Ambient air pollution and primary liver cancer incidence in four European cohorts within the ESCAPE project (2017)

Marie Pedersen, Zorana J. Andersen, Massimo Stafoggia, Gudrun Weinmayr, Claudia Galassi, Mette Sorensen, Kirsten T. Eriksen, Anne Tjonneland, Steffen Loft, Andrea Jaensch, Gabriele Nagel, Hans Concin, Ming-Yi Tsai, Sara Grioni, Alessandro Marcon, Vittorio Krogh, Fulvio Ricceri, Carlotta Sacerdote, Andrea Ranzi, Ranjeet SokhiRoel Vermeulen, Kees de Hoogh, Meng Wang, Rob Beelen, Paolo Vineis, Bert Brunekreef, Gerard Hoek, Ole Raschou-Nielsen

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)


Background: Tobacco smoke exposure increases the risk of cancer in the liver, but little is known about the possible risk associated with exposure to ambient air pollution.
Objectives: We evaluated the association between residential exposure to air pollution and primary liver cancer incidence.
Methods: We obtained data from four cohorts with enrolment during 1985–2005 in Denmark, Austria and Italy. Exposure to nitrogen oxides (NO2 and NOX), particulate matter (PM) with diameter of less than 10 μm (PM10), less than 2.5 μm (PM2.5), between 2.5 and 10 μm (PM2.5–10) and PM2.5 absorbance (soot) at baseline home addresses were estimated using land-use regression models from the ESCAPE project. We also investigated traffic density on the nearest road. We used Cox proportional-hazards models with adjustment for potential confounders for cohort-specific analyses and random-effects meta-analyses to estimate summary hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Out of 174,770 included participants, 279 liver cancer cases were diagnosed during a mean follow-up of 17 years. In each cohort, HRs above one were observed for all exposures with exception of PM2.5 absorbance and
traffic density. In the meta-analysis, all exposures were associated with elevated HRs, but none of the associations reached statistical significance. The summary HR associated with a 10-μg/m3 increase in NO2 was 1.10 (95% confidence interval (CI): 0.93, 1.30) and 1.34 (95% CI: 0.76, 2.35) for a 5-μg/m3 increase in PM2.5.

Conclusions: The results provide suggestive evidence that ambient air pollution may increase the risk of liver cancer. Confidence intervals for associations with NO2 and NOX were narrower than for the other exposures.
Original languageEnglish
Pages (from-to)226-233
Number of pages8
JournalEnvironmental Research
Early online date17 Jan 2017
Publication statusPublished - 1 Apr 2017


  • ambient air pollution
  • liver cancer


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