ets exposure, lung cancer - Legacy Tobacco Documents Library

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TABLE 1-A.dl" ttd Odds RatSat (OR)` and 95% Confidence lrrtavata (CO fw the Relatlonosure during Chtldhood and Lun9 Catxc-r In Wornen, Mlsaourl, 1986 through 1991 ~11 ,,SL~.)jedSb LIf2tlrnC NLYSSlTtOk9f7 Source of E)posure No . Cases No . Ccrmots OR 95% Cl No . Cases No. Corttrds OR 95% Cl Al1 hauatlol6 members t,}ew 430 928 1 .0 323 802 1 .0 Ever 185 472 0.8 0 .7, 1 .1 108 364 0,8 0.6, 1 .1 Ggarette pedc-years 0 430 926 1 .0 323 802 1 .0 >0-15 42 129 0.7 0 .5, 1 .0 27 104 0 .7 0.4 .1 .1 >15-25 31 119 06 0 .4,0 .9 20 91 0 .6 OA,1 .0 >25 34 117 0.7 0.4, 1 .1 21 87 0 .7 0,4, 12 Parents onty Never 489 1021 1 .0 357 877 1 .0 Ev¢r 126 379 0,7 0 .5, 0.9 74 289 0 .7 015, 0.9 Ciyaretie padc-years 0 489 1021 1 .0 357 877 1 .0 >0-15 19 90 0.4 0 .3, 0.7 12 70 0 .5 0 .2, 0.8 > 15-25 27 118 0.5 0 .3, 0.7 17 87 0S 0 .3, 09 >?5 33 99 0.7 0 .5, 1 .1 21 74 0 .8 0 .5, 1 .4 °,•dNLzted ror .9e, nmory of pr er.+xis r.rig c3seRSa, and .c:tr-e emo+orq ( ad v.ixecs ort4 `lrx7udea kfaarne np-ampRa-t end ax-rnoknrs wt)o had stapped at leasc 15 ywrs tx4 .xe diaasosa or wttio had srrnked !or 4eaa tnan 1 prScyear, ers (OR = 1 .8 ; 95% CI = 1 1, 2 .9) who reported heavy exposure to passive smoke . In general, there was no clevatcd lung cancer risk associated with passtvc smoke exposure in the workplace (not shoµr in table) . Only lifetime nonsmokers showed a sllght increase in risk at the highest quartile of workpface exposure (OR = 1 .2 ; 95% CI = 0 .9, 1 .7) . Among the 4,58 lung cancers that were verified histologjcal}y, the predominant cell types were ader>ocaxcinoma (62 .49c), other/ mixed cell types (25 .2%), squamous cell carcinoma bronchioah-colar carcinoma (4 .11,1), and small cell carcinoma (2S5`c) . The other/mixed cell type category con- sisted mainly of large cell lung cancers, though these lacked suff•icient pathologic evidence for precise classincation . Table 3 presents results of cell typc-specific artalyses for adulthood exposures . Elevated risk was shown for otherhnixed cell typcs at more than 40 pack-years of exposurc (OR = 1 .6 ; 95% CI = 1 .0, 25). Akhouzh it was based on small numbers, a risk estimate of 1 .7 was observed for small cell carcinoma at the highest level of exposure . We also examined risk among women who had been exposed to passive smoke in both childhood and adulthood, in childhood but not in adulthood, and in adulthood but not in childhood .7lure was no evidence of interaction between exposure during the two periods . Discussion Our study suggests that exposure to high levels of environmental tobacco smoke in adulthood incTCascs the risk of lung cancer in nonsmokers . Exposure of more than 40 pack-ycars' duration increased the risk of lung cancer among nonsmokers by approximately 30% . 'I"ttis relationship %vas consistently demonstrated among lifetime nonsmokers whether the exposure variable was pack-years or the time-weighted product of pack-years and average number of hours exposed per day . Our findings are similar to those of another large study of lung cancer in nonsmoking womenm that identificd an OR of approxunately 1 .3 due to exposure to greater than 40 pack-years of spousal smokingIn earlier studies, the most commonly reported index of passive smoking exposure has been the presence or abscnceofasmokingspouse . Inourdataset, no elevated risk was noted for this variable . Since our study was limited to women, part of the difference between our findings and those of earlier studies may be due to differences in the effects of passive smoke exposure by gender . -Ilx National Rcscarch Council's summarv of 13 studics=t found overall relative risks of lung cancer in nonsmokers due to spousal smoking of 1 .32 for women and 1 .62 for men (although the estimate for men was based on few cases) . It is possible that men are exposed to other factors (e .g ., occupational exposures) that may interact w~ith passive smoke exposure to increase ruk above that observed in women . Pruencc or absence of a smoking spouse is a relatively erudc measurc of passive smoke exposure, with a potential for wide variabtliry in acrual exposure . It was noted in one survey, for example, that 47% of women married to smokers reported zero hours of passive smoke exposure at homa.s' It has also been shown that considering spousal exposure alone may underestimate total household passive smoke exposurc .M Another factor that may account for the differences in lung cancer risk due to spousal smoking between our study and earlier studies may be time trends in smoking patterns . The de- clining prevalence of smoking among men39 has probably resulted in decreasing years and perhaps levels of exposure to passive smoke in the home among nonsmoking women whose husbands smoke, Contrary to the findings of two earlier case-control srudies,'•26 our data showed no evidence of excess lung canccr risk due to passivc smoke exposure in childhood . The risk of lung cancer due to childhood passive smoking may have some analogy to risk among ex-smokers . After 10 years of abstinence, the lung cancer risk for exsmokers declines to 3oro to 50% of the risk for continuing smokets .p Siuu7arly, lung cancer risk due to passive smoke exposure in childhood may decline by adulthood, espccially in the absence of adult- Novemtxr 1992, Vol . 82, No. 11 Amenean loumal of Public Health 1527 http://legacy.library.ucsf.edu/tid/wyk81f00/pdf
iI ''wt•• *~aw'..rrr .-,~ ;r,r,wt.d nl~YBi~W 3L~ ,d6 ~- - -~_ Brv .+nsan ct .I . TABLE 2-Adlustrd Odcta RaUoa (Ofi)' and 96% Cortitdcnce Intervals (CR for t1x Relation,chlp txtween Paacatve Srnoke Exposurrc duMg Adulthood and LLN Cancer In Wonxn, Mlasourt, 1966 throagh 1991 A1 SubieCS° LJkti-ne Norrsrnokers Souce of Exposvre No . Cases No . Corwnls OR 95% CI No . Cases No. Contro(s OR 95% CI AD taus*)O~d members Never 221 527 1 .0 170 470 1 .0 Eyer 394 873 1 .0 0.8, 12 261 896 1 .1 0 .8, 1 .3 tte -YearS 0 221 527 1 .0 170 470 1 .0 >0-15 88 234 0 .9 0,6, 1 .2 56 181 0 .9 0 .6 .1 .2 > 15-4A 91 261 0 .8 0.6, 1 .0 52 199 0.9 0 .6 .1 .2 >40 146 264 1 .3 1 .0, 1 .6 107 217 1-3 1 .0, 1 .8 C'k-ette pack-years x hotrsJday` 0 221 527 1 .0 170 470 1 .0 > 0-50 90 261 0 .8 0 .6, 1 .1 63 206 0 .9 0 .6, 1 .2 >50-175 89 246 0 .8 0 .6, 1 .1 58 189 0 .9 0 .6, 12 > 175 124 238 1 .2 0 .9, 1 .6 92 192 13 1 .0, 1 .8 tJ, .wer 287 650 1 .0 213 568 1 .0 Erer 328 750 0 9 0 .8, 1 .1 218 598 1 .0 0 .8, 12 Ggatene pack-years 0 287 650 1 .0 213 588 >0-15 58 166 0.7 0 .5, 1 .0 32 128 0.7 0.5, 1 .1 > 15-40 81 258 0 .7 0 .5, 09 54 200 0.7 0 .5, 1,0 >40 150 266 12 0 9, 15 110 216 1 .3 1 .0, 1 .7 Cigarelte pack-years x hours/dey` 0 267 650 1 .0 213 568 1 .0 >0-50 64 201 0 .7 0 .5,0 .9 4t 161 0.7 0 .5, 1 .0 >50 175 81 237 0 .7 05, 1 .0 52 183 0.8 0 .5, 1,1 > 175 126 241 1 .1 09, 1 .5 94 193 1 .3 1 .0, 1 .7 `A4 .s1a7 lor aqe, hmpy of p(ev,a .a lu)g dsewe, ard acttve smo+~Yq (al sut~ec's orYy; . °SrrJLqect Itenme normxyKers ar4 ex-sndcers who had ntppw i3 Vaa :A 15 yea-s Deta'e d egrOOS or wM had srnc4utl tor Ita3 thw i pack-ysar, `The proad of lotai pack yea•s anf everage nurber Of hours ctaosed per cay to pamrve urq-e n the hortA . TABLE 3-AtSJusted tOdds Ratloa (Oft)' and 95% Corrfidenae IMerrala (CI) for Ux Re{rrionshlp btrtwesn Pasalve Smoke Exposure cturktg Adt>nftood and LuN Cancer In Women, by Hlstolo9lc Type, 6,Ussotxi, 1986 thrwph 1491 Ade)ocercr~ Other/Maed SquamaJS Ce4 Srnall Cell Source of Epostxe No, Cases OR 95 % Ct FJo . Cases OR 95% CI No . Cases OR 95% C1 No . Cases OR 95% Cl !+l hot~old members Never 100 1 .0 37 1 .0 10 1 .0 3 1 .0 Ever 192 1 .1 0 .8, 1-5 80 12 0 .8 .1 .6 16 0 .7 0 .3 .1 .7 9 12 0 .3, 4 .5 Cigwete pack-ya- 0 100 1 .0 37 1 .0 10 1 .0 3 1 .0 >0-15 49 1 .1 0.8, 1 .6 17 1 .0 05, 1 .7 4 0 .7 0.z 22 1 OS 0 .0 .4 .6 >15-40 48 0.9 0 .6, 1 .4 18 0 .8 0 .5, 1 .6 5 0 .7 02, 20 2 0A 0 .1, 4 .8 >40 61 12 0 .8, 1 .7 31 1 .5 0 .9, 26 2 0 .3 0.1 .1 .4 5 22 0 .5, 9 .7 Spoc.6C Only Nevet 131 1 .0 48 1 .0 14 1 .0 4 1 .0 Ever 161 1 .0 0.8 .1 .3 69 1 .1 0.7, 1 .7 12 0 .6 0 .2, 1 .3 8 1 .2 02,41 CiQarette pack,/ears 0 131 1 .0 48 1 .0 14 1 .0 4 1 .0 >0-15 36 1 .0 0.7, 1 .6 10 0 .7 0,4, 1 .5 3 0 .7 02, 2.4 1 0.7 0 .1, 6 .6 >15--40 41 0 .8 0 .5,1 .1 16 0.8 0.4,1 .4 6 0.8 0 .3,2.1 3 12 03,5 .6 >40 62 1 .1 0.8, 1 .5 34 1 .6 1 .0, 25 2 02 0 .1, 1 .1 4 1 .7 0 .4, 7 .0 'Adxntod ta .qe, hmory at pre~ 1ng doease, arw azfY.v cno+cns, hood exposure . In addition, there may be assessment of lung cancer risk due to pas- especially problematic when a large perlow reliabt7ity for quantitative measures sive smoke exposure in chiJdhood panic• centaee of surro¢atc inteniews are con- (intensity and duration) of passrvc smoke ularly difficult . Reliabiliry and validlty of ducied (as in our study) . Partially because exposure in childhcad,•1•'= which makcs measures of childhood exposure may be of these limitations, few studies of child- http://legacy.library.ucsf.edu/tid/wyk81f00/pdf
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