Journal of Environment Pollution and Human Health
ISSN (Print): 2334-3397 ISSN (Online): 2334-3494 Website: Editor-in-chief: Dibyendu Banerjee
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Journal of Environment Pollution and Human Health. 2016, 4(3), 66-71
DOI: 10.12691/jephh-4-3-2
Open AccessReview Article

The Effect of Air Pollution on Cancer in the Eastern Mediterranean Region: A Systematic Literature Review

Yousef S Khader1, , Nour Abdo1, Mostafa Abdelrahman2, Munjed Al-Sharif3, Ahmad M. Bateiha4 and Mazen Malkawi5

1Department of Public Health/ Faculty of Medicine, Jordan University of Science and Technology

2Faculty of Applied Medical Sciences, Jordan University of Science and Technology, P.O.Box 3030, Irbid 22110, Jordan

3Water and Environmental Engineering Department, German-Jordanian University

4Department of Applied Biological Sciences, Jordan University of Science and Technology

5Centre for Environmental Health Activities, Regional Office for the Eastern Mediterranean, WHO, Genève, Schweizer

Pub. Date: September 24, 2016

Cite this paper:
Yousef S Khader, Nour Abdo, Mostafa Abdelrahman, Munjed Al-Sharif, Ahmad M. Bateiha and Mazen Malkawi. The Effect of Air Pollution on Cancer in the Eastern Mediterranean Region: A Systematic Literature Review. Journal of Environment Pollution and Human Health. 2016; 4(3):66-71. doi: 10.12691/jephh-4-3-2


This study was conducted to assess the risk of cancer associated with air pollution in Eastern Mediterranean Region (EMR) by summarizing the existing knowledge from previous studies in the region and to identify knowledge and research gaps to support further research efforts. Combinations of search terms from three categories (“country” keywords AND ‘air pollution” keywords AND “cancer” keywords) were used to search for the relevant literature published between January 2000 and June 2016 using MEDLINE and other databases. Six case-control studies and three studies of other designs had assessed the association between air pollution and cancer in the EMR and met the inclusion criteria. These studies have assessed the effect of various indoor and outdoor air pollutants on the risk of different types of cancer. In this review, cancers were classified into: lung cancer; nasopharyngeal cancer; urinary bladder cancer; overall incidence of cancer in adults; and childhood cancer incidence. Limited epidemiological studies were found in the literature that properly address cancer incidence and air pollution in the EMR countries. Outdoor air pollution was not properly addressed in the included studies. Studies showed that using fuel for heating and living near an electricity generator and diesel exhaust exposure were significant contributors to lung cancer. NO2 has been shown to increase the risk of lung and breast cancer incidence. PAHs exposure did not increase the risk of cancer incidence. In conclusion, studies on the link between air pollution and cancer in EMR are limited to few studies in few countries. The reviewed studies have many limitations that make the evidence about the link between air pollution and cancer weak.

air pollution cancer eastern mediterranean region systematic review mortality

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[1]  Jacob DJ, Winner DA. Effect of climate change on air quality. Atmos Environ 43: 51-63, 2009.
[2]  Samet J, Cohen. A. In: Cancer Epidemiology and Prevention (1).
[3]  Schottenfeld D, Fraumeni JF, eds). 3rd ed. New York:Oxford University Press, 355-376; 2006.
[4]  IARC (International Agency for Research on Cancer). Outdoor Air Pollution. IARC Monogr Eval Carcinog Risks Hum 109.
[5]  Loomis D, Grosse Y, Lauby-Secretan B, El Ghissassi F, Bouvard V, Benbrahim-Tallaa L, Guha N, Baan R, Mattock H, Straif K; International Agency for Research on Cancer Monograph Working Group IARC. The carcinogenicity of outdoor air pollution. Lancet Oncol. 2013;14(13):1262-3.
[6]  Grant WB. Air pollution in relation to U.S. cancer mortality rates: an ecological study; likely role of carbonaceous aerosols and polycyclic aromatic hydrocarbons. Anticancer Res. 2009; 29: 3537-3545.
[7]  Crouse DL, Goldberg MS, Ross NA, et al. Postmenopausal breast cancer is associated with exposure to traffic-related air pollution in Montreal, Canada: a case-control study. Environ Health Perspect. 2010; 118: 1578-1583.
[8]  Castano-Vinyals G, Cantor KP, Malats N, et al. Air pollution and risk of urinary bladder cancer in a case-control study in Spain. Occup Environ Med. 2008; 65: 56-60.
[9]  Chen G, Wan X, Yang G, Zou X. Traffic-related air pollution and lung cancer: A meta-analysis. Thorac Cancer. 2015;6(3):307-18
[10]  Filippini T, Heck JE, Malagoli C, Del Giovane C, Vinceti M. A review and meta-analysis of outdoor air pollution and risk of childhood leukemia. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2015;33(1): 36-66.
[11]  Josyula S, Lin J, Xue X, Rothman N, Lan Q, Rohan TE, Hosgood HD 3rd. Household air pollution and cancers other than lung: a meta-analysis. Environ Health. 2015; 14: 24 .
[12]  Brauer M, Amann M, Burnett RT, et al. Exposure assessment for estimation of the global burden of disease attributable to outdoor air pollution. Environ Sci Technol. 2012; 46: 652-660.
[13]  Gharehchahi E, Mahvi AH, Amini H, Nabizadeh R, Akhlaghi AA, Shamsipour M, et al. Health impact assessment of air pollution in Shiraz, Iran: a two-part study. J Environ Health Sci Eng. 2013; 11: 1-8
[14]  U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
[15]  Edraki M, Rambod M. Parental smoking and risk of childhood cancer: hospital-based case-control study in Shiraz. East Mediterr Health J. 2011; 17(4):303-8.
[16]  Sasco AJ, Merrill RM, Dari I, Benhaïm-Luzon V, Carriot F, Cann CI, Bartal M. A case-control study of lung cancer in Casablanca, Morocco. Cancer Causes Control. 2002;13(7):609-16.
[17]  Aoun J, Saleh N, Waked M, Salamé J, Salameh P. Lung cancer correlates in Lebanese adults: a pilot case-control study. J Epidemiol Glob Health. 2013;3(4):235-44.
[18]  Luqman M, Javed MM, Daud S, Raheem N, Ahmad J, Khan AU. Risk factors for lung cancer in the Pakistani population. Asian Pac J Cancer Prev. 2014;15(7):3035-9.
[19]  Feng BJ, Khyatti M, Ben-Ayoub W, Dahmoul S, Ayad M, Maachi F, Bedadra W, Abdoun M, Mesli S, Bakkali H, Jalbout M, Hamdi-Cherif M, Boualga K, Bouaouina N, Chouchane L, Benider A, Ben-Ayed F, Goldgar DE, Corbex M. Cannabis, tobacco and domestic fumes intake are associated with nasopharyngeal carcinoma in North Africa. Br J Cancer. 2009;101(7):1207-12.
[20]  Zheng YL, Amr S, Saleh DA, Dash C, Ezzat S, Mikhail NN, Gouda I, Loay I, Hifnawy T, Abdel-Hamid M, Khaled H, Wolpert B, Abdel-Aziz MA, Loffredo CA. Urinary bladder cancer risk factors in Egypt: a multicenter case-control study. Cancer Epidemiol Biomarkers Prev. 2012;21(3):537-46.
[21]  Al-Ahmadi K, Al-Zahrani A. NO(2) and cancer incidence in Saudi Arabia. Int J Environ Health Res. 2013;10(11):5844-62.
[22]  Wheatley A, Sadhra S. Carcinogenic risk assessment for emissions from clinical waste incineration and road traffic. Int J Environ Health Res. 2010;20(5):313-27.
[23]  Kamal A, Malik RN, Martellini T, Cincinelli A. Exposure to dust-bound PAHs and associated carcinogenic risk in primitive and traditional cooking practices in Pakistan. Environ Sci Pollut Res Int. 2015;22(16):12644-54.
[24]  Edraki M, Rambod M. Parental smoking and risk of childhood cancer: hospital-based case-control study in Shiraz. East Mediterr Health J. 2011;17(4):303-8.
[25]  World Health Organization. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008.
[26]  Jemal A, Bray F, et al. Global cancer statistics. CA Cancer J Clin 2011;61:69-90. 24.
[27]  Cohen AJ, Pope III CA. Lung cancer and air pollution. Environ Health Perspect 1995;103(Suppl.):219-24.
[28]  Taylor R, Cumming R, et al. Passive smoking and lung cancer: a cumulative meta-analysis. Aust N Z J Pub Health 2001;25:203-11.
[29]  Kurmi OP, Lam KB, Ayres JG. Indoor air pollution and the lung in low and medium income countries. Eur Respir J. 2012; 40(1): 239-54.
[30]  Lissowska J, Bardin-Mikolajczak A, et al. Lung cancer and indoor pollution from heating and cooking with solid fuels: the IARC international multicentre case–control study in Eastern/Central Europe and the United Kingdom. Am J Epidemiol 2005; 162: 326-3328, 29.
[31]  Mattioli S, Farioli A, Legittimo P, Miligi L, Benvenuti A, Ranucci A, Salvan A, Rondelli R, Magnani C; SETIL Study Group. Tobacco smoke and risk of childhood acute non-lymphocytic leukemia: findings from the SETIL study. PLoS One. 2014; 9(11): e111028.
[32]  Boffetta P, Trédaniel J, Greco A. Risk of childhood cancer and adult lung cancer after childhood exposure to passive smoke: A meta-analysis. Environmental Health Perspectives, 2000, 108: 73-82.