Incidence of cancer in the area around Amsterdam Airport Schiphol in 1988–2003: a population-based ecological study

BMC Public Health Incidence of cancer in the area around Amsterdam Airport Schiphol in 1988-2003: a population-based ecological study Otto Visser 2 Joop H van Wijnen 1 Flora E van Leeuwen 0 0 Netherlands Cancer Institute, Dept of Epidemiology , Plesmanlaan 121, 1066 CX Amsterdam , The Netherlands 1 Municipal Health Service Amsterdam , Environmental Medicine, POBox 20244, 1000 HE Amsterdam , The Netherlands 2 Comprehensive Cancer Centre Amsterdam , POBox 9236, 1006 AE Amsterdam , The Netherlands Background: Amsterdam Airport Schiphol is a major source of complaints about aircraft noise, safety risks and concerns about long term adverse health effects, including cancer. We investigated whether residents of the area around Schiphol are at higher risk of developing cancer than the general Dutch population. Methods: In a population-based study using the regional cancer registry, we estimated the cancer incidence during 1988-2003 in residents of the area surrounding Schiphol. We defined a study area based on aircraft noise contours and 4-digit postal code areas, since historical data on ambient air pollution were not available and recent emission data did not differ from the background urban air quality. Results: In residents of the study area 13 207 cancer cases were diagnosed, which was close to the expected number, using national incidence rates as a reference (standardized incidence ratio [SIR] 1.02). We found a statistically significantly increased incidence of hematological malignancies (SIR 1.12, 95% confidence interval [CI]: 1.05, 1.19), mainly due to high rates for non-Hodgkin lymphoma (SIR 1.22, 95% CI: 1.12, 1.33) and acute lymphoblastic leukemia (SIR 1.34, 95% CI: 0.95, 1.83). The incidence of cancer of the respiratory system was statistically significantly decreased (SIR 0.94, 95% CI: 0.90, 0.99), due to the low rate in males (SIR 0.89). In the core zone of the study area, cancer incidence was slightly higher than in the remaining ring zone (rate ratio of the core zone compared to the ring zone 1.05, 95% CI 1.01, 1.10). This was caused by the higher incidence of cancer of the respiratory system, prostate and the female genital organs in the core zone in comparison to the ring zone. Conclusion: The overall cancer incidence in the Schiphol area was similar to the national incidence. The moderately increased risk of hematological malignancies could not be explained by higher levels of ambient air pollution in the Schiphol area. This observation warrants further research, for example in a study with focus on substances in urban ambient air pollution, as similar findings were observed in Greater Amsterdam. - Background Amsterdam Airport Schiphol is one of the main airports of Europe. The airport is a major source of complaints about aircraft noise, noise related adverse health effects and especially since the crash of an airplane in a suburb of Amsterdam on October 4th 1992 about safety risks. A longstanding subject of concern of the surrounding population is the exposure to aviation fuels and their combustion products and an alleged increase of cancer risk. Particularly in warm summers the smell of aviation fuels can be distinguished outside the airport grounds. Aircraft emissions vary with the engine type, the engine load and the kind of fuel. Combustion of aviation fuels results in CO2, CO, Ce, NOx, particles, and a great number of other organic compounds, among which a number of carcinogens [1]. Among the emitted polycyclic aromatic hydrocarbons no compound characteristic for aircraft engines has been detected so far. A committee of the Health Council of The Netherlands recently reviewed the data on the health impact of large airports [2]. It was concluded that, generally, integrated health assessments are not available. In the last 30 years, several adverse health effects in relation to exposure to airFNiogiusereex1posure (in Kosten-units) in the Schiphol area in 1991 Noise exposure (in Kosten-units) in the Schiphol area in 1991. The area surrounded by the blue line indicates the core zone, the black line includes the total study area. The location of the three air quality monitoring stations are indicated by asterisks (*). Table 1: Summary of the results in g/m3 (except benzo(a)pyrene: ng/m3) of the air quality monitoring system of the Schiphol area in 2002 Limit Location of monitoring station craft noise have been the subject of study, such as the use of tranquillizers, the prevalence of bronchitis and cardiovascular disease as well as child stress responses and cognition [3-6]. However, little information is available in the international literature on cancer risk in relation to airports. In the late 1980s, mortality due to cancer in the community of Haarlemmermeer, which hosts Schiphol, was investigated by the Municipal Health Service of Amsterdam on request of the general practitioners in the area [7]. The total cancer mortality and the lung cancer mortality in Haarlemmermeer during 198186 did not differ statistically significantly from the cancer mortality in the two standard populations that were used. The mortality due to non-Hodgkin lymphoma (NHL) was statistically significantly increased, but conclusions as to the cause of the excess mortality were not possible. In the 1990s, we carried out a first study on the incidence of cancer in the vicinity of Schiphol, as part of the health surveillance of the resident population of the Schiphol area [8]. During 19881993, the incidence of cancer in the area around Schiphol was close to the national average. The differences in incidence of certain types of cancer in comparison to the national average, as well as those between two study areas characterized by different levels of increased aircraft noise, were considered to be most likely due to differences in life style, such as smoking. In order to investigate whether cancer risk of the resident population of the Schiphol area (in comparison to the national average) changed since 19881993, we continued monitoring cancer incidence and we report here on the second, much larger population-based study of the cancer incidence around Schiphol. Methods Definition of the study population and the study area When we designed our first study, relevant exposure data on the ambient air quality around Schiphol airport were lacking and we could not define a study population exposed to increased ambient levels of aircraft emissions. The airport itself has no permanent residents and the most heavily exposed population the airport personnel and the travelers cannot be defined geographically. Therefore, we defined our study population as the population most heavily exposed to increased levels of aircraft noise. Since 1994, the ambient air quality outside Schiphol has been monitored and no differences with the background urban air quality have been reported for the compounds that were measured [9]. Table 1 summarizes the results of the three monitoring locations (...truncated)