1. Association of lung cancer and mould in the flat in an environmental epidemiological survey Mihály János VARRÓ 1, Mária POSGAY 2, György UNGVÁRY 3, Zsolt LANG 4 1 National Institute of Environmental Health, “Fodor József” National Center for Public Health (NCPH), Budapest 2 National Institute of Occupational Health, NCPH, Budapest 3 NCPH, Budapest 4 Nomogram Ltd., Budapest ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005

2. A survey – To evaluate the health impact of environmental asbestos exposure – Lung cancer & mould in the flat Introduction To assess associations between mould in the flat and lung cancer in an adult town population Objective ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005

3. Methods 1. Questionnaire study –Interviewers –2007 standardized questionnaires –Nyergesújfalu, Hungary (asbestos cement factory) (asbestos cement factory) –>35 years –Both genders ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005

4. Methods 2. Data processing – Data entry:Epi Info 6.04d – Analysis:Stata 7.0 – Occupationally exposed to asbestos: excluded – Crude odds ratios (cORs) / adjusted ORs (aORs) (gender, age groups of 10 years, smoking behaviour) – 95% confidence intervals (95% CI) – 1470 subjects ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005

5. Features of >35 year olds Nyergesújfalu, Hungary, 1998 – 630 (of 1465, 43.0%) male and 835 (57.0%) female – Median age:53 years (interquartile range=44–63 years) – 745 (of 1466, 50.8%) smoked (currently or formerly) – 11 (of 1450, 0.8%) lung cancer – 92 (of 1354, 6.8%) worked >20 years in a dusty workplace – 132 (of 1437, 9.2%) persistent mould in the flat ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005

6. Lung cancer cases and prevalences by gender, age and smoking Nyergesújfalu, Hungary, 1998 Women Men 35+ 45+ 55+ 65+ ys Non-/Smokers (2-sided Fisher exact test: not significant at p<0.05) 382 23 4 47N 382 23 4 47N

7. Gender (male) – cOR=3.51,95% CI=0.94–13.48 – aOR=3.28,95% CI=0.79–13.70 Age (+10 years) – cOR=1.40,95% CI=0.81–2.41 – aOR=1.43, 95% CI=0.81–2.52 Smoking (current or past) – cOR=1.69,95% CI=0.49–5.79 – aOR=1.25, 95% CI=0.33–4.77 Goodness-of-fit p=0,73 Associations of gender, age and smoking with lung cancer Nyergesújfalu, Hungary, 1998 ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005

8. - +- + - +- + Dusty workplace, Persistent mould >20 ys in the flat Dusty workplace, Persistent mould >20 ys in the flat (2-sided Fisher exact test: *p<0.05) * * * * 0 7 3 7 4N 7 3 7 4N Lung cancer cases and prevalences by workplace dustiness and mould in the flat Nyergesújfalu, Hungary, 1998

9. Dusty workplace for > 20 years – cOR=6.10**,95% CI=1.55–23.99 – aOR=4.17*, 95% CI=1.02–16.88 Goodness-of-fit p=0,92 Persistent mould in the flat – cOR=5.76**, 95% CI=1.66–19.96 – aOR=6.13**, 95% CI=1.73–21.67 Goodness-of-fit p=0,81 *p<0.05; **p<0.01 Associations of dusty workplace and mould with lung cancer Nyergesújfalu, Hungary, 1998 ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005

10. Conclusions A strong assocation (even if adjusted) – mould in the flat & lung cancer – mould in the flat & lung cancer E. g.: aflatoxin B1 – IARC Class 1 human carcinogen – It is to consider: the possible carcinogenic role of airborne mycotoxins – The number of lung cancer cases: few – The association: highly significant – Further literature and field research is needed ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005

11. Thank you for your attention! ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 E-mail: varromj@okk.antsz.hu

12. Gender (male):mOR=3.18,95% CI=0.69–14.72 Age (+10 years):mOR=1.49,95% CI=0.79–2.81 Smoking:mOR=1.06,95% CI=0.25–4.46 Dusty w. > 20 ys:mOR=3.67,95% CI=0.89–15.08 Mould in the flat:mOR=6.67**, 95% CI=1.77–25.18 Goodness-of-fit p=0,94 **p<0.01 (Statistical validation: not possible!!!) A model for lung cancer Nyergesújfalu, Hungary, 1998 ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005