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Air pollution is a major health concern for Europeans, with 91% of the urban population still exposed to air pollutant concentrations above the 2021 World Health Organization (WHO) air quality guidelines (WHO, 2021a) and more than 300,000 premature deaths each year attributed to chronic exposure to fine particulate matter (PM2.5) alone (EEA, 2021a). Part of this premature mortality is due to cancer: the International Agency for Research on Cancer (IARC) considers that outdoor air pollution, PM in outdoor air pollution, and indoor air pollution from household burning of coal and biomass are linked to lung cancer. Large studies in Europe (Cesaroni et al., 2012; Heinrich et al., 2013; Raaschou-Nielsen et al., 2013; Hvidtfeldt et al., 2021; So, 2021) and elsewhere have confirmed the association between PM and lung cancer, as reflected in the WHO air quality guidelines (WHO, 2021a). Air pollution may be linked to 0.5-1% of all cancer cases in Europe (Couespel and Price, 2020) and to over 7% of lung cancers (Kulhánová et al., 2018).
In terms of cancer deaths, around 2% of all cancer deaths can be attributed to air pollution in Europe (IHME, 2020). The proportion of lung cancer deaths attributable to air pollution is much higher, with a conservative estimate of 9% (IHME, 2020) and a likelier one of around 17% (Prüss-Üstün et al., 2016; EEA, 2020c). In addition, recent studies have detected associations between long-term exposure to particulate matter and leukaemia in adults and children (Bräuner et al., 2010a; Amigou et al., 2011a; Vinceti et al., 2012a; Houot et al., 2015a; Magnani et al., 2016a; Tamayo-Uria et al., 2018a). A study investigating indoor air pollution from solid fuel use has also found an association with oesophageal cancer (Sapkota et al., 2013). Links between some air pollutants, such as polycyclic aromatic hydrocarbons (PAHs), and other types of cancer have been hypothesised, and recent research seems to support them (WHO Europe, 2021), but the evidence is not conclusive.
In the period 2005-2019, emissions of all key air pollutants in the EU-27, including certain carcinogens, declined (EEA, 2021a). The COVID-19 lockdowns further decreased the concentrations of specific pollutants in many cities, although that drop was temporary, and pollution levels — with the relative exception of NO2 — have largely gone back to pre-pandemic levels (EEA, 2020b). The long-term decline in emissions has resulted in a gradual decrease in the concentrations of air pollutants. For instance, annual mean concentrations of PM2.5 decreased on average by 22% in the decade 2009-2018 (EEA, 2020a). This means that people are on average exposed to less hazardous levels of air pollution than before. The percentage of the urban population exposed to PM2.5 concentrations above 10µg/m1 decreased[1] from 97% in 2006 to 61% in 2019 (EEA, 2021a). Lower levels of exposure translate into a decrease in health impacts from air pollution, including cancer. There are, however, some caveats to this positive trend:
In fact, according to the current and more stringent 2021 WHO air quality guidelines, 96% of the European urban population was still exposed in 2020 to PM2.5 levels above the recommended threshold (5µg/m3)(see Figure 1). And this threshold is, as admitted by the WHO and the research community, still not safe.
Source: EEA (2021a).
The EU bases its clean air policy on three main pillars: (1) the National Emissions reduction Commitments (NEC) Directive (EU, 2016); (2) source-specific legislation for key sources of air pollution (EC, 2022a); and (3) the Ambient Air Quality Directives (EU, 2004, 2008), which set air quality standards. In 2021, the European Commission (EC, 2021)started a revision of the Ambient Air Quality Directives (AAQDs), partly to align the EU standards more closely with WHO recommendations. This is key to achieving one of the goals of the zero pollution action plan: reducing by 2030 the number of premature deaths caused by exposure to PM2.5 by at least 55% compared with 2005 levels (EC, 2022b). Two known carcinogenic air pollutants, benzene and benzo(a)pyrene are specifically regulated by Directives 2008/50/EC and 2004/107/EC, respectively, and they will also be reassessed in the context of the revision of the AAQDs. In the international context, the EU Member States work closely with other UN Economic Commission for Europe (UNECE) member countries to control international air pollution under the UNECE Convention on Long-Range Transboundary Air Pollution.
[1]The 10µg/m3 threshold was set in the 2005 WHO guidelines on air quality, which were in force in the period referred to.
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Cover photo © Kouji Tsuru on unsplash.com
For references, please go to https://www.eea.europa.eu/publications/environmental-burden-of-cancer/air-pollution or scan the QR code.
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