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Review

Cancer Risk Associated with Residential Proximity to Municipal Waste Incinerators: A Review of Epidemiological and Exposure Assessment Studies

by
Jose L. Domingo
Laboratory of Toxicology and Environmental Health, School of Medicine, Universitat Rovira i Virgili, Sant Llorens 21, 43201 Reus, Spain
Green Health 2025, 1(1), 4; https://doi.org/10.3390/greenhealth1010004
Submission received: 17 February 2025 / Revised: 23 April 2025 / Accepted: 21 May 2025 / Published: 26 May 2025
Review Reports Versions Notes

Abstract

:
Municipal Solid Waste Incinerators (MSWIs) are facilities designed to burn municipal solid waste to reduce its volume and mass and generate energy. A significant concern related to MSWIs is the emission of toxic and carcinogenic pollutants, including polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), heavy metals, and particulate matter. This review synthesizes global epidemiological and exposure assessment studies investigating cancer risks associated with residential proximity to MSWIs. Findings reveal a complex relationship: older incinerators with high emissions correlate with elevated risks of non-Hodgkin lymphoma (NHL), soft-tissue sarcoma (STS), and liver cancer in some studies, particularly in Europe. However, results remain inconsistent due to methodological limitations such as exposure misclassification, latency periods, and confounding factors like socioeconomic status. Modern facilities equipped with advanced pollution control technologies demonstrate reduced risks, often within regulatory thresholds. Key challenges include accurately quantifying historical exposures and disentangling MSWI-specific risks from other environmental or lifestyle factors. While advancements in dispersion modeling and biomonitoring have improved risk assessments, geographical and temporal variations in findings underscore the need for continued research. The review concludes that while historical evidence suggests potential cancer risks near older MSWIs, stricter emissions regulations and technological improvements have mitigated health impacts, although vigilance through long-term monitoring remains essential to safeguard public health.

1. Introduction

The incineration of municipal solid waste (MSW) stands as a common and efficient strategy for managing waste across numerous nations. While municipal solid waste incinerators (MSWIs) effectively diminish waste volume and, in some instances, generate power, they also release pollutants into the surrounding environment [1,2]. These emissions encompass highly hazardous and persistent organic pollutants, such as polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), alongside arsenic, heavy metals, particulate matter (PM) capable of penetrating deeply into the lungs, polycyclic aromatic hydrocarbons (PAHs) resulting from incomplete combustion, and various gaseous pollutants (SO2, NOx, and CO) [3,4,5,6,7,8,9]. The International Agency for Research on Cancer (IARC) has classified several pollutants emitted by MSWIs as Group 1 carcinogens, with 2,3,7,8-TCDD being a notable example [10]. In addition, elements like arsenic are implicated in lung, bladder, and skin cancers through mechanisms involving oxidative stress and DNA hypomethylation, while cadmium has been linked to breast and prostate cancers, and chromium (VI) can induce DNA strand breaks. Long-term exposure to these toxicants, whether through inhalation, contaminated soil, or food, may act synergistically to elevate cancer risks, especially among vulnerable populations.
The potential health effects of PCDD/Fs, arsenic, and other toxic elements have prompted extensive research, including cancer risks in populations living near MSWIs [11,12,13,14]. The present review analyzes the scientific literature, focusing on epidemiological studies and exposure assessments and investigating residential proximity to MSWIs and cancer risks. The objectives of the review are to (a) critically evaluate epidemiological evidence linking MSWI proximity to cancer, (b) summarize exposure assessment studies on cancer and toxic emissions of MSWIs, and (c) discuss current policies and research priorities.

2. Methodology

2.1. Literature Search

A comprehensive search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies published until 31 January 2025. Keywords included “municipal solid waste incinerators”, “MSWI”, “cancer risks”, “PCDD/Fs”, “dioxins”, “heavy metals”, “environmental exposure”, and combinations thereof. The search was initiated following the first report of dioxin emissions from MSWIs by Olie et al. [3] in 1977.

2.2. Study Selection and Eligibility Criteria

Inclusion criteria were (1) peer-reviewed studies involving human populations, (2) focus on cancer outcomes related to MSWI proximity or emissions, (3) epidemiological or exposure assessment designs, and (4) publications in English. Exclusion criteria included (1) non-human studies, (2) studies focusing solely on non-cancer outcomes, (3) non-peer-reviewed articles, and (4) studies lacking clear exposure or outcome data. Approximately 500 articles were retrieved from initial searches. After title and abstract screening, ~100 full-text articles were reviewed, and 65 studies were included based on relevance and methodological rigor. Studies were evaluated for quality during synthesis, considering factors such as exposure assessment accuracy, control of confounders, and study design robustness, although no formal quality scoring was applied due to the narrative review format.

2.3. Data Extraction and Synthesis

Studies were categorized by geographic region (Europe, North America, and Asia). Data included study design, population, exposure metrics (e.g., distance, biomonitoring, and dispersion modeling), cancer outcomes, and risk estimates. Findings were synthesized to compare regional trends, methodological approaches, and risk patterns.

3. Summary of European Studies on Cancer and Waste Incinerators

Table 1 summarizes key European studies on cancer risks associated with MSWI proximity, highlighting study designs, populations, and main findings.

3.1. Great Britain

Elliott et al. [15,16,17] conducted multiple studies on cancer incidence near UK incinerators. In their first study, Elliott et al. [15] examined larynx and lung cancer incidence near the Charnock Richard incinerator and nine other sites using cancer registration data (1974-1984, England and Wales; 1975–1987, Scotland). Standardized observed/expected (O/E) ratios within 3 km and 3-10 km showed no significant differences, suggesting no link to incinerator emissions. In a broader study, Elliott et al. [16] analyzed cancer incidence near 72 MSWIs (1974–1986, England and Wales; 1975–1987, Scotland). Adjusted for deprivation, the study found a significant decline in risk with distance for all cancers, stomach, colorectal, liver, and lung cancers. Excess risks near incinerators were attributed to confounding and misdiagnosis, particularly for liver cancer. A follow-up study [17] confirmed primary liver cancer in 66 of 119 cases, estimating 0.53–0.78 excess cases per 100,000 within 1 km. The need for further histological review was emphasized. Knox [18] reported associations between childhood cancers and proximity to industrial sites, including incinerators, supporting a potential link in vulnerable populations.

3.2. Italy

Italian studies present a mixed picture, with early research suggesting cancer risks and recent studies showing reduced associations, likely due to technological advancements [19,20]. Rapiti et al. [21] conducted a retrospective mortality study of 532 male workers at two MSWIs (1965–1992), finding increased gastric cancer risk after 10+ years of exposure but reduced lung cancer mortality. Parodi et al. [7] assessed lung cancer mortality in La Spezia, finding increased risk in females but not males, possibly due to occupational and smoking differences. Biggeri and Catalan [22] identified a non-Hodgkin lymphoma (NHL) cluster near a Campi Bisenzio incinerator (1986–1992), linked to dioxin contamination. Zambon et al. [23] found a 3.3-fold higher sarcoma risk in Venice with high PCDD/F exposure, particularly in women. Cangialosi et al. [19] estimated low cancer risks from a Taranto MSWI using dispersion modeling, suggesting that modern facilities pose minimal risk.
Chellini et al. [24] observed elevated liver, larynx, lung, NHL, and leukemia risks near Pietrasanta incinerators, though other risk factors were noted. Federico et al. [20] found no significant cancer clusters near a Modena MSWI (1991–2005), supported by robust ecological design and dispersion modeling. Ranzi et al. [25] reported no overall mortality/morbidity increase near Forli incinerators but noted cancer mortality associations in women. Salerno et al. [26,27] identified colorectal and lung cancer risks south of Vercelli, potentially linked to multiple pollution sources. In turn, Minichilli et al. [28] found increased cardiovascular and respiratory risks near an Arezzo MSWI but no significant cancer risks, while Romanelli et al. [29] reported increased mortality trends for lymphohematopoietic tumors in males near a Pisa MSWI. On the other hand, Di Maria et al. [30,31] used life cycle assessment (LCA) to estimate low health impacts from Italian MSWIs, supported by epidemiological reviews, whereas Piccinelli et al. [32] found no significant disease associations near a Valmadrera MSWI, except for liver/biliary cancers.
Table 1. Summary of European studies on cancer and waste incinerators.
Table 1. Summary of European studies on cancer and waste incinerators.
CountryKind of StudyPopulation StudiedHighlightsReference
UKCohortResidents near 72 MSWIs (1974–1987)Significant decline in cancer risk with distance for stomach, colorectal, liver, and lung cancers; excess risk attributed to confounding.Elliott et al. [15,16,17]
ItalyRetrospective Mortality532 male workers at two MSWIs (1965–1992)Increased risk of gastric cancer after 10+ years of exposure; reduced lung cancer mortality.Rapiti et al. [21]
ItalyEcologicalResidents near Modena MSWI (1991–2005)No significant cancer clusters or excess risk near the MSWI.Federico et al. [20]
ItalyCohortResidents near Arezzo MSWI (2001–2010)Increased cardiovascular and respiratory disease mortality/morbidity; no significant cancer risks.Minichilli et al. [28]
FranceSpatial AnalysisResidents near Besançon MSWI (1980–1995)Clusters of STS and NHL near the incinerator (SIR = 1.44 and 1.27).Viel et al. [33]
FranceCase–Control222 NHL cases vs. controls near Besançon MSWI2.3× higher NHL risk in highest PCDD/F exposure areas.Floret et al. [34]
FranceCohortWomen near Besançon MSWINo increased breast cancer risk except reduced risk in women >60 (OR = 0.31).Viel et al. [35]
SpainRisk AssessmentResidents near Montcada MSWICancer risk reduced by 67.6% after EU emission controls; total risk remained below thresholds.Meneses et al. [36]
SpainEnvironmental MonitoringResidents near Sant Adrià de Besòs MSWI (2014–2017)PCDD/F levels and cancer risks (2.3 × 10⁻6) exceeded thresholds despite improvements.Domingo et al. [37]
Table 1 provides a concise overview of European studies, showing a trend of reduced risks with modern incinerators, though historical data suggest potential concerns for specific cancers.

3.3. France

French studies, particularly around Besançon, focus on PCDD/F emissions. Viel et al. [33] identified STS and NHL clusters near a high-emission MSWI (1980–1995), with standardized incidence ratios of 1.44 and 1.27. Floret et al. [34] found a 2.3-fold higher NHL risk in high PCDD/F areas, though incinerators were not the primary dioxin source. A microspatial study [38] found no significant STS risk increase. Floret et al. [39] confirmed the MSWI as the dominant PCDD/F source via soil analysis. Viel et al. [35] reported no breast cancer risk increase, with a reduced risk in women over 60, possibly due to dioxin’s anti-estrogenic effects. On the other hand, Viel et al. [40] found a 1.12 relative risk for NHL in high-exposure areas across four departments, while Goria et al. [41] emphasized advanced modeling to reduce exposure misclassification. In turn, Viel et al. [42] linked serum PCDD/F levels to NHL risk, and Mariné Barjoan et al. [43] noted higher blood cancer rates in women and STS/myeloma in men near a Nice MSWI (2005–2009), with reduced risks post-2010 due to stricter regulations.

3.4. Spain

Meneses et al. [36] estimated a 67.6% cancer risk reduction near a Montcada MSWI after EU compliance, with risks dropping from 1.07 × 10⁻7 to 3.08 × 10⁻9. A Tarragona surveillance program [44] reported low PCDD/F levels and cancer risks below 10⁻6. In Sant Adrià de Besòs, high cancer risks (2.5 × 10⁻6) were found in 2014 [45], persisting in 2017 (2.3 × 10⁻6) despite lower soil PCDD/F levels [37]. Domingo et al. [46,47] highlighted ongoing risks and questioned the safety of current PCDD/F emission limits.

4. Summary of American Studies on Cancer and Waste Incinerators

Table 2 summarizes North American studies, focusing on the United States and Canada.

4.1. United States

Nessel et al. [48] estimated lifetime cancer risks from PCDD/Fs at 1.8 × 10⁻7 to 6.7 × 10⁻6, deemed low, while Hallenbeck et al. [49] found elevated risks from arsenic and chromium (VI) near Chicago MSWIs, exceeding EPA thresholds. In turn, Pronk et al. [50] reported no overall NHL risk near MSWIs but noted reduced risks with modern facilities. On the other hand, VoPham et al. [51] found increased breast cancer risk within 10 km of MSWIs, stronger within 5 km, whereas Rhee et al. [52] reported an 18% higher breast cancer risk in high-PCDD/F-exposure areas. Studies by Fisher et al. [53] found elevated NHL risk near high-emission facilities at 3–10 km, while Moy et al. [54] compared landfill and waste-to-energy risks, finding landfilling risk five times higher.

4.2. Canada

Ollson et al. [55] assessed a Durham/York facility, finding no significant cancer risks from emissions.
Table 2. Summary of North American studies on cancer and waste incinerators.
Table 2. Summary of North American studies on cancer and waste incinerators.
CountryKind of StudyPopulation StudiedHighlightsReference
USARisk AssessmentGeneral population near MSWIsLifetime cancer risk from PCDD/Fs ranged from 1.8 × 10⁻7 to 6.7 × 10⁻6; deemed low.Nessel et al. [48]
USACase–ControlNHL cases in SEER registriesNo overall NHL risk near MSWIs; reduced risk observed near modern incinerators.Pronk et al. [50]
USACohortNurses’ Health Study II participantsIncreased breast cancer risk for women living within 10 km of MSWIs, stronger within 5 km.VoPham et al. [51]
CanadaRisk AssessmentResidents near Ontario WTE facilityNo significant cancer risks from facility emissions.Ollson et al. [55]
Table 2 highlights lower risks in North America, particularly with modern facilities, though specific cancers like breast cancer show associations.

5. Summary of Asian Studies on Cancer and Waste Incinerators

Table 3 summarizes Asian studies, covering Japan, Taiwan, China, and Vietnam.

5.1. Japan

Yoshida et al. [56] found acceptable cancer risks for adults near MSWIs but noted neurobehavioral risks for infants/fetuses.

5.2. Taiwan

Ma et al. [57] estimated dioxin cancer risks from 1.4 × 10⁻8 to 7.1 × 10⁻5, with food ingestion as the main pathway. In turn, Shih et al. [58] found workplace PCDD/F levels 5-15 times higher than outdoor air.

5.3. China

Li et al. [59] reported acceptable cancer risks for residents near an MSWI, while Liu et al. [60] found risks below 10⁻4, and Li et al. [61] noted elevated risks from airborne dioxins at some sites. On the other hand, Yu et al. [62] reported low indoor PCDD/F risks and Huang et al. [63] found risks below 1.0 × 10⁻6 for 96 waste-to-energy (WtE) plants in 30 cities.

5.4. Vietnam

Nguyen et al. [64] found low cancer risks from ash-bound chlorinated benzenes, though other pollutants were not assessed.
Table 3. Summary of Asian studies on cancer and waste incinerators.
Table 3. Summary of Asian studies on cancer and waste incinerators.
CountryKind of StudyPopulation StudiedHighlightsReference
JapanRisk AssessmentResidents near MSWIs and heavy fish consumersPCDD/Fs posed neurobehavioral risks to infants/fetuses; cancer risks acceptable for adults.Yoshida et al. [56]
TaiwanExposure AssessmentWorkers and residents near two MSWIsWorkplace PCDD/F levels 5–15× higher than outdoor air.Shih et al. [58]
ChinaRisk AssessmentResidents near Beijing MSWILifetime cancer risk < 10⁻4 (acceptable).Liu et al. [60]
ChinaEnvironmental MonitoringResidents near MSWI in Bohai Rim citiesCancer risks below 1.0 × 10⁻6 for 96 WtE plants.Huang et al. [63]
VietnamExposure AssessmentWorkers at medical and municipal waste incineratorsLow cancer risks from ash-bound CBzs; other pollutants not assessed.Nguyen et al. [64]
Table 3 indicates generally low cancer risks in Asia, with food ingestion as a dominant exposure pathway.

6. Discussion

The studies here reviewed provide a comprehensive overview of cancer risks associated with MSWI proximity, spanning Europe, North America, and Asia. Methodologies have evolved from simple distance-based approaches to sophisticated dispersion modeling and biomonitoring, improving exposure accuracy. However, challenges persist, including quantifying historical exposures, long cancer latency periods, and controlling for confounders like socioeconomic status and lifestyle.

6.1. Methodological Bases for Discrepancies

Inconsistencies across studies stem from methodological differences. Early studies often used distance as a proxy for exposure, leading to misclassification [41]. Modern studies employ dispersion modeling [20] or biomonitoring [42], reducing errors but not eliminating them. Study designs vary, with ecological studies [7] prone to aggregation bias, while cohort [25] and case–control [34] designs offer greater precision. Confounding variables, such as smoking or occupational exposures, are inconsistently controlled, contributing to variable findings. These factors explain why some studies have reported elevated risks for NHL and STS [33,40] while others found no associations [20].

6.2. Historical vs. Contemporary MSWI Risks

Older MSWIs with high PCDD/F emissions [33] were associated with elevated NHL and STS risks in Europe, particularly in France and Italy. These facilities lacked advanced pollution controls, leading to significant environmental contamination. In contrast, modern incinerators, equipped with advanced filtration and emission controls, show reduced risks, often below regulatory thresholds [19,36]. Studies like Federico et al. [20] and Ollson et al. [55] have reported no significant cancer associations, supported by robust dispersion modeling and cohort designs. However, persistent risks in some areas [37] suggest that improper management can still pose concerns.

6.3. Environmental Justice Considerations

Marginalized communities, including low-income individuals, racial/ethnic minorities, and socioeconomically disadvantaged populations, are disproportionately exposed to MSWI emissions due to systemic inequities in facility siting. These groups face higher risks from older, high-emission incinerators, compounded by limited healthcare access and cumulative environmental exposures. Policy responses should include participatory siting processes, enhanced monitoring in vulnerable areas, and phasing out outdated facilities to address these inequities and reduce health disparities.

6.4. Communicating Scientific Uncertainties

Conveying complex scientific uncertainties to public and policy audiences is challenging, given inconsistent findings and methodological limitations. A balanced framework should combine evidentiary standards (e.g., robust epidemiological data) with precautionary approaches (e.g., stricter emission limits) to protect public health, especially in regions with limited regulatory infrastructure. Clear, transparent communication, using accessible language and visual aids, is essential to build trust and inform decision-making.

6.5. Global Research Gaps

The absence of studies from Latin America, Africa, and other regions highlights a significant research gap. This may reflect limited research infrastructure, informal waste management practices, or reliance on unregulated incineration. Future research in these areas is critical to understand local risks and inform global waste management policies.

6.6. Policy Alternatives

Reducing reliance on MSWIs through alternatives like zero-waste strategies (e.g., recycling or composting) and mechanical-biological treatment can minimize health risks. These approaches prioritize waste reduction and non-combustion technologies, offering sustainable solutions within a broader waste management framework.

7. Conclusions

Historical evidence suggests increased cancer risks, particularly for STS and NHL, near older MSWIs with high PCDD/F emissions, though findings are inconsistent. Modern facilities with advanced pollution controls generally report lower risks, often within regulatory limits, as seen in studies using robust methodologies [19,20,36]. Specific cancers (e.g., STS, NHL, and liver) show associations, but causal links require further research. Challenges in exposure quantification and confounder control persist. The absence of studies from Latin America and Africa underscores the need for global research, potentially supported by visual aids like maps in future reviews. In 2025, the continued operation of MSWIs emitting carcinogens remains concerning. The concept of “safe limits” for carcinogenic substances is fundamentally flawed, as no level of exposure can be considered entirely risk-free. It has been shown, for example, that smoking one cigarette per day does not guarantee immunity from lung cancer [65]. Policy alternatives like zero-waste strategies should be prioritized to reduce incineration reliance.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The author declares no conflicts of interest.

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MDPI and ACS Style

Domingo, J.L. Cancer Risk Associated with Residential Proximity to Municipal Waste Incinerators: A Review of Epidemiological and Exposure Assessment Studies. Green Health 2025, 1, 4. https://doi.org/10.3390/greenhealth1010004

AMA Style

Domingo JL. Cancer Risk Associated with Residential Proximity to Municipal Waste Incinerators: A Review of Epidemiological and Exposure Assessment Studies. Green Health. 2025; 1(1):4. https://doi.org/10.3390/greenhealth1010004

Chicago/Turabian Style

Domingo, Jose L. 2025. "Cancer Risk Associated with Residential Proximity to Municipal Waste Incinerators: A Review of Epidemiological and Exposure Assessment Studies" Green Health 1, no. 1: 4. https://doi.org/10.3390/greenhealth1010004

APA Style

Domingo, J. L. (2025). Cancer Risk Associated with Residential Proximity to Municipal Waste Incinerators: A Review of Epidemiological and Exposure Assessment Studies. Green Health, 1(1), 4. https://doi.org/10.3390/greenhealth1010004

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