Breast cancer survivorship in the era of climate change: Impact of extreme weather, air pollution, and cancer therapy on heart and lung health

ABSTRACT Climate change is a global public health emergency that will increase cardiovascular (CV) and respiratory/pulmonary (R/P) morbidity and mortality as the population is exposed to more frequent extreme temperature events and high levels of air pollution from wildfires. The synergistic effects of heat in the

presence of elevated air pollution increases mortality. CV and R/P morbidity and mortality are also health consequences of certain breast cancer therapies that cause the heart and lungs to function at lower than optimal levels. This therapy-related tissue damage may increase survivors' susceptibility to CV and R/P

disease from extreme temperature and air pollution. In this grant, we will identify breast cancer survivors' unique health risks from climate change, by elucidating: · Exposure mechanisms/timeframes of interest, including whether pre-diagnosis exposure climate-related conditions (temperature, wildfire smoke, air pollution)

during cancer therapy and post-diagnosis acute exposure to these conditions predispose breast cancer survivors to greater CV and R/P toxicity; · How survivors' risks compare to individuals without cancer; and · Which breast cancer survivors face the greatest health risks from climate change, such as Hispanic women or

those with low socioeconomic status. To answer these questions, we will utilize a statewide Utah cohort of 21,835 female breast cancer survivors developed using the Utah Population Database, an epidemiologic data resource that contains lifetime medical data and longitudinal residential histories. This resource enables us to

measure exposure to temperature and air pollution both prior to diagnosis and in the years following. We will also utilize a cancer-free, age-matched female population sample (N=65,503). We aim to: 1) Determine if pre- diagnosis, long-term exposure to extreme temperature and air pollution are associated with CV and R/P health

outcomes occurring while BC survivors are on therapy, limited to