Residential greenness and lower breast and prostate cancer incidence: Evidence from a retrospective cohort study of 977,644 participants from Israel

Background: There is limited evidence on the associations between residential greenness and cancer incidence in longitudinal studies. Objectives: The aim of the study was to evaluate the associations between weighted mean residential greenness exposure and cancer incidence. Methods: This is a registry based retrospective cohort study of 977,644 participants. The residential greenness exposure was estimated for every participant, as the weighted mean residential greenness exposure. This was based on the mean Normalized Difference Vegetation Index (NDVI) in the residential small geographic area and the duration of the residence in this area. Cancer incidence cases included consecutive newly diagnosed cases of primary cancer. Analyses were conducted for all cancer sites, lung cancer, bladder cancer, breast cancer, prostate cancer and melanoma -skin cancer. Cox regression models were used to evaluate the crude and adjusted associations (hazards ratios (HR) and its 95 % confidence intervals (CIs)) between tertiles of residential greenness and cancer incidence. Further adjusted models to nitrogen oxides (NOx) were estimated. Results: After adjustment to covariates, exposure to the highest tertile of residential greenness, compared to the lowest, were associated with lower risk for all cancer sites (HR = 0.88, 95 % CI: 0.86-0.90), breast cancer (HR = 0.85, 95 % CI: 0.80-0.89) and prostate cancer (HR = 0.85, 95 % CI: 0.79-0.91). In addition, lower risk were observed for the middle tertile of exposure and all cancer sites (HR = 0.88, 95 % CI: 0.86-0.90), breast cancer (HR = 0.88, 95 % CI: 0.84-0.92) and prostate cancer (HR = 0.83, 95 % CI: 0.79-0.89). There was no evidence for mediation by air pollution (NOx). Discussion: Residential greenness demonstrated beneficial associations with lower risk for all cancers, breast and prostate cancers. If our observations will be replicated, it may present a useful avenue for public -health intervention to reduce cancer burden through the provision of greenness exposure.