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.

Public Health Relevance

Cancer therapies can damage the lung and heart tissue of adolescent and young adult (AYA) cancer survivors, resulting in major health problems after therapy ends. Breathing air pollution also damages lung and heart tissue and may cause additional health problems for survivors. This study will examine how short-term air pollution exposure increases the risk for lung and heart problems in AYA cancer survivors and how risk may be modified for survivors who were treated with chemotherapy, and will provide new information on how to prevent health problems in cancer survivor populations.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1)
Program Officer
Shelburne, Nonniekaye F
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Utah
Salt Lake City
United States
Zip Code