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fASSIVE SMOKING IN C'11)NESE FEMALES 167 TAILE VI11 - MEASUREME"l7S Of PASSIVE SwOK1NG AND tR FOt LI~NG CANCFJt !Y LOCATION OF TVMOR hnp/Ynl Wn1ar M crr,' e..r~c, e( roe .ra, RR' eri71 Cli RR~ (151 Cfi N-0cr d ar~w,rr r1 cav w, heasr+sl (1SI Ci) . . . R!
http://legacy.library.ucsf.edu/tid/wyk81f00/pdf 168 KpOETAl . Measurements based on increuing intensity of exposure, defined as increasing years (or hours, or cipretus/day) by mesn hours/day of exposun, also did not indicate a doseresponse relationship Likewise, the analysis of toul years of exposure with age of exposure did not suggest ehat arlier age of initial exposure and increasing years of exposure led to higher RR . it wu troubling to find stut in both rypes of analysis, the RR for the lowest amounts of exposure were among the highest values . Dalhamn et al . (1968) noted from their study of the retention of cigarette smoke components in human lung, that waterinsoluble volatile compounds and particulate maner from eigarenes tended to be deposited primarily in the deeper parts of the respiratory tret, Sina aderwcarcmorru is predominant among non-smoker lung cancer cases (59% of our typed cases) and it is tencrYlly a peripheral tumor, we wanted to see whether the passive smoking measurements would exhibit a more consistent pattern among the adenocarcinorna and largeall types, and/or among the peripheral tumors . In general, the pcripheral tumors as a group showed stronger dose-response results than the adenoearcinomu . • The RR for total years, hours, and hours/day measurements of squamous and snull-cell lung tumors indicated consistently elevated risks with increasing exposure . This panern was not found (or an) of the adjusted RR for adenocarcinorna or largeeell lung cancers . This association of histology with passive smoking is also suggested from previous studies by Trichopoulos er al . (1981) and Correa er al . (1983), Analysis of the cases by the lobe location of the tumor was done to sce whether the primary tumor resided more frequently in the upper lobes than in the lower lobes . This is because it is known that when dust is inhaled, it first enters the upper lobes where much of it is deposited . and then travels down to the lower lobes (Time, 1980) Furthermore, it has been observed (J .H-C . Ho, personal observation) that up to half of the Hong Kong adult population have radiologically evident scars on the upper lobes of their lungs Most of these scars are due to previous tuberculosis infection Since "lung ancer is more common in the scarred and chrontcally diseued lung" (Stone er al ., 1978), we were interested to see whether the lobe data would subsuntiate any of these possibilitiesln fact, 37 of the lung ancers were found in the upper lobes, and 43 in the middle or lower lobes . The results from the RR estimates from the 4 types of ineuuremenu did noa show the upper lobu to be more scnsitive to eavironmental tobacco smoke . Wynder and Goodman (1983) suggested that lun u»cer in non-smokerslvu more likely to occur in the periptery of the lung . This wu found in our smdy, as 54 % of the determinable cases had peripheral tumors vs . 46% with proximal tumors . Moreover, the pattern of RR with die various rneuurements of passive smoking indicated that peripheral tumors seemed to exhibit better dose-response RR than proximal tumors . 14'hen the RR were alculasod for die 12 pouibk 1 :1 canbinations resulting from histological type, location by lobe, e+t proximalp /periplseral txsmon, the hifheu RR were found for pen tKral tumort in the rniddk or bwer lobes . Signifieant adjusted RR as hith as 1E .7 wett fouad for some of shese measurements . Att~ough RR at die bwer doses tendod to be higher dun tfut for the hig3ser doses, the dau were consistent Yt that all the RR for ttwse with some exposure were much ~rca ter tt~an 1 .0, and the adjusted RR for at least one of the itR fot erchtype of ineasurement .ras ttuistially significant or ocarly sitnt'frcanc, 7tx RR analysis for aquunous and small-cell 1ung cancers in the middle or lower lobes also appeared somewhat better ttun the others, with tocal hours and hours/day muzuremenu alsowing some dose-responu panern . With the above two combined analyses showing some promise, perhaps the best RR would have been obtained if analysis had been done with squamous or small-cell peripheral tumors in the middle or lower lobes . We were unable to do tl>ese calculations because only 8 cases fined into this ategory . Actually, the finding of a possible risk of squamous and Kmall-eell tumors in the middle or lower lobes was somewhat unexpected, given that dust particles tend to adhere to the upper lobes, and tuberculosis usually affects the upper lobcs . To see whether calcified foci or fibrosis in the upper lobes could account for the higher RR in the middle or lower lobes because the previous presence of such lesions might disturb the expected distribution of inhaled particulate or gaseous matter, most of the chest radiographs of cases with squamous and small-cell lung tumors were re-txamined . No significant difference was found in the proportion of positive cases with upper lobe vs . lower lobc tumors . In out analysis of all never-smoked cases, the lack of a doseresponse pattern, and an almost consistent drop in the RR at the highest doses of exposure would seem to lend linle, or only weak support for the passive smoking linkage with lung cancer for women in Hong Kong This might be due to the facr that it has been estimated (Rylander er al ., 1963) that the non-smoker exposed to environmenul tobacco smoke receives about 1% of the active smoker's dose of tobacco smoke based on coatnine levels in the body, and this is toughly equivalent to the tobacco smoke of 0 .1-1 .0 cigarene inhaled by art active smoker in a day . Moreover, a 15- to 17-year longitudinal study of 97 non-smoking females in Holland did not find an usociation between passive smoking exposure and pulrrionary function decline (Brunckreef er al ., 1985) . Thus the effects of passive smoking might be so weak that they are easily overshadowed by other environmental factors such as diet or exposure to inhaled gaseous/paniculate rnaner from other sourtrs in the home or the workplace . When the lung tumors were segregated by histological rype and location, the resulting analyses showed that peripheral tumors in the middle or lower lobes, and squamous or smill• eell tumors in the same lobes, exhibited better RR parurns foi passive smoking in terms of consistency, strength, arxi dose• response . We are not sure whether this proclivity for passive . smoking-relat.od lung tumon to reside in the middle or lowei lobes might be due to the fact that the lower lobes have morc bronchial cells at risk than the upper lobes, or whether the size, weight, or composition of gaseous or particulate manet from passive smoking may favor its adherence to die periph• eral areas and the lower lobes . Nevertheless, the overall proportion of lung tumors in the middle or lower lobes among oui 88 cases ranged from 27% for the peripheral turnors to 209E for the squamous or small-cell tumon . Thus, the rrujoriry o . lung cancers among our non-srnoking population were proba~ bly due to some factor(s) which yet remam to be identified, The results from this uudy, showing a weak effect of passive amoking on the risk of lung cancer among never-smoked Hong Kon~ Chinese women, must be interpreted autiously, since i was based on only d8 cases and 137 controls . With this umplc size, RR less than approximately 1 .4 would be difficult u detect with 95% power and at the 5% level of signiflance This problem was even greater when the cases were suatifKc by histological type and location of the primary tumor . How ever, these data seem consisunt with the findings from othe epidemiological, biochemical, and physiological audies i• showing higher risks for squamous-eell eumors in the peripF~ ~ eral areas of the lung . Confirm>Uon of these findings fror, , other studies is therefore needed . ~ ACKNOWLEDGEMENTS Cz We tfunk the Hong Kong Anti-Canoer Society and the Un versiry of Hong Kong for financial auisunce in the carryin 601 OA CA 0;1A C4
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