Environmental and Biological Monitoring Pilot Study for Polycyclic Aromatic Hydrocarbons in Linxian, China
Condition: Esophageal Cancer
MeSH terms: Esophageal Neoplasms
Study type: Observational

Summary: 
      The overall goal of this project is to determine whether polycyclic aromatic hydrocarbons
      (PAHs) are contributing to the high rate of esophageal cancer in Linxian, China.

      Esophageal cancer is one of the most fatal cancers worldwide with Linxian, China having one
      of the highest rates in the world. In the United States esophageal cancer causes
      approximately 10,000 deaths each year. It is the fourth most common cause of cancer death in
      black males and the eighth leading cause of cancer death in men of all races. Although
      several recent studies have identified some of the molecular changes associated with
      esophageal cancer, its prevention and treatment within high risk groups continues to be
      limited by our inability to identify specific etiologic agents.

      Human exposure to PAHs, including benzo [a]pyrene (B[a]P), is associated with an increased
      rate of skin, lung, and upper GI tumors and also with an increased mortality from causes
      related to atherosclerosis. Evidence, including the preliminary results from histologic and
      food analysis pilot studies, supports the idea that this region's high rate of esophageal
      cancer may be related to long-term, high-level exposure to PAHs via inhalation of air-borne
      pollution and ingestion of food cooked with soft coal.

      Thus, to assess the association of PAHs with the high rate of esophageal cancer in Linxian,
      China, we plan to analyze samples of food for the presence of PAHs, samples of blood for Hb
      adducts (a marker of long-term PAH exposure), samples of urine for 1-OH-Pyrene glucuronide (a
      maker of short-term PAH exposure), and samples of coal for characteristics that may be
      associated with increased carcinogenesis. We will also administer environmental
      questionnaires that will include questions about the type of fuel used for cooking and
      heating, the location and type of stove and/or heating unit (i.e., vented versus unvented),
      and time spent cooking.
    

Detailed description: 
      The overall goal of this project is to determine whether polycyclic aromatic hydrocarbons (P
      AHs) or acetaldehyde are contributing to the high rate of esophageal cancer in Linxian,
      China.

      Esophageal cancer is one of the most fatal cancers worldwide and Linxian, China has some of
      the highest rates of this cancer in the world. In the United States esophageal cancer causes
      approximately 14,000 deaths each year. It is the fourth most common cause of cancer death in
      black males and the eighth leading cause of cancer death in men of all races. The prevention
      and treatment of esophageal cancer within high risk groups continues to be limited by our
      inability to identify specific etiologic agents.

      Human exposure to PAHs, including benzo[a]pyrene (B [a]P) is associated with increased rates
      of skin, lung, esophageal and gastric tumors and also with an increased mortality from causes
      related to atherosclerosis. Preliminary results from histologic and food analysis pilot
      studies supports the possibility that the high rates of esophageal cancer in Linxian may be
      related to long-term, high level exposure to PAHs via inhalation of air-borne pollution and
      ingestion of food cooked with soft coal.

      Exposure to acetaldehyde could also be an etiologically significant exposure in Linxian.
      Acetaldehyde is a carcinogenic metabolite, and small quantities of ethanol where recently
      found in homogenized Linxian food samples. The Salaspuro laboratory at the University of
      Helsinki has demonstrated that oral bacteria can produce acetaldehyde from food containing
      similar small concentrations of ethanol, so such acetaldehyde exposure could be etiologically
      significant in Linxian. Genetic polymorphisms, particularly those involving alcohol and
      acetaldehyde dehydrogenases, may also influence the effect of this exposure.

      To assess the association of PAHs and acetaldehyde with the high rate of esophageal cancer in
      Linxian, China, we plant o analyze samples of food for the presence of PAHs, ethanol and
      acetaldehyde, samples of blood for Hb and DNA adducts( markers of long-term PAH or
      acetaldehyde exposure), samples of urine for 1-OH-Pyrene glucuronide (a marker of short term
      PAH exposure) samples of saliva for acetaldehyde and samples of coal for characteristics that
      may be associated with increased carcinogenesis. We will also administer environmental
      questionnaires that will include questions about the type of fuel used for cooking and
      heating, the location and types of stove and/or heating units, and the time spent cooking.
    

Observational model: Ecologic or Community
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Two of the oldest individuals (a male and a female greater than 18 years of age) from each
        of 10-15 nonsmoking households from the high-risk region of Linxian, China and, to the
        extent that is possible, from appropriately age matched controls from a total of 20
        nonsmoking individuals from the low-risk region of Gejiu, Yunnan province will be selected
        to participate.
      
Keywords: Esophageal Cancer; Polycyclic Aromatic Hydrocarbons