Arsenic and Nonmelanoma Skin Cancer in Slovakia.ppt

Arsenic and Nonmelanoma Skin Cancer in Slovakia Beate Pesch Environmental Health Research Institute, Germany Part of the EU-funded Project EXPASCAN ?Exposure to Arsenic and Cancer in Central Eastern Europe‘ www.icconsultants.co.uk/EXPASCAN.html Objective Estimation of the risk of environmental arsenic exposure from power plant emissions for non-melanoma skin cancer (NMSC) Estimation of the risk of environmental arsenic exposure Choose study design(s) Assess exposure Estimate risk Discuss confounders Arsenic and arsenic compounds Environmental Health Criteria (EHC) 2nd edition, 224; 2001 WHO, Geneva Estimate by Distance to the Power Plant Environmental As exposure NMSC incidence Associate As exposure with NMSC risk control for covariates ENO Power Plant (Slovakia) Cancer Incidence Analysis Prievidza district versus Slovakia Within Prievidza district by distance to the plant Comparative Incidence Figures (CIF) Prievidza district versus Slovakia 1975-84  All malignancies 1.1 NMSC 1.6 Lung cancer 1.0 Bladder cancer 0.9  CIF by Distance to the Power Plantcutoff 7.5 km 1977-1991 Basal cell carcinoma 1.6Squamous cell ca. 1.6 Lung cancer 1.0 Bladder cancer 1.1 SIR NMSC (1996-1999)by Distance to the Plant 5km 5-10 km 10km Reference District 1.2 1.1 0.8 0.9- 1.6 1.0-1.3 0.6-0.9 Slovakia 1.6 1.5 1.0 1.2- 2.2 1.3-1.7 0.9-1.3 Population-based Case-Control Study 264 NMSC cases (1996-99)response rate 80% 286 population controls response rate 72% Matching by sex, age Statistical Power ? = 5% one-sided ?= 20% (power 80%) controls exposed to As=10% N cases = 264 N controls = 286 RR to be detected = 1.9 NMSC Risk Estimation Logistic regression conditional on age, gender:Odds Ratio (OR), 95% CI Potential co