Tobacco Documents Online

Appendix C J,rreA3t, tra0-tyt uart On Air Po(lution, Environmental Tobacco Smoke, Radon, and Lung Cancer W. A6an Crawtatl ComWtwn n oacup.aaiW .fE rnonorwMnw rwNn $..fap6 Au.aaxa 7M MaIN NpeouldNna Yt YkwIrMMM woMNe Me leen MleaNd tnr nyny yean !y .mYtent Nr pdiulanla pretentMp a tlr.M M NweMS Mendl6la wat Aey aanaar. ie Ine lfaoa ttier ,eYwn4 ra.NvN npren n.edN lmeNlyaaan to aeaw Malr neterN N aoa/N• Ewom m enWmnremal lebeo6a einMte ana rldee is Mw IM eaa/Ne/ M tnY011 reeeenn and eenan• t1W n.lw.nuryta a pm.ome,enpeanw aa Mn6 aano« Md I..nrquteble t. pelhne eapeeure te ak0arae polpnanh. The dew Y apreeuN 1Fea ek poAapen oaMrN /NINnt/aN Mra /IayM aM en Olayby e malor nle In Ae.Nn Nqnvan.nL This review has baan prompted by tw. .n componentt of recaM publications concerning pollution and health. 1. The collabwative study report of 1967 oof Mumford et aL' on indoor air pollutlon and htn6 eanca In China which dewn'ba environmental eondi• tiona In amaky. coal.ualn6 .retl q comparable to the taptida ot eokin6 ov ena many yean ago. Lung cancer rataa in womaa in a population wMre loee eban ona in a ehouwnd women tmokad are very high with a lung cancer rate of 787/1.t>00,600 b.in6 detected In oae aurwyed popu)adon of 90,000. 7. A paper by Swki et at.t In 1667 from Japan describing the tardnaq• ntctty of a.traeta of airborne 1rp.Ne to Tokyo. a. The recent (19861.pata of activity in rtearcb on poteatial human efGats of exposure to enviroament.l tobacco amoke (EfS), indoor a'tr po8utanta. in• cludin6 radon, and Ihe emer88enw of "atak buildinp." 4. An analysis of urbanisation utd cancer Incidena in Sweden by Ehrea• berlr, von Bahr and Ekman' In 1966, in which the data from their Caneer•Bn• vironmeat Registry support the ton• capt that tom.10 percent of lung can• e.n in m.lu and possibly 70 pereent in femalea can be statistically e=plained by urbani.ation. Such peraentapa wen derived after subtracting the ef- facte of diytaetic routines and emak- I+f• 6. An analysis of cancer riaks paaad by wlaeted air pollutann ia th. Unit.d St.t.s by Thomson et olt of the U.& Environmental Protection Agency in 1966 and the dafinin6 of research pro- 6e.m., the magnitude of the rWta in Cs..r ut.-.rC,t rtdation to pollutant aourcat and po• paphk diatributlona. 6. Tlte statement of Professor P. J. Lawther` at a 1986 aympadum of the Royal Society of Medicine on Tha Ch.mieal Industry and th. Health of the Community: "Tha la{k of a sense of history and panpaetiw often aoeomp.. ai.a the most laudabla ted, but the dit• tortimt which follows carelw, albelt poeionate, thou6ht and tAunour for action will impede progress in the eearck for the nd eff.ats of poSutioa and the implemmtationof inewtw to abate it. Wo must be on our guard." 7. A foatmxs by Doll and Patd in their roriew of tb. Risks of Cancer ia the Unitad Stata ia 1981 tHarrint to polluttoa atatet, ••...it ls dtRtult to make due aSowana for the difference in effect between perhaps 20 yaeit of indmtrial e:paaura and perhaps 70 yean of environmental e.pown. and th.letter might be a much .a one or two orden ol ma6nituda more dw6n• ous per unit at daily doaw" lt would apPear that while In 1878 there was a lot of int.re.t in the ueoel• etlon between aatuar and environmen- t.l pollution. this bu now waned. The subject has been adrtud In 1978 by Cunow,, Ford and B41ak! Doll! Ca derlof et eLto and Shaa is aLtt The .ubJect of health and pollution haa b..n more recently addressed hy Vena't (1968), Seheltenf.ldu (at a workshop on chronic disease in the workplace and aavironraant. 1964), and Jacobaont4 (196). In this review benn-(a)-pyrene (S.P). an animal carcinogen and a eue• peemd human c.rciao6en, CIARCI Is taken as a turtopte for polycyclk aro- matk bydroarbona (PAH) and poly ayclk organic matter (POM). S.P meaturementa mar indlata about %e of the ov.ta8 PAH to which people an e.poaad ln their air environment In- deotf and autdoms. In the 396G there hY been increased Intenat in the btaRlt effects of eavl• ranmental tob.rao smoke and an ap• p.eatt d.aaw ia concern about the huleh dheta of pest aad present pn• m) air poNutaot.. Thia review at• tempta to put aew penpaetlw an the potential health eCufs of air pol)ut• ants to which meet re.dara will bive been espoa.d atna bittl, Health OeMd.ra6eaa T)u oonceM that taplratary i8neer et aud lun6 cannr might be nuaed by .ubataata pol}udn6 the ambient ab it by na meana new. la e redew by Elli.oo aad Waliartt in 1976 relatin6 partiau• larly to sulphur otldw and particulate toattor. it 4 reported that the problem had bem reeo6aiwd in the 13th antu- ry and apitt in the 17th e.atwy paper by Evelyn (1661) entitled "Fumifu- 6ium." to the early part of the 20th century in the UK, the Cod Smoke Abatement Society waa e.tablithod. Activity intenaiMd to the mid•1690t liut was Int.rrupted by World War 11. !t was not until the appallln6 t'o6 In London in 19112 whicb caused the ez- e.ea deaths of 106t1 people, the ald and the youn6 porticularly.that aone.rr.d action took plaae in tbo UK. Tha.e people In 1967 who an now 60 or mon years of a6•, aod who lived In N 0 N T.NeL Luntraneodt.tkntr(epyevald+)pr100A66• ~ ~ Native Auw.llaoe URmAu.tra0a ai 91 N UK 164 ~ ~ 0

industrial cities In their earlier yeere, h.ve been eapaud to high levels of pol. lution with epieodee of ntremely high pollution, not only by eulphur oxides and partkulatn butelso by the.o¢om- paAYlnf polyeyelic or=aaic maqr (POM1 emitted by the incomplete combustion of coal. As the use of coal was replaced by alternative fossil liquid and gaseous fu- eb the poUutlon visibly dlminGthed and the uneeen POM prospered with the increoed numbers of mobile souras. Pollutants from the combustion of to.t and the Aewer foedl fuels have careino• aenic propertiee and in Western coun- trias our life spane of eome 70 years brings us into the potential lung cancer hi~h.r raa. TM moet common disease usaciat- ed with air pollution was chronic bron- chitis which was clinically exacerbated in episadee of high pollution in urban are.a. The sourca were in the toai. heatd eerrid ranks of terraced homes and the local Industrias. Chronic brom chitta with or without concomitant ia• factione, such as tub.rculcsis, was com- mon in towns prior to the advent of the motor vehicles and eipe.tte smoking. Lung cancer is predominantly a dietaw ot older aqe Roups and appaars not to beW played a Ii6niHcant role in the cauee of death in the leth and l9tk century and early 2Oth century ea the short expectations of life would Aot haw allowed the time required !ot the development of the diaeeu.. In the 1550a In the L'K life expectancies for mea and women were 39.9 and 41.0 years respectively, by 1910-12 the es- pectandes were 61 and 66 and reaahed 60 and 64 yean in 1939-1941. U.S. data an reasonably similar. Lung eanae catea in nonsmokers begin to rise atnp. ly in the iye group 55-64 and there- efter. Polycyclic organk matter is mainly produced by ilw combustion of faril fue4 and industrial esposuret and eae- cer induction has beea widely reported since Pott.ie in 1775, observed ecrotal cancer In chimney eweepe and facial epitheBomu In coke, coal. tu and pitch worken were reported by But- I1n17 in 189Y. Further reports from Je• p.n and the UK followed and later Doll,'t ln 1965, confirmed the etcau of lung oanqre in aas workers. In coking ovens, thoae working Particularly on the top side hed lung cancer risks Y.S- 10 timr greater than other In the works area, a risk nta confirmad by Lloydts in the U8, Lawthera in the UK pravrdd data on the conantratian of POMs in such arae. The concenuaticn owr long pariod sampling wY 6000 At/ mr utd abe" aA old relort, 416,000 ng/ mr was measured. An estimat. of 5.6 na/mt was atimaad for a city dwelisr. tA revbtra„ som* major points have been made. Tlu tak fora report from the WHO collaborative antre at the Karollnska Institute (Cedarlo('t) makes the important point that it hu been aaublished that POM in urban atmosphera is contained in ffne re.pi- rabb partlcla and in thew eondltiom polyaromatle hydrooarbona are partk- ularly e(feative in the induction ot lung cancer. In crowded conditions the pos- sibility of passive smoking might peri- odically pnliute the ambient air to the same degree w other pollutanta aad the Task Force offns the opinion that it is unlikely to make a material trontri. button to the urban-nual difference. Carnow,t in addressin5 air pollution, lung cancer and confoundint faetors, notes the multiGctorial nature of the diseasa and strusea that major reduc. tiona in elI facwn will be necpsary if the incidence is to be diminished. In the face of the epidemiological data nn smoking he expresses the view that the other factors must have considerable influence and be etrongn than might otherwise appear since they emerge from a heavy spidsmiolo5icel bwh- ground ot ciy.reta use. Doll,t referring to the urban-rural cancer rate Sradlent, expresses the view that the differences were not pn- eratly larlie, being commonly about twofold but that 1t was nouble that mortality Increased propasively Mth the aitm of the town. He nGm aleo to specific carcinogenic apnta In the ur- ban air environment ettch ae POMs, w b.sta, anenic, and radon. He ata nota the ntbatantl.l dllfereaeae in ea incidence between m.ln and females in all countries studied and the wide ranp in rates from country to country. As enmpie, Scotland h.d a5o•standar- diaed lung cancer rates per 100,000 of 7&1e In ma1M to 1471 In femalq while Portugal had 10.91 and 4.74, respec- tively. A eimilar wide range of rates In towns ie reported from the polluted to not eo polluted aean. The twofold fAcr.ue in rate has been noted by Curwan et nl.t3 (1901), Haens- teln (1981), Prlndletl (1959). Levin et ol." 11960), and Bu.ll and Dunny (1957). The majority of the attudiea were controlled for smoking effwta 1>oll and Petot conclude their evelu- ation of environm.utal expoeure to BaP with the awet6ment that it is un- likely to .ccount (or more thau i pa- cent (emy, 1,000) of the U.S. aaaa of lung eancer in tAe /uture. What of as put exposure which effecta us now? That lung canar ia mors common in urban areaa doa not by itself give wi- dents sufficient to {nfu that urban air pollution ia the attribLLtable faetor for lung cancer. Then an confoundiry factam in urban related to emok- inf, drinking, eatity 10ta, work, life- etyl.. Indoor pollutants from h..ting and cooklry, and familial occurrenea CarnowT alao notea the evidence from studies of migrants whieh add we/ilht to the hypatheds that ait poqu. tion in industrial areas Is related to lung nnrar, e.6., migranp from Britain going to r.latively le." polluted couA- trlee euch as South Afrie., Aueuaha and New Z.aland, The Brltala-South Africa migrant lung cancer changes an described by Oeaes' (1959), the Brit- ain-Au.trdla also by Oeanr (1964), and Britain-New iealend by laat. cotta (1956). Dun'a data clearly de. scribe the chanqe (eee Table I). The NRC 1972 POM studia con. clude tlut, °A variety of typee of epide- miologic studies lead to an estimate o( the effect of pollution on lung canpr death rate of a S percent incrow per unit increase in urban pollution as iA. de:ed by bertto-(a)-pymne (i unit is 1 nt/ms)." It is not uneaanable, then- (on, to suggest that levels of B.P of 20 nt/m3 in urban air would impoae a 100 pere.nt increeee in risk. Thew and higher Iwels have been common espo. stusa for persons Aow 60-60 yeers of ap, Particulatly in industrialised muntrio. One naaqram of benm-(a)-pyrens may acrount for some four lung cancen 1»ryat (Pikea) per 1 millton In men aged 40-74 years with average BdtLh smokina babfu. Another estimate puts the rate of lung ancu at 5-10 caaaqu 100,000 ma4a per ypt (CederkXw). Tk.w «tlmaaa nfet to Britlah, U.SL or European type papulatlona of non- uuokem and amokera. A p.eaon who Uva trhem the air con- tains B.P at 10 Wmt and who brwthea l5 mt of air per day would breathe in roughly the same amount of B.P as he would from smokit>s 6 old• etyle cigarettes per day (HoffAten,r° cited by NRCI. It Is therefore not uA- rea.onable to auume that this degree of polludoA- which was very common onlyY0yunqo,maybemlatedtoa signi(leaot amouot of bmg wtr.r. A 1993 NRC estimate of a Ufetlme lung cancar risk (to a5e 70) (a 16/ 100,000 from exposure to B.P carboai- tatlon at a level of 1 ng/mo. As lung cancer is bade.lly a diww of older age groups with a latency of decades and relaud to chronic exposure, some 60 percent of the incidence could be the result of prolonged etpoeures to urban pollution in the 10-100 ae/mr range for B.P with episodic extreme pollutions of 100-1000 ng/mI plus or minus in. door and ooeupationd exposures and the pollution from motor whielss in N the laet five decades. ' ~ Ie Sydewy, Auetralf., an intake of 66 N n par day was derived by Clary,tt Thia wr 10 mt breathed at a maa N level of 4.6 rK. DId this induce 7795 ~ "•IY.tim." c.aeen by 70 yeam of age In N Sydney? Atmospheric dispersion modeliAg by QJ 1npJy and Garbep ot vehicle emie- %] N

T.Yle u. 90 annantrmloa in 197t ta nve ritit4r 9priM 9unwner Autuma wbner London YS-1{t 12-21 44-122 16-t47 H.mbur9 14.71 10-26 l6-9H W-7/1 7ydnry 0.6-A{ 0.F1.1 1(H7.e 3.9.+.1 N..York 0.S1t 0.1.L9 1.t-e.0 0.3-9.1 Ofake 5.7 0 9.4 11 • Not.: anvunnmenul tobacco unoke may antribvto only ame 2% of the PAH and P0M to whieh paple ae apaeed (N". aiow enlmata absorption of BaP by ut urban dweller. In onm such eakula• tlon a person living in an urban ua. 100 m.tra from an expre9tway with a 1-hour eommute to a )ob in a aentr.l city location could inhale 20 nE of BaP per day. If the worker had stayed at home the'•doee„ would have been 3 p{. Theee estimates relau to 1979 eondi. tiona, tla th91940-19s0a which would be mon relevant to auaemente of lunE cancer risk of people now aged SO-!0 and who may or may not develop lung caneer. It ha proven diffituh to extrapolate from industry to the city dw.tlem o the fume mmplex on the top of ovens ie different from indoor and outdoor pol- lutants produced in and by dwetllnp. The NRC POM study warm of this problem and notes that lung cancer lo. ddma has.wdily inereaad since the 19Wa while the car0inoqn content of urban enWronmentd pollution h.s bouw befn~~yhM phased ou~it should ~ auld be al~e o eo noqd that bty-term apa.uew prfor to the 1940a, and indeed the 106% had alrwdy ornvred in those aged 60-70 yeus by the 19e0e. 1Vh11e raognislry that 8aP la a eur- ropta for POMe and PAH, the pio• neerluE work of Sawiaktm is of Impor• tanw in understanding the wban•rurtd twofold risk rates for lung eenaer. Ur• ban v.lua at 100 eita etudid k.d 9,9 ng/mJ and rural areae 0.4 eq/m3 with peak Iewla found in winter. Other atudia conducted in other eo0ntrta basically confirm the 9awivki findings and er# reviewed in the NRC evahm• tbna. 1Mm•(¢pyrene Expoeura and EsUmaled Lun9 Canear Rahe Tba concentrations of B.P for many eltia have ban reported by COllud and Begemanm and cited by the NRC a eamplee (ae Table Ill. ta London before 1971 BaP levels ruyed from 13 to 147 n{!mt with the low values ia summer end high in autumn and win- ter u follows for London and some oth• er eltiaa. Table III presents lung taneer mte9 for man and women by age group, Ta• ble IV rhowa lung euua raua owr time by ery group. Two major obaerva- tione can be oadc 1) that lung eanear, whatever the aiologieai facton. is a diseaa of older ages, and 21 there Ie a detreue in rata appearing aapt in the 90--91 an group. 1•his decrease has ban.aribed by ame to the reduction nalninE POM and PAFl., tndoot9 ad outdooei, would bew bam ooe ley than 60 yean starting from bitRh TN Epurae d pOM ak PAR (MeeweN w EeP) Tlu (enu.l public is larsely un• aware of eacttno(ene in ttN environ- mantel air, partieutarly btdoota The source mat widely emphulud by health authorities In reant years is the espaure to environmental tobacco amoke. ltobbtnax br cautiously .uS• pated that the B.P eontributfon from ETS may be around 2 perant Even if the contribution wu 10 percent this would 1aw wurea to be reealiniwd for the remaining 90 paaat of B.P. What Is not known to tha pnenl pub• lie b that BaP 4 commonly faund le the endaeioa fmm the combustion of mou tueL In transport systems, anto• mobila. whaka pedio9 or dieul fu• eled oil fueled induetry, now rarely coal.fited euept for electricity pradue• PC" hotn.eooktn9 a~nd bthe eokya~rd 6~urnmE. T.Ne IV. Lunt cane•r ran. per 100,000 mala in the UK owr rha pnied 19e} 1967.• !0-,N 40.+1 !C-6n~d0.M 70-7e 1641e 1943 e 20 u 107 a0 111113 a 2s 1.23 t61 216 lte 1te7 3 22 133 a97 491 $42 1913 9 t1 107 361 619 a9 1N9 1 t9 77 2" 640 aU • 9ourec IAACP in the "tar" eontant of eyarata.m However, litqe attention eeama to have been given to the eoneept that diminu• tion of nneral urban pollution m.y also baw eontribuwd, Tk1s aontribu• timt would be more appprmt in non• tmokm for whom the r9epiratory, up• take of BaP would be Indoor and out- door pollutants. In the UK. thoa born before 1990 would haw ban eapaad to the poUu- tion levele of at teat those preanted in Tabie 11, with increased apaure to workNte and domestic indoor pollution during the wartime btaakoute.nd odt• er conatraints on ventilation. In thaw born before 1930, apaure to BaP eon• Tabla atl. The "b..t mnmate" of fung eanrer mortality ratw pu 100p00 twpufatlaa per year by ya groups in nonwgken (l...d oa Gu0nke1O)! 33-44 {6-bt A9e taap (reen) 56-ee 6a_TI 7N Mem 2.48 9.27 1120 76.10 43.50 woman 1.17 3.141 11,99 19.32 77.71 • nauer UBCX vol. Jh s. 291 Pollutba aonetal authorltlee baw made malor improwmena in the rtu.l• ity of urban air by enfoMall tba use of modern tahnolop on stationary and mob0e wurea of pollution to the Eu• ersl eaMtoomenL RMew9 by the US. National Aadamy of CdeaeWNation- al ReeeeroA CaunmWm deeen'M ia d.- tW the quantity and quality of theM emfafooa and addrae the health hu. arde. The NRC° giw9 the atimaad total annual BaP emission as shown ia Table V. T1m table .howe a rductioo of 10 petant at wont perant at baet to 50 over the decade 197~1890. What were the condit'wn. In the pnadleE dr eada7 How.v.r, from cigarettes (autLor's atimate) 1967: 200,000,00p U.S. duMa 9,800 pci retfie pn US aduk per Y2o-a0~ne BaP p.rey ar.eeaz (2x10elxtS9z10qz(90x10'e)• 14 k{ a 0.014 metrle tons pa adult (7x10a1%(86x10s)x(N0x10-4• 25 kg - 0A2E matrk Wo9 pu adult I

i Ah Pepullon by [T8 aed XNilh t.OneOYenN In th.1980s there has been increased Interest in the Impact on Indoor envb toamental Quality of passive rmok• ing.wT7nre has also been an upturje in interest in other indoor carcinogenic substances such as radon, formalde- hyde. POH and PAH. It la not pnerally appreciated that n.4fly all etudia. P.rticul.rly related to STS and cancer of the lung have been conducted on the rpoutet of emoken. Na studies have addressed the riske for the general public, Other lamliy members and close (riends. That then ie wry low expoeure for nonemokm is evidenced by the pne• .nn in the urine and saliva of a tobw• eo-epedfie chemical, cotinine, a meu• bolle productof nicotiae.1eA Other hypothetieal effecu on the r..pintory tracr• cardiovauvlar and other aystema are lacking In the quality end quantity of research end are sub• t~he NAS/NRC~ebk.u IARa Atd by The nports of eflacts of ETS on haaltb have been studied in depth by th. U.B. Department of Hea)td.° the NationalAcademy o(SciencdNatlonal flsseenh CouncU0/ and the Intenu- tiani A(enoy for Iteeearek on Cao• en! 7ben k.w slw ban confllctln9 parsoael viewi etpreeacd.u.y Various eympoafa have been published on the lesva44-46 The twneluslons reachd by those q.ndae, P.opN, end workahope are in confilct It Is of note• however, that the Uest majority of studies have coneerned the effects on nonsmoking spaueee and in only two of the sntd- ke.n.N *yre araustiaUy eifnillcant n- eults attained, tdth about a twofold In• crew in lung cancer. Both of thaee studies lud major fLws which are dia• euaeed in the reports by the NRC. IAAC sed USSO. In U.S. and UK atttdkts, the results baw been nonty- aiflcant. Aa increase of risk estimated at between 14 end 30 percent wu in contrpt to the 100 perant or peater increase found in urbut•rurd cancer gradienn. The relevant studies are those ol Akibam (19501, Chaup (198Y), Correatt (19a8), Garflnkelnp (t991 and 1989). Glllkry (19SN, Hirayeme°a' (1951 and 19M), KabaNt (19841, Knothis (1980), KodtAI (1969 and 1967), lwev (1986), Mifl.cp (198{), Penha8enrt (1984), Sandler" (1956), Trlehopeuloace (1951), and Wur (I9S61. The neral appr.eistions of theee etudirSy the major wthoritiw arr. 1. IARC,m P. SO& "Seversl epidemi- oloded atudfee hew nported an In• crsaud risk of lunt eaaar In nonemok- ing apausee o/ emokere, although a.ome oth.ee have not. In eome studies the rirk of hmg caaer in non.moken ia- Mini.urt Intermediate Na.imum • 9oueu: NRC,n Tabh 2.19. «.ued in relation to the astaat of tpouaei smoking. Eaob of the studies had to conund with wbetantiel diffi- culties in deurmin.tion of patsive es• potun to tobacco tmoke and to other potaible risk factors for the various cancers ttudied. The risultiM errors could arguably have artilectually ded pr.ued or raised eetimated rirks. and, a a coneepuend. each is trompetibla either with an incr.ue or with an ab wnce of risk. Ae the estimated relative risks an low. the acquisition of furtMr evidence hearing an the daue may n• Quire larp•.cale observational etudies ' involvingnliable measures of e:poau+ both in childhood and in aduit life." 2. ,)RC?r p. 231: "Two alternative e:planations wa be given for the Rnd• in~ of an increased risk in the epideml• olo~k atudiee. The finding may repn• wnt a direct and causal affea of ETS esporun oa lung cancer in nonamok- ers; or It could be due in whole or in part to bias, either in the form of eye- tematla erron in the reporting of infor- mation or a confounding factor that is ar.oefated both with lung cancer and the fact of living with a epouw who smokes." 4. USSG!r p. 96: "Previoua reports of the Surgeon Grneral have reviewed the data establishing active dpntte smoking M the mapreeuN of lunsan• cer. The absence of a threshold for r.r- Piratory esreinnpnaie in active emok• mg, the presence of the eame eardno- 9eos in mainstream emoke aod udesuum amoke, the demonstrated uptake of tobacco smoke constittnmts by involuntary amokerr. and the dem• onstration of an increased Suni; canar riek In some populations with eSpo- wrer to ETS leadt to the conclusion that involuntary smoking is a uuee of lung cancer." Referring to the lSSG report. Wefee and Spnsn.ei Wnte, 'The Sur~eon General, clearly raopi=ing that the government cannot regulate what (oes on In private homa, b+.aklnj the only aatloo available to him Sn waretoi that work•plaa esposun k.noed.h. The he.lth impact of eapoeure at work. esaept for its irritation• Is larryely mt• lttowtt, The report is oC itu weakest ground scientifically hae.'• The U886u in his 1958 report "Smoking In the Workplace" eeare.Yy mentions pwive smoking. In relation to smoking and the UfiSG war rubjeet to a b ---- crttici.m by the AF'L(CIO, ISO m.~ trede union body in the USA. Th. AFUC10 indleatd that tonantrating on the effects ot smoking would nrf. oueiy detract from efforta to cleu the workplacea of aumeroue toxic hazards, would permit employers to blame smoking and exposure to 8T8. and would diminish efforts to recapies and control Industrial exposures. The n- cent emphasis on ETS may timilarly affect the elu) steps to t»ntrol the am- bieat air polluttonr in urban, suburban and kus populeted areu as retl as n• mote anas .(fecnd by fall-out. Cne may nfiset on the B.P emission esti• matea shown in Tab4 V and the eqie man by the author. of B.P from ti9a- rettee. Homa have been polluted by the pramaree of penetration of outdoor aie poliutanta and genaatioo af POH and POM from beetin and cooking pro- cewn. The t+anat trend to decrease ventilation for !ud etwamy reuoes increasae ehe ~tratbs d numer• oue pollutaate and a new dieeaee com- pki dereribed vatieusa)y Y the "slek building syndrome" and "buildin{ tl1• nu." has been reoepnised. BtarUw Londudq that, while emokhy «stric- tien could perhepe affect the prwe. lenoe of emokiog in offiwe, such n- etrletlaeu have not beeu shown to haN a menurable effect on.ewdeted wm- fort.nd health patterns na on indoor air quality. The ventilation required to control body odor and COt will nmow ETS wnstitttents. He advisre that in• adpuate ventilation will rault in the unacceptable build-up of Intenally generated wbsteanm etd tuiretances from outside even in tbe absence of 6T& Air POMtdlon by 1ladae 04 Healih N Coeuqu.noa O O( the indoor air podutantr in manyN hom.a, rdon is currwtly the otupa•6h htp tbe 9reatast thnat to baltL, 9aC raesrch undertaken by the GwreoaCAH.duby labontadee ia San Traoc'r•~ co (a ehs U.S. Dep.rtment of LnerpN and the Rnvlronmental Proteetlono AMMwe ml , an htdom Air QuWty~fCIAQ ~ of maJar importance. Nuon espreewGj

tho view that indoor connntratione of radon ore usually, but not alwaye, laee thaa thoee experienaed in uranium mining. Tht concentrations are high enough to cause a risk of lung canar• perhapea higher ruk than that hypoth- euaed for tobacco tmoke. A lifetima risk of 1 in 300 for luniteancer contr.et• ed from radon and ite decay produc4 is xu{peted. Same few radon conantra• tions indoorx an tufflciently high that they pow a 50 percent chance over a 30 yeu occupancy of one of the occupanta developing lunt; cancer. Thie, he wHta, ix no trivial ttmtter. He aho expreaaea the view than aynuSixm between ra• don, Its decay productt, and ETS may occur. The EPAy hae officially warned that 5.000 to 20,000 lung cancen per year may be associated with such expo- wrp. In many countriee. Including the U.8" UK, Canada. and S+eden, the ra• don pteblem Ia being actively pursued an are the effecp of ETS and other in• door pollutants. Edlingil eapr.a.d the view that the attributable ineidenee of lung cancer In the pnenl population may b. de• peoditq an theoriea, as much as 10-40 p.rant of lung cancero or relatively bw in the 1-6 percent braket. Rad- ford'x„ 1Sl6 ateimate of IiGtlme risk (10 yws) from rdon daughter app- eun we not mon than 40 percent of lung cancers in ttonemoking wromen In contraat to Cohea'Pt 1985 utimate of 140 percent. Other radiation eareino• puk heatude to the public vary from 1 to 20 percent and have beon discussed by Walter et 01.11 C440hm$m The health benefits atuibuuble to the acti.itlu of air poUution control aaientietk have been coneiduable and will continue to be notable as more and mon peopa w axpaed to itxnadty numb.re of yeme ot exposure to dlmin• Wtin quantifiee of potentially rarci- noamie pollutantu. The recent trend toward lower lung canat ratm un• doubtedly hu a large air pollution con- trol component aa one of the factors in this multlfactoHal diaew. The more recent inter.et in indoor air pollution wiU put into acientifle perspective the Importance of all recoani.ed and tue• petted lung earcino{enia apnte and their eourc.a. The control of pot.ntial and real eer- einopnic yenta in indoor and outdoor air patlutentk pret.nte a challonp to elr pollutbn control scientists to con• tinue th decades of aueeadut redue• Alr pollution by polycycNe aromatic hydraarbow aud polyeycHe organic tnatnr, trreepatlve of eoura, present a threat to health which will be related to the amount of pollution, duration of exposure, and tota) doN. Activity to control any one toura aad not aU rourcea will have limited benefit to public health. The reality of the air pollution aitua• tion is that the mere presence of trac. emounte of carcinogens poee trrea amounn of harud to health. No one ean1ogledly claim that In the preema of such «.cm there is no ruk.lt le aLo impaeible to demonstrate the pra• ena or absence of a threshold quanti• tative concentration above which ef• facta will be found and below which effects will not be found-a negative cannot be proven. Hypotheat. not ideas, can be uxted for validity ip ata tiaticai terms In relation to !ow risks from air poAutaou and derived health effects estimates. Cauae•eHect rela• tionehipt cannot ecientifloaUy be ptoved by utimatet btwd on auch a4- tutia. A 100p.rcentlnereae o(e bw risk la difficult to dlecern. .iudgement and practicality in rNation to the low levels of air pollution to be achiwed muat prevait ta our eeeking a dieeaao hee society. ANeneeea t.J.LMumford.X.ZHaR.S.CI.w man. B. R Caa D. R. Harr4. X. LJ,M. Y. L. Xlaa. C. ~V. Xw J. C. Chuana, W. L Wilwn. M. C?oke. l.unt aapar.ud 1~ door air pel utloe in 7tuad Wel, Chtna." Sci.ee 117 (1M11. 1 Y. Seodti, T. I~ fik awaL K•L ahyama, A. Nakeme, R Eeda "Greinopaieity of n Vact of airborne pardolN uNp new- barn mia and eompuadve etudy of eareinapnk: md mutatank dfom d the ntraet" Are). J:nwren. Health eh 1/ tie7). 3. L. nb.rry. D. ven lsitr. a. Ekmon, R.Pi.ar .na{yw of ineauurm d ur• b.nuatton.nd cancer incidence in 0.0- da0." TSknoumirowne., tnr. 113 ~ ~D itpY1. 4, pr Sulpewald'7kL. avb p4lam in th. United Smtu an udy- rn d eanar nakr rel.eled air oaUut.a..' JA A 7f: (IM6). 6. P J. L~tMr. "Air Pollutlpn-A P.r- rp.auv. The CMmkat Inlwtry end fhe Hn~(tA of Me CammunitY 1toYe1. Society d Nad'uino. Inurnetional Cen• ~rer utd Sympmlum Sulaa. P. J. C. Roo, ad. Number aR p. 75-81,1p16. b ii. Ddh k. Pau. "The caume of caoar. yuantitattve eetimatn of avoidable risks of cancer in the United Stotee w daY,' J. Not. Canser fwt. ap 1193 7. B.NW 1Carnew. "Tbe Lrbon foeter' ad I nneer. ef[entM wwk/ne ae atr u 91111911 ~uebnt" 6nuitan. HwltA F"enpaet. . >t. A. !, Ford, . i11eLk. "Air poLLutlon aed urban fKmre in nletiml to Omta mCa- teu A.N. Snu4on. HmGk Sft 360 as`~i. 9, ti Doll. "Atmc.pkaric pollutlen and iun~mar," Snu'vvn. H.a4k Pnp.et. fft17(1p711. i0. 14 Cedarlef R. DeO. !. Pewler. L Pd• beq, N. N.aOn. V. Vouk..0a, "Air pel• lutmn and eencer. risk enuement mahadoloo and eplderbtotied eA- dmeo." L%Nran. HNOh Perepret.3L t R1 e711. lt. L 5hear. D. Y. faelw M. !. CetttIek, "Evidence for epace-tims elurt.rhK of lung cancer duttu•" AreA. Snuvea. H.abA 1N 17S (IY781. l2 N. L Yana,"Lua{ e.nnr iMdena aad olr pollution in 6rie County, New Yeek•" Arc/t. 6nuiron. Hn11A itt 2211 tWRt. 17. D. Sebotteddd. "Chmtde dlaew In tha wakplan and envitonmepC aowt," 14. 0 J.eobeoe, "The ~ vr pollWutlan and other fattott m loal r.riatiom in aenerd mortality ud teear motta8• ty~ tb. J. M.Gl(.w A~rok. 8nwen. Health * 900 tI 6. WaOer."A rwisd wlphtu oatdm R oedPartic!!late m.tta Y W pollulMtt wlt\ paniNW rafd• enn to dGatt on b..ltk is ebe United K(iaidom:" dnpiren. Reo. tit 302 ia P.*PrOatr. "Chkurak.l obmrntiom rQa• tive w the atar.et. the palyptm d th. npw, eba mw d the Kmutm, the du• - frrentkindxafrupmraandthetnatill• ntaa d the tae epd fr4" r.andam L Haw.., W. Clorke, md Collins. 1773. 17. H. T. BmlN, "Three lemuras oo tuwr of th. endum In ehlmay-ewen end othus Locptre I. Saaedary emar wfthout pnmatY mne•" lbfe. Ned. J. tt ta41(1aN). ta ILDd4L~ W.PWn•LJ.aemmon, w, aum, G.O. Hu fk.. P.1f.tYnr. W. Wllten, "Mamlity d pe.mkwe .itk apacW r.teroaa to mar of the luy and kloddw• dtanie anakeeeedlh. ~~umaaaletlb" i+t. J. fnd. Med. 11 19. J. W. Lloyd LeaI-tarm morWity study af ato.~werkere, V. lim"atery, anear ia eoke_plaat weekme• J. ace. }x~ed. Aat(trr1). ~ W~~~A~,_~N.uWdy~~arf~tt m~ecmWLWaLa paµwerp reeert~kLmllm."~dn~/. J~nd. ~1. ~1Mf. P. L L Kene.way. N. M. Itmoaw.y ° t~mdena at aenar of the luna attd , Ip urbae end ruai d'rtrtem~' Hnt. Cmte. N 1U1(1Mt1. M. W. Hwaael. "C.ewr prWlty amoa~ tM kar. ia ebe Unud ltma J.Nat. fnat.faeTf(1N1) . 9& It. Prinala," meeiderotloro In tha muepeautbaafWpotlue1m healtkd• hetedate."JAPCA lit 9119H1. 44. M. LL.v~n, W. Hwamd.t a Cunlt. P R awb.rdt. V H. Hmdy i. C Lt• ~itdrshank:uduCW N~luuad } Not. Conrer. htat.ld: lt4i 119W1. 2S. P. BudL J. L Duna. Je. "p.:ative im• p.tt ot emokie{ .ud ele po0utiep on lung a~." AreA. Rnuiren. HeaitB tk caffer 26. SouN Afrtw~'i. Dnt. Med..r. k WWW Det (SpM1. 0 k AM• s'f. 0. Deat, "Lmy anme In South Proe. ant and ued.. &iW67t aet t pr R.Y. sae. ~1tl1iN{R°' "Th..okem GMC 26 1 ~ ~d ~ ~ D. i Zrl ind,~ ~ ~ ~ " Alr pollw C. PIk., A J. 4i. M. Ima,"10P.yn~an.r~.~Ylfu11 RukMCan• ,- J. p. tp C.nm~~nr &+ebay : Ctaurot Adomte Prar. N7ew Yoek• •dLaado4 tr+a r. 228-23L ~ tP

30. D.Hartman.l.Sehmoly, S.B.HWtIL 4 Wyndar, °Tbaeco Carcinee.n..q," in H. V. Golboln. P. 0. P. 1y'e, .da, Po/ytye/ie Hydroewkona and Canea. Vol 1. Enoirennunt. Chamistry and MeraDo/iam• Aead.mle Preo, N.w York, 1978, yp. 86-117. 31. C. J. C1.arX. "Muwnmtnt of polyry. clic aromattc hydracabon. in tho ur of 5ydn.y uain8 vary lon8 alumuy col• umrwfaapu atmn,"Int.J W044, Po4 Wt.7:753(1W~ 32. M. N. In6alla, R. J. Caba, "Ambint Pntlutent conemtmlmu fram mebUe aouren fn micro.cdo ntwtiana. 3A6" P\Por 82076T, SoaNly of Automotiv. Gtnn.en, warendala. PA. t/81 33. rol~ryalie arnmatit hydrocor6orvr f~..lyaton a/soWtN sad.ffate, Na. ilanal Rcoeack CounaL ommttta an Pynna and Salnt.d . Roud on Tosicolafy and Environm.ntal HWtk Hmrds. Commheioa on Lifo W.~Nailn01, 14a9101181 Aead4 m7 Prua, 3L 6 S.WeeW ~V~C ta~b.rt• T. R. Hausa. F. T. Poa, T. W. St.N.y "8.amlalpyra ena eonum ef the air af Amaic.n cam- muMtln," Am. Ind. ttyl. Atme. J. 71: 96. . M. Colued. C. R Ha(la.n, "Carelao. paie dr pollut.nu in r.latlon m auw• qrstivy trafOc In No. Yak." anuiran. 3ei. rah+w/.6t 116 n97D. 36. Lnwranmeato/ 7ub¢aa 9ntow. No.• wrin! as oeurrt and Auutiar R..ItA g/P.rte, Natlopal R.narch CoaxS• Committn an Pamlw Smak• le~ Boad on 89Nranmanul Studim .n Tod<olop, Nuienal Academy wmhItgloa. DC,18K 31. G.A{nkoL "RYmo leatda is IutK m• ea maWlty, .mee8 nnnaaokee wd a ~yon psm+vo.mak , J. Nat. Caa• cvr 1Mt. 88:1061(196~ " 70, fARC MoneNephs on, the aoameticn of tAf Cn.mned.nie )Rytt of CMntteals te Humant. Vol. Jtf Tobaaa BmaMlry, lnYrnatioeul At.ney lor R.eoaeb aa Canar. LYa~ F~r.na, 1910. 39. AIHICulal etltyCY~(ie Gr'ant0 Matta. Natimul R.o.raa Cauxd, Dlv4toa of M.dleal Sdann., Cno~mmittao an Hio• N:mtlm~Ni my af S~daaea, Wr4 LOM 40. FW(.A i Rurall,"FAtlamtfanof~pp daw6o aad monality 6f een.amokan from aaWronmonta tob.etv .nmka," rosicai Lat. 392. 9 f19871. 41. N. J. WakL If. N.nekahd 8.0. Thomup son. H. S. CucHw "Dtw ~ratkiy oth- a a tabaeto .moke ntw Imy 016 n~a "d. NN. J.8lk 1417 (1966'. 12 U. 9. SurBaoa C.n.r.l• r/w Nalth G'onIfqYfnlN of IMq/Y"lary RmOk1~V A Rfpea o/ the 9w Gfurd. U.& D.Patmont of HWtaad HtWma6a• viar. Pubne H.ahk S.r.k.• RotkvilN• MD.19M. t9. D. A.lado. "H.tlN lmua Rahtlng to Pap/w Smokiy; " in S~pA~ and Sya~ciNpyy,T.n~tl lpa fa~ad., La:lapa. Hcob, 11. 8. Ryumr, Y. PeMnaa. M.•C. Sn.R., ad.. ara-Rnutronment.t ro6aeee BntoM,Re Jrama WaWepanRl• peuw twwM• f end l Ud.aYq 16. "Madlrl Par>pmtlvem ae PamFa 8aa W8," In Pnuenriw NN1e4w. Am• dule PNOr 19N. /6 "~Ptama~dmt.~ af tha pIntunatieed Es• PaMf.a m167eF.' 04t.a m ~ +~ur. ~ icN• LrtL mvW, AmNaCam, 17. T. Htrarima, "NOaimekln~ ri.w of hm.vyamokm have a h'yh.r r"bk ottuee ea~.naf homJ.Pw, Rr. NM J. I13121). td D. A.Kd.adidl.LSPa . on. "Lur,e eanca and ra, B. pMt~. amekin8•" lnr. L Conev 37- 1 11961/. 18. S. AkiW tL Kata W. J. 8101. •Pwlvw mtakln8 and 1mta.eqn~ J.pj non wotam..1 nnr Rae Nt a601 I1/M). 60. W. C. CAM. S. C. FunB "Lunr e.nar la non•.mukan ia Haq Rea_8 !n L Crondm.na d Cannr Campsy n, vaL 6. C.nta dpiam~o~o~, GtuWr Plsehar Vvl S u~vt, 1Y~ti 61. P. Corrw L~V. l~kki.. 6. Pamham. Y. tAn. W. Haao.nL "Pwl" .mckine and I eaaea." Lansa >r 696 ( i963/. 61 L. Osr~inWl, 0. Auabaeh, L Jeubon, ' lavoluntary amekln~.nd ~1yty e.ne.r. A um-wauvl studT• J. Ivef. Cannr fnrt. 7/=168 (IH6). 53. C. R. Gillis, yJ. Hokt V. M. Har• thoma. P. 9e 'Tha ffl:oetolaavlean• mmtal tabaeee .mok. In etvo urban cama1udtNa in the wpt of Seeel.od." aar. Rapir.Ob. lik la pp6~). 61. T. lllroyama. "C.nme moet.iitr ia war .mokln8 woym~ae. ~wWiti ameklrq kua• Ja~pn,o~~ :o. M.d. tL /!Gahm O fliN) Y ie 56. 0. C. Kak.L E. G W"ynda, "l.mK eu. eor Ia nmMmokat6 Canea tiL 1214 (1961). 36 A. Kamh, IL Eoh., F. SckmldL "Pu• duo.~mok(8~ ~Y. ~a ptY! hft6e el bPo0" a~ XNn.~aotum°kan." Medisfn4eA 7k (1881R 67. L C. Kaq J. IL•C. f~tN~. L~w, "Aa ~ e N~ ~eB," l nom ~e'mi[ontKent. J. Canw M1K(19N~, 6r. LC.KewJ.H..C.HaQSow,C.Y.Hy Mwumm"m of PamM smnkia8 ud mtimarr af Wapi; mnme tblt aoa•amoklae C¢1mw, hmah.." tUN7 Cenea 71t I7t t M~l 61. P. N. f~,. J. CMmbaWn, M. R. Ald.r- nn, " IatfoeWP N lmmiy .mokiW to ruk ot aatwa and ot6ot amok- ty.~a7~1 d4amm," Jr. J. Caaea 66. 0. H. MLL~k+e.l•~Cadoar. s.riwo.ym.daklea ~~ Wn. L(N. ~la/kd 689/1Y6{I wf~ 41.0 . PMkaPpl& s Hnrba.~, C. Sronroa. SParwodlL6t ~ ~ J. "anrtoL I1i:17(19flL 68. D. P. laadla, A J. W{1ope. R, A$wt• wn."CumuL Wlabaflitalm.pm. eiva.mekly and e.aoa e4Y,"Lanea ls 319n 1. 66. A. H. c Y. L. Hoadaoat, M. C. PR., M. C. Yu. "Smolun8 and otha ri.k /ar toe fm lung e6enl In wetnan." J. Nat. Cancalnat.Ta7Q 1W6 S4. S.T.W.im,RiSp , 9uq.an G.naal'a n9on on t!a hadtk eoma. quaxaa ot laroltmw7 amakl~ a oom• 1r~mt~'Ant. Rau.Rmp, i'ti.wcs Ie6M 66. U!.lurpea Canaalt Y7uHea/N Can• tu9u.nsn o/ ~nesAtng: Canesr and CAnNe ~Ltuq D(..winr~~Nnt pW.a~N.r•. P~n. ADaa~ a t~ g ; 1laalek and H omLaaU~Sanfam,~Pubpi ea.la~i. Hrtlm ~ M i{mekln<; Wl~j. Q. T. D, atar .iADC.°W: cdMet, E. M. Sw- I7ee mv4onm.nW tokaem ameb aad'Itdoar air audlN' la ma~ae o/fla .rork.e.ln,w...wea •J n." .A .a a~ (1987). 67. A. V Na0. "ladea Hr. nar battle. 8round arylna poluttonq" fn YnrboM of 9daoo and the PLmn. Lnqvkpn. d'm 8rit.ank.. CAleya,l9l6. N. "Radem Guflq Up b Dpl wkh Ra. don: Aetien. Ilotun oa R4k in Homu• 77Ya Natto.'r lluRA•yoqumba 196d. 69. C. Cdliq. "14doa dauehta a ad lun6 eaaw," 13rtt. J fnd. Ac b 70. 61P196Rtl6 top,. , d ~ lurmmnev." 1Y WJ.N.~ 81L1810 (1/861. 71. e. L Cakan. "R~oa and lun6 eannr in Swedish mltNn•" N. Ent. J Nfd. l lx 1I68t1Y88). tt S. 0. wdta• J. W. MUp, J. P. Hmtan• '"l3. rNatkmefdp dnnaa tnddma ta t.rrnvla/ r,diatioe aadpopulatim damity in CnnMnkut• 1966-197{," Am. J. apldemiaL 1!k I(IN6). Dr. W. AIL.Cn~w7ad,0J.L,Ia  mtoa~u.lt~.n.eINalt4~baadN~, ~. S.t. tN Boul...rd.. 9..fertk, NdW. 7M AtmadY• TkfsP8pa w tuk- mitmd far P.r m.iN Nowmba 0. W' APt~18. 9K~t.rin