IARC 60th Anniversary - 19-21 May 2026
Session : 20/05/26 - Posters
Air pollution exposure and mortality among women with breast cancer: a multi-country cohort study from the EU4Health-funded ELISAH project
USSAI S. 1, MELZI C. 1, MAKSYMOVYCH O. 2, SYDOR U. 3, GALCERAN J. 4, ZACHOU M. 5, MARNER A. 6, GEROMETTA A. 7, TRUETA J. 8, MANCUSO A. 9, TAGLIABUE G. 1, CONTIERO P. 1
1 Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 2 CARPATHIAN INSTITUTE OF ANALYTICS (FrankoLytics), IVANO-FRANKIVSK , Ukraine; 3 UTILITY NON-PROFIT ENTERPRISE IV ANO-FRANKIVSK CENTRAL CITY CLINICAL HOSPITAL (CCCH), IVANO-FRANKIVSK , Ukraine; 4 Tarragona Cancer Registry, Cancer Epidemiology and Prevention Service, Hospital University Sant Joan de Reus, Reus, Spain; 5 Department of Applied Medical Physics, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece; 6 Breast Unit, 1st Propedeutic Surgical Department, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece; 7 Cittadini per l'aria onlus, Milan, Italy; 8 Catalan Institute of Oncology, Girona, Spain; 9 Salute Donna onlus, Milan, Italy
Background
Ambient air pollution is classified as carcinogenic to humans and has been associated with cancer development and progression. However, evidence on its impact on survival among women with breast cancer in Europe is limited, particularly from large, multi-country population-based studies. Within the EU4Health-funded ELISAH project, we investigated the prevalence of exposure to major air pollutants and their association with mortality among women diagnosed with breast cancer across several European countries.
Objectives
To assess exposure to major air pollutants and their association with all-cause mortality among women with breast cancer across multiple European countries.
Methods
We conducted a retrospective cohort study including women diagnosed with primary breast cancer between 2017 and 2021 in Greece, Italy, Spain and Ukraine, using data from population-based cancer registries participating in the ELISAH project. Individual residential exposure to PM2.5, PM10 and NO? at diagnosis was estimated by linking geocoded addresses to European Environment Agency and Copernicus air pollution models. Neighbourhood deprivation indices were incorporated where available. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality, adjusting for age, stage, tumour characteristics, urbanisation and deprivation.
Results
The cohort included 119,673 breast cancer cases, with survival analyses conducted on 37,167 women with sufficient follow-up. The vast majority of women were exposed to PM2.5, PM10 and NO? concentrations exceeding WHO guideline values. Statistically significant associations with mortality were observed for PM2.5 and NO? exposure. In multi-pollutant models, increases in PM2.5 and NO? concentrations were associated with elevated all-cause mortality risk, with variations across age groups.
Conclusions
Women with breast cancer across Europe are widely exposed to harmful levels of air pollution, which are associated with increased mortality. These findings highlight the importance of implementing WHO air quality guidelines and integrating environmental risk reduction into cancer prevention and survivorship policies.