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Journal of Environmental and Public Health
Volume 2013, Article ID 684035, 8 pages
Research Article

Lung Cancer Risk and Past Exposure to Emissions from a Large Steel Plant

1National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
2Community Health Service Kennemerland, P.O. Box 5514, 2000 GM Haarlem, The Netherlands
3Comprehensive Cancer Centre Netherlands, P.O. Box 9236, 1006 AE Amsterdam, The Netherlands

Received 26 February 2013; Revised 16 September 2013; Accepted 8 October 2013

Academic Editor: Marco Martuzzi

Copyright © 2013 Oscar Breugelmans et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We studied the spatial distribution of cancer incidence rates around a large steel plant and its association with historical exposure. The study population was close to 600,000. The incidence data was collected for 1995–2006. From historical emission data the air pollution concentrations for polycyclic aromatic hydrocarbons (PAH) and metals were modelled. Data were analyzed using Bayesian hierarchical Poisson regression models. The standardized incidence ratio (SIR) for lung cancer was up to 40% higher than average in postcodes located in two municipalities adjacent to the industrial area. Increased incidence rates could partly be explained by differences in socioeconomic status (SES). In the highest exposure category (approximately 45,000 inhabitants) a statistically significant increased relative risk (RR) of 1.21 (1.01–1.43) was found after adjustment for SES. The elevated RRs were similar for men and women. Additional analyses in a subsample of the population with personal smoking data from a recent survey suggested that the observed association between lung cancer and plant emission, after adjustment for SES, could still be caused by residual confounding. Therefore, we cannot indisputably conclude that past emissions from the steel plant have contributed to the increased risk of lung cancer.