ets exposure, lung cancer - Legacy Tobacco Documents Library

of the study, inereased risk of hmg cancer
from adult ETS exposure was stronger
for adenocsrcinoma of the lung than for
al7 cell types combined? That ffnding is no
longer apparent with the additional cases
of each cell type . Although the estimates
of RR for pulmonary adenocarcinoma are
not different from tHose for other cell
types, adenocarcinoma of the lung is by
far the predominant cell type diagnosed
in women with lung cancer who are lifetime
nonsmokers, and oo the ef5ects of
ETS exposure may be particularly rel•
evant for this histopathologic cell type .'
More than 75% of the cases in this study
were diagnosed with prim.v-yy pulmonary
a.denecarcinoma, twice the proportion of
adenocareinoma of the lung diagnosed in
all US women without regard to smoking
history: 37% among female lung cancer
cases in the SEER program .° In other
studies of E'I5 in female nonsmokers in
which histopathology was reported, adwnlocstrcinoma
comprised 60 K or more of
nll cases in six of nine studies .L'"'6' ' In
the other three studies, the proportion of
udenocarcinotna cases ranged from 43%
Ro 549E ." 1' Differences in the physical and
themical properties of sidestream smoke
compared with mainstream smoke, including
the distnbution of the vapor and particulate
phases and the concentration of
Imov.-n or suspected carcinogens!' combined
uith ditferences in inhalation, nasal
vs oral, may yield a higher proportion of
peripheral adenoatranomas .u
Ddisclassification of disease status was
minimized in this study by the eligibility
rriteria (microscopic diagnosis required)
and an independent review of diagnostic
ataterial that was completed for 85% of
the cases . The amall proportion of cases
found ineligtble by independent review
may result from the populat.ion•based tumor
registry affiliation of four of the five
study cent.ers. The consistency of the findings
w-ith and without nonreviewed cases
supports the contention that the study
results were not measurably altered by
incluaion of ineligible caees .
Misclassification of eversmoker6 as lifetime
never smokers is more problematic .
'I11e objective of this study was to evalu•
ate the risk of lung cancer in women who
had never smoked . At present there is no
known biomarker of lifetime tobacco use .
Cotinine, the major metabolite of nicotine,
is the most widely accepted biomarker
of current (I to 2 days) tobacco
exposure and is useful for distinguishing
current active 6wrukers from current nonainokers
.'"' The proportion of reported
nartsntokersin the present study with a
cotininelcreatinine concentration above
100 nghng was 1 .9%, the same proportion
vrith a concentration above 100 nghng
obeerved in a 10-country, multicenter
study of self-reported ETS eupo6ure"
.lAMN, Jwte 8, 1 ;W-VO( 271, No 22
http://legacy.library.ucsf.edu/tid/wyk81f00/pdf
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A higher proportion of controle than
cases was exc]uded from the study s6 a
result of elevated ooncentrations of urinary
cotinineJcreatinine, 2.3% vs 0 .6% .
(',ases were klenti4ed at ho6pitals, and
aaeedng of medical records and physieLUU
about the patient's current and past
use of tobaxo preceded the screening by
telephone and at the interview for all 6Ux1yy
subjecw .'Itiia procedure may have eliminated
some curnent amokers from the case
series who would have been inclined to
self-report as nonamokers in an interview
format. Alternatively, some cases who
would miareport smoking status may be
less likely, because of health status, to be
actively antddng and less &ceh• to be revealed
than healthy, free-living controls .
Other data suggest that lung cancer aa