Ingela Helmfrid Ingela Linköping University medical dissertations, No. 1699 Exposure and body burden of environmental pollutants and risk of cancer in historically contaminated areas Ingela Helmfrid Exposure and body burden of FACULTY OF MEDICINE AND HEALTH SCIENCES environmental pollutants and risk Linköping University medical dissertations, No. 1699, 2019 of cancer in historically Occupational and Environmental Medicine Center and Department of Clinical and Experimental Medicine contaminated areas Linköping University SE-581 83 Linköping, Sweden www.liu.se 2019 Linköping University Medical Dissertation No. 1699 Exposure and body burden of environmental pollutants and risk of cancer in historically contaminated areas Ingela Helmfrid Occupational and Environmental Medicine Center, and Department of Clinical and Experimental Medicine Linköpings universitet, SE-581 83 Linköping, Sweden Linköping 2019 © Ingela Helmfrid, 2019 Printed in Sweden by LiU-Tryck, Linköping University, 2019 Linköping University medical dissertations, No. 1699 ISSN 0345-0082 ISBN 978-91-7685-006-0 Exposure and body burden of environmental pollutants and risk of cancer in historically contaminated areas By Ingela Helmfrid November 2019 ISBN 978-91-7685-006-0 Linköping University medical dissertations, No. 1699 ISSN 0345-0082 Keywords: Contaminated area, cancer, exposure, metals, POPs, Consumption of local food Occupational and Environmental Medicine Center, and Department of Clinical and Experimental Medicine Linköping University SE-581 83 Linköping, Sweden Preface This thesis is transdisciplinary, integrating toxicology, epidemiology and risk assessment, and involving academic institutions as well as national, regional and local authorities. Systematic and transparent methods for the characterization of human environmental exposure to site-specific pollutants in populations living in historically contaminated areas were used. Associations between environmental pollutant concentrations, exposure levels and observed or reported health effects were evaluated. Due to the uncertainty regarding exposure and health risks in populations living in contaminated areas, the authorities and some of the people living in the contaminated areas in Gusum village and in the “Kingdom of Crystal” in Nybro and Emmaboda, in the county of Kalmar, contacted the Department of Occupational and Environmental Medicine at Linkoping University Hospital, Sweden. They wondered whether it is dangerous to live in these contaminated areas and whether they can consume home-grown vegetables, berries and fruit without health risks. Some of the residents in these contaminated areas regularly consume locally produced food, especially in the summer. Some of them were worried about cancer risks or their children’s and grandchildren’s health. At the beginning, it was difficult to answer these questions and the attempt to do so initiated several discussions with experts at the Swedish Environmental Protection Agency, the Public Health Agency of Sweden, the Institute of Environmental Medicine at the Karolinska Institute, Stockholm, and with colleagues at Occupational and Environmental Medicine, Region Östergötland and at Linköping University. Additional uncertainties were identified, due to the many gaps in knowledge in this research area. In cooperation with local authorities and consultants, several exhaustive studies were performed, including environmental medicine assessments and research. Three of these studies are included in this thesis. Hopefully, this thesis will increase our knowledge regarding the risks to human health posed by living in a contaminated area for shorter or longer periods of time, will be helpful in prioritizing substances/pollutants of high concern in contaminated sites and will support decision-making for remediation in historically contaminated areas. Hopefully, the results of this thesis will feed into the Swedish Environmental Protection Agency’s (SEPA’s) model for health-based generic guideline values (GVs) for contaminated soil. Finally, we hope that the results of the study will improve the residents’ situation and reduce their anxiety, and ultimately improve public health. Ingela Helmfrid List of scientific publications This thesis is based on the following papers, which are referred to in the text by their Roman numerals: I Helmfrid I, Berglund M, Löfman O, Wingren G. Health effects and exposure to polychlorinated biphenyls (PCBs) and metals in a contaminated community. Environment International. 2012 Sep;44:53- 8. Doi: 10.1016/j.envint.2012.01.009. Epub 2012 Feb 13. II Helmfrid I, Salihovic S, van Bavel B, Wingren G., Berglund M. Exposure and body burden of polychlorinated biphenyls (PCB) and metals in a historically contaminated community. Environment International. 2015 Mar;76:41-8., Doi: 10.1016/j.envint 2014.12.004. Epub 2014 Dec 16. III Helmfrid I, Ljunggren S, Nosratabadi R, Augustsson A, Filipsson M, Fredrikson M, Karlsson H, Berglund M. Exposure of metals and PAH through local foods and risk of cancer in a historically contaminated glassworks area. Environment International 131. Epub 2019, Juli 9. Abstract There are many villages where environmental contamination is substantial due to historical industrial activities. According to the European Environment Agency, there are about 2.5 million potentially contaminated sites in the European member states. In Sweden, there are about 80 000 more or less contaminated areas. About 1000 of them are classified into the highest risk category, Hazard Class 1, and should be remediated. Population exposure due to these industrially contaminated sites may contribute to adverse health effects and is a global environmental problem. The general aim of this thesis was to evaluate the occurrence of cancer in populations residing in contaminated areas in relation to indirect exposure via the long-term consumption of locally produced food, taking into account residential, occupational and lifestyle factors. Associations between reported local food consumption frequencies, biomarker concentrations and environmental and lifestyle factors were explored. The Swedish national cancer registers and questionnaire information was used to identify cancer risk groups in the study population. The questionnaire was evaluated regarding how well it reflected measured levels of biomarkers in human biological samples, and how the consumption of local food from contaminated areas contributed to the total body burden of contaminants. Despite historically high environmental levels of contaminants in the soil and sediments, current contaminant exposure in the studied population living in the contaminated areas was similar to or only moderately higher than that of the general population. No significant associations with increased cancer risk were detected in the highest tertile of metals concentrations in blood or PAH in urine. Reported long-term high consumption of certain local foods was associated with higher cadmium (vegetarian food) and lead (fish, meat) concentrations in blood and urine. Long-term high consumption of non- local food from places outside the study areas was not associated with increased concentrations of metals compared with consumers of local food. It was concluded that the questionnaire information on consumption of locally produced food describes differences in food consumption in the study population reasonably well. An increased risk of cancer was associated with smoking, family history of cancer and obesity. Residing in a contaminated area during the first five years of life was associated with an increased risk of cancer, which may indicate exposure to contaminants in early life. Also, long-term high consumption of particular local foods (fish, chicken, lamb, game meat) was associated with an increased risk of various forms of cancer, while reported high consumption of these foods from non-local sources was not associated with increased risk of cancer. The associations between habitual consumption of local food and different types of cancer may reflect a higher exposure in the past, and thus, if consumption of local food contributes to the risk of acquiring cancer, that contribution is probably lower today than previously. Furthermore, it cannot be ruled out that other contaminants in the food contribute to the increased cancer risks observed. In conclusion, the questionnaire that was developed for the present thesis can identify risk groups within populations and can be used as a tool in a health-risk assessment. Sammanfattning Är det farligt att bo i förorenade områden? Industrialismen har inte bara medfört positiv utveckling, utan också bidragit till utsläpp av föroreningar till luft, mark och vatten på många platser i världen. Idag är utsläppen från industrin betydligt mindre på grund av miljökrav från myndigheter, vilka inte fanns tidigare. I Europa finns det omkring 2,5 miljoner områden som har förorenats av historiska utsläpp. I Sverige finns cirka 80 000 förorenade områden, varav 1000 områden är allvarligt förorenade och behöver genomgå sanering. I närheten av dessa områden bor många människor som riskerar att utsättas för höga halter av föroreningar, som eventuellt kan bidra till allvarliga hälsoeffekter. Fisk, grönsaker, svamp, bär etc. kan innehålla förhöjda halter av skadliga ämnen, som kan leda till ökad kropps- belastning av föroreningar. Syftet med avhandlingen var att studera om boende i förorenade områden har varit mer utsatta för skadliga ämnen, och om de i så fall har en högre kroppsbelastning