ets exposure, lung cancer - Legacy Tobacco Documents Library

DR, KABAT : Thaak you .
The problem of pusive smoki4 and lung eaneer hu provoked a good deal of debste botk
on a scicntific tnd on a public poliry level, Do the ctud ;es tlut purpon to sbou am assoei~tioa of
exposure to environments] tobacco smoke (ETS) snd lung caneer occurring in lifetime aotumokers
providc adequate evidcnce to resalvc the issue? As Naacy Haley has just ebo ..rs, zbc and bet
eollca.gues s.re very good at measuring recent ezpcswc to ETS uuing eotinine measured in etliva,
serum, and u,rine . Unfortunately, tbcsc biomarkers ue not belpfiil for asscssia~ exposure over tbc
sevcril deeades relevant to tbe induuion of lun .g ea.ncer . Given the lack of a biomuker for loagtcrzo
ezposure to ETS, epidemiologic stvdies havc had to rely on ssl!•reporu or prozy•repQrts of
ETS czpc>stuc .
I propose to raist F hat I eonsidcr to be some of tbe key aspects of the roujlJ ; IS
epidcmiologc stud.ics of tbe iuuc of ETS and fu .mg cancer and to poi.at out eertain ueu t.b : : rcqu!- :
furtber study . I Mill I-iefl} refer to our owm study ..,hicb is sti.lJ in proYress at tbe Amcri :a: Hca: :~
Fou.ndation . FAnall), i wilJ stsggcst a possible d'ueaion for furtber stud7 of tbis iscuc .
EPIDE1.ilOLOGIC
Table 1 lists studies cumi .t:inE tbc lung eafleer risk of non•s .mokiag vrivcs of smok.ing
btubi.nds eoWpued to the non•smoking wives of noo•smol ;iag busbinds . One notes tbat tbe
grutest ms ;zitude of thc overall relative risk (RR) is 2 .1 . A .fter the Tricboposilos and Correa
aud;es, the higbest RR is 1 .65 (Laas et al ) . The national Reseueb Couneil's committee on pusi%c
smoking earricd our a meta-anaJysis of tbc erist.iag uud.ics in 1986 and eame up .ritb am overall RR
of 134 (95e"ro eonfidenee inten•al 1 .18•1S3) (1) .
In four out of the fu`teeo studies listcd, the overall RR is etatistiesll} tigaif~cani . 1A'bcn
onc exuaines the diti by level of ezposurc, i .e ., aumber of eiguenes ptr day emoked by the
husbi.nd slratified into two or more levels, 8 of the 15 ,studies sbow evidence of a dou•response
rclatiotubip,
MSTOLOGY
http://legacy.library.ucsf.edu/tid/wyk81f00/pdf
Wben we look at tbc eftect of ETS exposure by histologic type, wn sts an interesting
disaepttnry (Table 2) . Dalager et al . (2) and Pershagee et al . (3) sbow roughly eompsrably elevated
odds ratios (OR) for squi~mous oeU and emaU ecll cuanomu eambines, but not for
adenocua.noma . In eontJast, Lam et a1 . (4) obuined a sigaiftcant eI(ctt for adcaor.arinomr+ but not
for squamosu cell eucinoma .
Tbe rtsulu of Hir .yama's atudy (5) prestunably agee on this point .vitb those of l,am et
a1., sioce the majority of bis lu,j eatnacr ease .s +s+erc apparently adcnocareinoma . . Tricbopoulos et al
restslts (6) prestuaably wtigb in on Ibe side of Dalagcr e1 al . asd Pers2sagyn et al, since
Tric,bopouloc s :clude.d adenocxrizoma and term .iaaJ brme6ia) zuciaocsa from t}seir aeries .
Since adenocariaoma oceurs morc eommon}y 'sa never amokers thia ba smokers snd
rencrally more cammoa}y in .romen than ia men (7), oat wotild ezpect t2tat itf .FI'S ezocxurc is an
appreelable risk factor tor hm ; aaa.r, it is auooiate .d w?it.b sdenocudssoma, as wtll as posS.r'bly vritb
o6er types . 'I1e ina>asiuenry ia the results to dule regardi.ng Li.uoloLy iadieates that tLis is one
uea thit merus furtber uudy.
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