BMJ：中国宣威县家庭使用烟煤与患上肺癌的风险相关联

根据在中国云南省宣威县开展的一项研究，用于家庭烧饭做菜和加热取暖的烟煤(smoky coal)与一生当中患上肺癌的风险显著性增加相关联。这代表着对任何人群患上癌症的风险而言，环境污染是最为强烈的影响之一。它也强调了采取行动降低人们暴露在最为危险类型的燃料之中的重要性。相关研究结果发表在British Medical Journal website期刊上。

暴露在某些类型的固体燃料烟雾之中与几种疾病相关联，包括慢性阻塞性肺疾病(chronic obstructive pulmonary disease)、急性呼吸道感染和肺癌。

然而，人们对烟煤的使用与肺癌之间的关联性，仍然没有充分理解。因此，一个由中国、泰国、荷兰和美国研究人员组成的国际小组比较了将烟煤和无烟煤用于家庭烧饭做菜和加热取暖的终身用户因为患上肺癌而死亡的人数。这项研究是在中国云南省宣威县开展的，这是因为在这个地方，肺癌发病率特别高。

在20年(1976-1996)期间，研究人员总共追踪了3.7万多人，在这期间，他们记录到有2000多人因为患上肺癌而死亡。在考虑到其他可能的风险因素(包括抽烟)之后，相对于无烟煤的用户而言，肺癌患病人数和死亡人数在将烟煤用于家庭烧饭做菜和加热取暖的用户之间显著性地提高。

研究人员说，他们的发现对中国这个区域的公众健康有着非常重要的影响，并且提示着使用其他更不致癌类型的煤炭或其他燃料能够显著地降低肺癌患病率风险。

与肺癌相关的拓展阅读：

• Thorax：肺癌患者可从辅助性抗凝治疗中获益
• JCO：肺癌的HER2靶向治疗方案应纳入HER2基因检查
• Radiother Oncol：FDG-PET可评估局部晚期非小细胞肺癌同步放化疗后放疗剂量和急性食管炎的关系
• AJRCCM：Th9细胞对肺癌细胞有重要免疫调节作用
• J Thorac Oncol：利用化疗和药物治疗延长对肺癌恶化的控制
• Diabetes Care：糖尿病患者使用二甲双胍与患肺癌风险无关
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Risk of lung cancer associated with domestic use of coal in Xuanwei, China: retrospective cohort study

Objective To estimate the risk of lung cancer associated with the use of different types of coal for household cooking and heating.
Setting Xuanwei County, Yunnan Province, China.
Design Retrospective cohort study (follow-up 1976-96) comparing mortality from lung cancer between lifelong users of “smoky coal” (bituminous) and “smokeless coal” (anthracite).
Participants 27 310 individuals using smoky coal and 9962 individuals using smokeless coal during their entire life.
Main outcome measures Primary outcomes were absolute and relative risk of death from lung cancer among users of different types of coal. Unadjusted survival analysis was used to estimate the absolute risk of lung cancer, while Cox regression models compared mortality hazards for lung cancer between smoky and smokeless coal users.
Results Lung cancer mortality was substantially higher among users of smoky coal than users of smokeless coal. The absolute risks of lung cancer death before 70 years of age for men and women using smoky coal were 18% and 20%, respectively, compared with less than 0.5% among smokeless coal users of both sexes. Lung cancer alone accounted for about 40% of all deaths before age 60 among individuals using smoky coal. Compared with smokeless coal, use of smoky coal was associated with an increased risk of lung cancer death (for men, hazard ratio 36 (95% confidence interval 20 to 65); for women, 99 (37 to 266)).
Conclusions In Xuanwei, the domestic use of smoky coal is associated with a substantial increase in the absolute lifetime risk of developing lung cancer and is likely to represent one of the strongest effects of environmental pollution reported for cancer risk. Use of less carcinogenic types of coal could translate to a substantial reduction of lung cancer risk.