PROJECT SUMMARY ABSTRACT
Cardiovascular (CV) and respiratory toxicity from cancer treatments are a major causes of morbidity among
adolescent and young adult (AYA) cancer survivors. This toxicity may reduce a survivor’s ability to neutralize
the added physiologic stress from short-term air pollution exposure, leading to a higher risk for cardiovascular
and respiratory problems. However, the health effects of exposure to air pollution on AYA cancer survivors are
largely unknown. To fill this knowledge gap, we will examine how fine particulate matter (PM2.5) is associated
with CV and respiratory health events among survivors diagnosed with the five most common AYA cancers in
the state of Utah (thyroid, melanoma, breast, lymphoma, testicular) between 1997 and 2016 (N=9,382). We will
employ a case-crossover design nested in this preexisting cohort to examine the effects of short-term PM2.5 on
the risk for cardiovascular and respiratory health events defined from statewide hospital discharge and
emergency department data, and outpatient records from Utah’s two largest health systems serving >85% of
Utah. Using data from the Utah Population Database, we can measure residential PM2.5 exposure at the
address level for our sample. We will: 1) Investigate the association between short-term PM2.5 and CV and
respiratory health events among AYA cancer survivors, and compare survivors’ risk of PM2.5-associated health
events to a cancer-free sample, and 2) Determine whether treatments with known toxicities modify the
association between short-term PM2.5 and CV and respiratory health events among AYA cancer survivors. We
will identify temporal trends in these associations among survivors from diagnosis to the end of follow-up.
Subgroups of survivors will be investigated to determine differences by smoking, race/ethnicity, and other
relevant factors. Utah has severe PM2.5 pollution due to winter inversions and summer wildfires. Because of the
pervasiveness of air pollution in United States and the lack of data on how environmental pollutants affect
cancer survivors, this project represents a unique opportunity to determine whether air pollution is a risk factor
for cardiovascular and respiratory health problems among AYA cancer survivors. Our study will provide a deep
examination of cancer treatment, health care utilization, and PM2.5 exposure, and expand upon the established
perspective of survivorship research by adding information the role air pollution on the risk for health events
among cancer survivors.
