their domestic exposure to traditional cooking and heating sources. Industrial hygienists did not miss in the study due to their exposure to over three hundred occupational chemicals.

Questions regarding heating and fuel sources include; whether the subject was in a house that uses traditional sources of fuel and if they were living at any given time permanently in house using traditional sources of cooking. These two questions happened to be in the form of stratification to two windows of time (to the age of 20years and additionally after attaining 20years of age). The coding of lung cancers histology is per the World Health Organization and the International Agency in charge of Research on Cancer (technical report 31(11)). The collection of smoking history from this study was standard in comparison to many of the modern case-studies.

Statistical Analysis

Simple descriptive statistics were responsible for characterizing the population under scrutiny.  The association that exists between the traditional cooking and heating sources and development of lung cancer was also under assessment. There was also the use of an unconditional multivariate form of logistic regression representations to estimate the odds ratio and at a ninety-five percent confidence interval. As potential confounders, the following variables came into play; sex, age, sum of school attendance years,  environmental tobacco smoke, smoking history a mean of the families income and whether the interview was on the ill individual or a surrogate

Putting the Montreal Case-Study into Perspective

There had been growing concerns about the by-products that come about as a result of heating and cooking regarding the amount of indoor pollution they were capable of causing. Canada presently relies on gas, oil, and electricity for purposes of heating and heating but traditional sources of energy had been put to use for a very long time. 739 male cases, 466 female cases, 925 male controls and 616 female controls were to complete questionnaires that the researchers would provide. The computing of odds ratio was put to use about the few indices of subject exposure to traditional cooking and heating sources. Making adjustments for a couple of covariates which would include smoking. Among the men in the case-study, there was a minimal indication of any excess risks. When it came to the women, the odds ratio for individuals who had been under the exposure of traditional cooking and heating fuel was around 2.5; which meant that it was at a 95% confidence interval mark). Findings for all the women who took part in this study suggests the dire need for intensive research in exploring the association that exists between an increase in cases of lung cancer and exposure to fumes resulting from indoor pollution.

Conclusion

Cigarette smoking has for a long time been thought to be the only factor that was responsible for lung cancer. Conversely, the epidemiological trait of lung cancer among non-smokers remains a complex matter to broach. A host of factors, mainly genetic and environmental, which also include occupational exposure are said to increase incidences of lung cancer. The particulate matter found indoors, and indoor poisonous emissions can directly accelerate the rate at which lung cancer afflicts individuals. The exposure to fumes that are as a result of cooking oil thus increase the risk of nonsmokers developing lung cancer.

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