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http://legacy.library.ucsf.edu/tid/wyk81f00/pdf 312 . LL•VOfS AND t.+.YARt) er al., 1988 ; Lc Marchand c1 al., 1991), and such corrclations could account for appareuc dose-responsc trends . As part of its justiflcation for concluding thrt ETS should be classificd as a Group A careinogen, the EPA claimed that the proportion of spousal smoking studies reporting a lung cancer risk elevation is improbably high and cannot be attributed to chance alone. However, this argument is meaningless, since it depends on the dubious assumption that the spousat smokinZ study design is essentially free of uncontrolled influences, and produces att unbiased estimate of an ETS effcc :t . The opposite assutnption, that the spousal smoking design is subject to positive bias and confounding, is more likely to be true, so weak spousal smoking-lung cancer risk elevations in the individual studies may well be the result of anifact alotte . Givcn the large number oi' studies, all using the llawcd spousal smoking study design, a statistical u :sl of association based on the proportion of positive studies will with high probability detect the influcncc of bias and confounding inherent in that design ; that is, such a test will likciy be significant simply due to anifact . 3. WORKPLACE ETS-1 .UNG CANCER STUDIES Having estimated an ETS-lung cancer risk from fcmale spousal smoking studies, the EPA extrapolated that risk to males, to exsmokers, and to workplace and other nonspousal. ETS exposure. A suhstantial majority of thc EPA's estimatcd ETS-attributable annual U .S . lung cancer deaths, 2200 of 30G0 total deaths (71 .9So), were ascribed to nonspousat exposure sources, primarily workplace ETS exposurc . Rcmarkably, the EPA did not use available information front nine U .S, studies of workplace ETS exposure to estimate workplacc ETS-lung canccr risk . Instead, the agency axsumcd that workplace l3TS risk can be axtrapolated from the spousal risk estimate . However, a comparison bctwcen the workplace BTS-lung cancer dttta and the spousal smoking data indicates that the workplacc data are not consistent with even the weak risk elevations roponed iu some spousal smoking studies, and indeed the combined workplacc studies exhibit no ETS-lung cancer association . To make this comparison, we performed, using the summarization method employed by the EPA, a meta-analysis of the rt,-sults of 12 studies that have reportcd lutts caneer relative risks for workplace exposure to L•-1'S (Table 2) . In most of these studies the exposure index was sclf-reponed exposure to ETS at work, and the comparison group was porsons not exposed at work . Of the 12 studies, 7 were conducted in the United States, 3 in Asia, and 2 in Europe . L•levcn studies, including 6 U .S . studies, reported results for women, 4 studies, including 3 U .S . studies, reportcd results for men, and one U .S . study rcported results for rncn and women combined . Reported sex-specific relative risks ranged from 0 .68 to 3 .27, with 9 of 16 being above 1 .0 and the remaining 7 being 1 .0 or bclow . The authors of two U .S . femalc studies, IIrownson er al. (1992) and Stockwell er aL (1992), considered workplace ETS oxposure and reported no sigtti6cant increase in lung cancer risk, but did not present numerical results . Of the 16 reponed relative risks, we combined 15 by computing a weighted average of their logarithms, the wcights being the inverses of the variances of the log relative risks (the Butler rclutive risk of 0 .0 for males could not be ittcludcd in the mcta-analysir). The sunttnary relative risk for 12 of the 14 worldwide studies was 1 .01, with 95% confidence interval (0 .92, 1 .11) . The summary rr,.lative risk for 7 of the 9
Fontham rc mJ. (199I) Gas6nkd d d. (1983) Jancrich d at (199(l) Kabal aal Wwdv (1934) Kab .t(1990) Kalaodidi d d. (1990) Koo cl al. (1954) Lae e e/. (1986) Slamizu d o). (1983) Stock.rcU ct uL (1992) Wu e cL (1955) iVu•WdGamf d ol. (1990) Comparison jnwp Not exposcd at +rork F Workod with smokn for 1l+ years /vcvff workod .rith a smokcr M Worked with rmokcr for 1 t+ years T:cvrswwkcd wilh a smoker F E•cr exposed .t .wrk Ncrcr esporad at work F Exposed at work in pasl 25 years Not apowd anywhere in past 25 ycars F d M 150 paw.-ycarY' of workplaoc ocpoaurt No history of workplace capowre F Raufulr exposed .t work Not rcqularly cxpor«f at wvrk 1,4 Rctulartp capo.xd at .+rork Not rcTulady cnposal at wvrk F Evcr cxpoad at work Ne .a espoa,d at work M Evcr exposed at work Nercr ctpoaal at .•ork F Exposed at work Not employed F Exposed at work only or at home and at work Not exposed al home or at work F ERpt»al at .rork Not caposod at work M Exposed at .rosk Not uposed al .•o+k F Someone al wotkplaoc snmka No one at .otkpiacc srnokcs, or su bjcct does not .ror k F Exposal at .rork No homc or .vork c.lwmnt F Extwwd .t nak Not expoxd at wotk F Ettporod .rt vrork Not exposed at wotk tn tcncril, no drntcd lunt pnccr risk »ociatod aitk ETS acpcmnc in the workplace 1 .47 0 .0 0 .15. 14 .06 1 .74 1 .03 . 1 .73 0.93 0 .73 . 1 .13 091 0 .60 . 104 068 0 .32, 1 .47 3 .27 1 .01, 10.61 1 .00 0.49, 2 .06 0.96 0 .46, 2_10 1 .39 0 .76 . 2 .54 1_36 0.50, ) .73 0.61 0.17 .2_33 161 0.39, 6.60 1_20 0.69, 2 .01 No si6ni6nnl Sncmuc in risk for Norkplacc exposure ' ProDmct of numbcr of ytus sabjoct worked in a pmrtiadar place and oumbcr of rmokcrs in srmc raom or arca, tummal ovcr 12 mrnt rcc=nt jobi_ http://legacy.library.ucsf.edu/tid/wyk81f00/pdf 1.3 0.5 .3 .3 1.1 0.9 . 1 .6 w
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, 1220 GNCER March 1 1984 TaaLE 4 .
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CONTENTS Monday, Fcbruiry 19, 1990
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CONTENTS Tu :sday, Fcbruar} 2 0, 19
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Wednesdsy, February 21, 1990 Sesslo
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