Long-Term Exposure to Ambient Air Pollution and Cervical Cancer Outcomes in Chinese Women: A Prospective Study on Recurrence and Mortality Risks

Abstract

The impact of air pollution on the prognosis of cervical cancer (CC) remains unclear. This study examined the associations of major air pollutants on recurrence and mortality among CC patients. We enrolled 3,758 women diagnosed with primary CC at the Obstetrics and Gynecology Hospital of Fudan University between 2019 and 2022, following them annually until June 2024. Air pollution exposure was estimated using high-resolution spatiotemporal models based on residential addresses. Weighted Cox proportional hazards models based on the Fine–Gray approach were used to estimate the risk of recurrence, while stratified Cox proportional hazards models were used to estimate the risk of death, adjusting for demographic, clinical, and meteorological factors. Among the patients (median follow-up ∼ 3 years), 217 recurrences (5.8%) and 113 deaths (3.0%) occurred. Each interquartile range increase in fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂) was associated with elevated recurrence risk, with subdistribution hazard ratios (SHRs) of 1.93 (95% Confidence Interval (CI): 1.40–2.66), 1.65 (1.13–2.42), 1.60 (1.14–2.24), and 1.26 (1.07–1.48), respectively. Higher exposure to PM_2.5, PM₁₀, and NO₂ was also linked to increased mortality risk, with hazard ratios (HRs) of 2.55 (95% CI: 1.78–3.67), 2.21 (1.38–3.54), and 1.37 (1.03–1.84), respectively. No significant association was observed for ozone (O₃). Exposure–response and sensitivity analyses supported these findings. This cohort study provides the first evidence that long-term exposure to air pollution after surgery is associated with increased risks of recurrence and mortality in primary CC patients, highlighting it as a modifiable environmental determinant of CC prognosis.