ets exposure, lung cancer - Legacy Tobacco Documents Library

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1 Environmental Tobacco Smoke and Lung Cancer in Nonsmoking Women A Multicenter Study El zabeth T . H Fontham, DrPH, Pelayo Correa, MD ; Peggy Reynolds, PhD ; Anna Wu-Williams, PhD, Patricia A Buffler, PhD, Raymond S Greenberg, MD, PhD, Vivien W Chen, PhD, Toni Alterman, PhD, Peggy Boyd, PhD . Donald F Aust n, MD, Jonathan Liff, PhD (3toctiv. .-To determine the relative risk (RR) of lung cancer in lifetime never smokers associated wit environmental tobacco smoke (ETS) exposure . Design,--tviutticenter population-based case-control study . Setting .--Five metropolitan areas in the United States : Atianta, Ga, Houston, Tex, Los Angeles, Calif, New Orleans, La, and the San Francisco Bay Area, CalK . Patients or UtMr Pa rtlclpants .-Female lifetime never smokers : 653 cases with histologicalty confirmed lung cancer and 1253 controls selected by random digit dialing and random sampling from the Health Care Financing Administration files for women aged 65 years and older . Main Chltcome M .asur. -The RR of lung cancer, estimated by adjusted odds ratio (OR) with 95% confidence interval (Cl), associated with ETS exposure . Resutts -Tobacco use by spouse(s) was associated with a 30% excess risk of lung cancer. all types of primary lung carcinorrla (adjusted OR=1 .29 ; P< .05), pulmonary adenocarrinoma (adjusted OR=128 ; P< .05), and other primary carcinomas of the lung (adjusted OR=1 .37 ; f~ .18) . An increasing RR of tung cancer was observed with increasing pack-years of spousal ETS exposure (trend P= .03), such that an W16 excess risk of lung cancer was observed for subjects wftt180 or more pack-years of exposure from a spouse (adjusted OR=1 .79 ; 95% CI=0,99 to 325) . The excess risk of lung cancer among women ever exposed to ETS during adult life in the household was 24% ; in the workplace, 39% ; and in social settings, 50"k . When these sources were considered joint)y, an increasing risk of lung cancer with increasing duration of exposure was otuerved (trend I= .001) . At the highest level of exposure, there was a 75% increased risk. No significant association was found between exposure during childhood to househoki ETS exposure from mother, father, or other household members ; however, women who were exposed during childhood had higher RRs associated with adult•Ilfe ETS exposures rilan women with no cNldhood exposure . At the highest level of adult smoke-years of exposure, the ORs for women with and without chikihood exposures were 3 .25 (95% CI, 2 .42 to 7 .48) and 1 .77 (95% CI, 0 .98 to 3 .19), respectively, C, wianai IMUtulg ta Occup,tovU sat .ty and HeaNn Cr+crnatut owo of Autt~ a nov, wrtn tM Orapon F4atm D-san, PoruanC a.wrru r.a, .st: to l.wrsun, sur, urvv«,M kMdrcai Gna+ D.partm.nt of Patnaogy 1901 P.raao St . N.w. OMU,¢ U 70112. 1393 (D+ FonUurn) IN JANUARY 1993, the US Environmental Protection Agency (EPA) issued a report on the reapiratory health effects • of paaaive amoking in which it concluded that environmental tobacco smoke (ETS) is a human lung calrlnogen, responsible for approldmately 30001ung cancer deaths per year in US nonamokera' A total of 30 epiderniologic studies conducted worldwide were included in the EPA risk aateasment, including 11 studies conducted in the United States?-'t Of the US atudies, the report of findings from the fitst 3 years of this multicenter study' contributed the greatest individual study weight to the US aumrnary relative riak (ER) estimates for lung cancer . 1 .19 (959o con- 5dence interval [CI), 1 .04 to 1&i) assoaated with "ever exposed" to npauaal ET5 and 1 .38 (95% CI, 1 .13 to 1 .70) for the highest level of spousal ETS exposure . The weight accorded this etvdy in the EPA report reflected the large number of tifetime nonsmokers with hing cancer (n-4X), as well as the study design used in thia caae-control study . This study was designed epecifScslly to evaluate the role of ETS exposure in the etiology of lung cancer in lifetime nonemokera . Two large US studies have been publiahed aince the preparation of the EPA teport~ Becauae t}>ese studies are aimilar in size and scope to our first report, their findings would have had a timi)ar impact on the summary US risk estimates . Brownson et ala observed no increased risk in the ever-exposed category for spousal ETS (adjusted odds ratio [OR)=1 .0; 95% CI, 0 .6 to 1 .2, however, the CI indudes 1 .19, the US summary point estimate . The highest exposure aategory (greater than 40 pack-years) in the study by Brownson et a] yielded an RR estimate of 1 .3 (95% CI, 1 .0 to 1 .7), quite similar to the US "high-exposwe" alunmary estimate of 1 .38. In the secorld study by Stockwell et al," the RR estimates are among the highest reported for US studies : 1 .6 (9596 CI, 0.8 to 3A) for ever exposed and 24 (95% CI,1 .1 to 53) for 40 or more smoke-yeara in adulthood . Thia report extends the findings of this multicenter study on completion of 2 additional years of subject accrual . METHODS Ihe methods and procedures followed in thia study have been previously deuribed in detaIl.' The study was & population-ba>,ed case-control study of hing csnces in rvomen who have never used any tobacco product- Eligible cases included racnoes-ropically rnnSrmed prvnary carcinoma of the lung (International Claaaifioation of Lhaenara, Ninth Rrvirion [1CD- 9), code 162) that .vere diagnosed between December 1,1986, and November30,19£?f3, 1752 JIJUA, kna 8. 1994-Va 271, No 22 Tooacco Srrnko antl Lunp Cancer-Forvr)wn tt a+ http://legacy.library.ucsf.edu/tid/wyk81f00/pdf
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