Evidence From Humans
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Mortality and morbidity in a population exposed to multiple sources of air pollution: A retrospective cohort study using air dispersion models
Ancona, C., Badaloni, C., Mataloni, F., Bolignano, A., Bucci, S., Cesaroni, G., Sozzi, R., Davoli, M., Forastiere, F. Environ Res. 2015. 137, 467-74.
Topic area
Environmental pollutant - Air pollution
Study design
Retrospective cohort
Funding agency
ERAS Lazio Lazio Waste General Directorate
Study Participants
Number of Cases
155 (breast cancer mortality) 731 (breast cancer incidence)
Menopausal Status
The menopausal status of women included in this study is listed here.
No analysis based on menopausal status
Number in Cohort
Cohort: 44,181
Cohort participation rate
Not applicable. This study was records-based.
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
731 incident cases and 155 breast cancer deaths/44,181 women in the Rome Longitudinal Study (based on 2001 Census) who were living in study area -- a 7km radius from one of the largest landfills in Europe -- for at least 5 years before 2001 and did not move during follow-up through 2010. Mortality followed in regional Registry of Causes of Death while incidence was followed through hospital admissions data.
Exposure Investigated
Exposures investigated
Residence from 2001 Census linked to annual concentrations of H2S (marker for landfill emissions), SOX (marker of petrochemical refinery emissions), and PM10 (marker for incinerator emissions) estimated from emissions and dispersion model.
How exposure was measured
Environmental sample GIS/geographic location
Exposure assessment comment
Pollutant levels estimated at residence do not account for exposures at other locations (e.g. occupational).
Breast cancer outcome investigated
Primary incident breast cancer
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
Age, gender, region of birth, educational level, occupation, civil status, an area based socio-economic position (SEP) index, and a surrogate for long term exposure to air pollution were considered. Outdoor concentrations of NO2 were also taken into accou
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Strength of associations reported
Breast cancer incidence:
H2S, per 0.043 ug/m3 increase: aHR 1.04 (95% CI 0.93-1.15)
SOx, per 2.882 ug/m3 increase: aHR 1.13 (95% CI 0.89-1.43)
PM10, per 0.027 ng/m3 increase: aHR 1.13 (95% CI 1.00-1.27)

Breast cancer mortality:
H2S, per 0.043 ug/m3 increase: aHR 0.65 (95% CI 0.38-1.13)
SOx, per 2.882 ug/m3 increase: aHR 0.72 (95% CI 0.39-1.33)
PM10, per 0.027 ng/m3 increase: aHR 0.97 (95% CI 0.71-1.33)
Author address
Department of Epidemiology, Lazio Regional Health Service, Via Santa Costanza 53, 00198 Rome, Italy. Electronic address: c.ancona@deplazio.it. Department of Epidemiology, Lazio Regional Health Service, Via Santa Costanza 53, 00198 Rome, Italy. Lazio Envir
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