The Authors: W-YL (MBBS, MPH) is a public health physician and Assistant Professor in the Saw Swee Hock School of Public Health at the National University of Singapore, with research interests in epidemiology and health policy. AS (MBBS, MD) is an Associate Professor in the Saw Swee Hock School of Public Health at the National University of Singapore; her research interests are in the epidemiology of lung cancer, malignant lymphomas, and in screening and cancer prevention.
Biomass fuels and lung cancer
Article first published online: 21 DEC 2011
© 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology
Volume 17, Issue 1, pages 20–31, January 2012
How to Cite
LIM, W.-Y. and SEOW, A. (2012), Biomass fuels and lung cancer. Respirology, 17: 20–31. doi: 10.1111/j.1440-1843.2011.02088.x
SERIES EDITORS: IAN YANG AND STEPHEN HOLGATE
- Issue published online: 21 DEC 2011
- Article first published online: 21 DEC 2011
- Accepted manuscript online: 18 OCT 2011 09:21AM EST
- Received 18 August 2011; accepted 23 August 2011.
- air pollution;
- environmental and occupational health and epidemiology;
- lung cancer
It is estimated that about 2.4 billion people around the world, or about 40% of the world's population, depend on biomass fuels (wood, charcoal, dung, crop residue) to meet their energy needs for cooking and heating. The burden is especially high in Asia. Studies suggest that levels of pollutants including particulate matter <10 µm and polycyclic aromatic hydrocarbons indoors in homes where biomass fuels are used far exceed levels recommended as safe. While in vitro and in vivo studies in animal models suggest that wood smoke emission extracts are mutagenic and carcinogenic, epidemiologic studies have been inconsistent. In this review, we discuss possible carcinogenic mechanisms of action of biomass fuel emissions, summarize the biological evidence for carcinogenesis, and review the epidemiologic evidence in humans of biomass fuel emissions as a risk factor for lung cancer. Finally, we highlight some issues relevant for interpreting the epidemiologic evidence for the relationship between biomass fuel exposure and lung cancer: these include methodologic considerations and recognition of possible effect modification by genetic susceptibility, smoking status, age of exposure and histologic type.