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! Appendix C Nranan 7oxitM. (14bY). k, 7-4 Editorial F:nrlronmental Tnhar'co Snsnke In the Cnnlrxt a( Indatrr A(r Quality At Ih¢ nqdura•ncc on 'Imhuu am! Atnhi: nt Air Oualit•v' nl 1Lnlx•dal CrAlepr un 1)_ I5 lunc, rslwsstue m envircruntntnl h>Lr;nTU smnka• I/i ISI ItanurJ ac nn nryric which. because n( Ixllili: imelinl and FDt'arnrntnlal eaneern, atll:Mled IIN' m,Tl aln•lltlntl. N7lcrcas fcw douM that aclivr nnokin>: aJvarxclv ah'rcls the health of the smoker. Ilte nauur and estcnt o( heallh riska fraat exlxnm c lo utf rtt pcuplc's smoke are more di(6edl to yuantl(y and, in some eases. debuahla. Lssng eaamr and res(Jruory disease In children are the health risks mrol resckrcheJ. while possible efkea of E1S on the incidence nf card'rovascular disease and rm the prugmnis o( (wr- sons who already suffer frnm cardiovax•ulnr disrau ruo a poor third. farcnstfngly Ilnre is little pcr• snasive evidence Ihat exrynurc to CTS Icads In dccreased IunE funclirm in ex(wva•d nJulr.. 11re ma)or(ly of >tudics on E1$ and lung cancer have been eaae-conlrnl studies. comllatiltg rhe smoking status o( the husbands u( aonanhiking (i.r. never snlnked) wonren wtro had rkvdnpcd lung carcerr w•ilh that of the hashanak uf wumcn amtnds. In wklitiun Iherc have been thrct pnxq><w•tila• smdk•. A maJorily, bw not all. of the pnhlishtd n•Ixms have shown a higher lung cancer risk in Ihc rontsotoking women nwrried to nmoken. liuwcrel nl.vnr u( rlu studies are small arW t>hetl to n tarirq• of tucthtrkt• logical eriticison, and few have aune up wilh JiG (ererlcea inrisk thM are anti.tiaJly significant. On the assumptkwr that II is kpilimarc In mmhide the results of differcnl atsnfi.sstvtral invcaigatnr, husr I><sokd Ihe data frmn multiple sludla and suhjcc7ed them to, so-ca1(cd, 'mcta-nnalysic'. In n>< UK the Irsl known of Ihrse anempts is thnl u( Wald rr w( 1 These audwn by (stwkrtg 1¢n easo-amind and three prospective studies calculated a retulive sisk for lung cnsreer of 1.35 (cprfidencc limits 1.17-I.S4), Ihis Bgurc has been widely assumed lo be nscaningful. The Independent Scicntiffe Committee on Srmlking and Health, for instance. cuncludcd recendy rhar ETS exposure increases the risk of lung cancer by 10-30%. However, mst everyone accepts that mela• analysis Is a legitlmme pfsxedurc ar rhal the celculations made by Wakl er al.' are apprnprialc. llws. Leual rr a(.a examined all 11f/.J ronthitmtinm of the ten case-contrd atudicr taf (amd thm nnly 24 uf thcse cnmbinalionc gave a N<k .ignllirnmly grnicr Ihan unily. Furthermore the signiiicunac in thesc 24 combinaliona was larpcly dctcunintd by only Illrc'e ,tudltx witidt ltu•y t.'iuirlt/cJ tn he purlKnlaJy IlawaJ. In Ibc liglu n/ Ih.ircal.vlelitmr the+r. aulh,xs crma•Imkd that Ihrla• is nn lbm cvkkmv of irrCrca>rvl risk uf luax tanaar in li 7$-cslMwJ (lcrstrm. lllr full busfc ul tlrr mcthtrktkrgical dispute hctwca'n surisriaan. is rwlsltk the saslle of this cdiuuial. fluwever, onc xssvrtr of nsofusiun rncrla spccial consida+thm. nanscty, the pmen/ial biaaing ef(ect of Ihe misra'fwrting of smoking status. Wald rr af.l found Ibat only 0.14% ofreportod two-srnokan werc current srmdtcrs whik 4ce' reports a Ilgure ren rimcs higher based on salivary eotinine measure- ments, llre number of ever-smrsken reporting that tllcy havc nclecr smnkayl is morc di((icuh to estirnare. Hnwever. the ealcm n( Ihe discreprrnq Is evideraxd by the JiscorJatue uf res(Mmses to similar yuesliun- naira•a ualminfatcred res twu necasi<wts lo Iht same individualk with an irncrvul yd s.wcral ycan. s Ckady 4 is vrry dillkult lu a+sav the eus'nt of prescm, let alnne past. exptcure tu F73 and. given the exrent td this unc.rtainty. mrc mua atriously sknl(a whether Iht prohkm can b: rnsrdvud by funhcr cyi- Jtmiuktgiral sttdics nf tht sarsrr kilsd. 1'tulharm,ea. :,< Ihc social aa<e(naidlity of slnnking eoelinmr la tWcline wr rnighr espcet wea mlueyxxdng u( .mnkiup IwMts lu gel wursc. Ahus. w'c rvn cx(Vct nn inireaaitig unwlllniglleO rM the IAIn rlf atmlkers tn aJmit td sulfering fnun a'acI(-inAictcJ wound'. If lhe risks offiei:dh' aurthutable to ETS ex(Knure ure real Ihen dle tnsic a•ffccts of EiS uem to he greater than rMr+t that otrc may pfcJicl by extrr- prlutnm (rnm the cflecls af ex(txurc to smoke ia active smnken. indeed such rnrra(solatinn ls far Irnm simrtc. The Itnl rntBttm Is lo Wimate eapnure rn L'1). E7'S is a csnnplcs mixture of many mlcriah willr both perliaulote (rAidAiyuid) and gauouacum- (wmenn. &:vernl authon bave tkmonstnted rhat the differenl components are deared from the for at diffcrrnt ralcs making the chrdee of wlirdl to use as a marker of E1S exposure cstrcrnely diflkalt. Some of tha malerinls that harc been used as marken are not spedfic (or EIS hut are aho Ixescnr In air tnx contaminated by smoke. Thus. particulate malter. CO and uxidas nf nitrogrn ean ckarly be derived from cither sources. t;itvtim!, being a lobacco specific a+m(vtund has been a popular choice (or dnsimelry, hm thi.lms une uf the shnrlesl half-!ives of any of the rtmqtuncnH nf El'ti. 'fhr dtci.nm a. In ,rhit'h cnln- 1>tlrltm shnuld hc uwJ lu asstss Ixult ea{wsure to 6111tr Mavmillan Pres t,tJ 14h4

4 R C. NROWN F.TS and the rfficfrncy of venlii.tion Is taainJ. One candidate is tha lerpinoid, solanasol. Although H ocrun In many'planu belonging to ehe Sounxeae indudio{ tobacco. its eoncentntbn in air pruvides a Ifamd meacurc pl rbe total amhient ndeauo srratke CmnenL' 7Tn ahernarive arpnmch af uMnS tti.Httieal mnnitoriug of exp.sed persnns is eyually diffkult since the ununl marken, ni..uine. irx meuhnlitc oninine in hk.xl aak,ea to urinc. tarlvrayhucnarhlohin and urinary muragens arc subject to many of the ssme problems ns tlane •hich affect the validity of markcn of aiAxanc snK+ko. Additionally there are also pharmaeokinetie and metatwlid diffezonees he• twecn smokers and ram•rmoken which may in• fhunce the results.' Another aspect of the problem is that the physical and chemical properties o(EIS Inlluenee the types of disease that might be expected to result from es• pnsure. Mainstream smoke wntairu small pareiefa which grow in the respiratory trae to a size such that deposHion occurs in the larget airways and this could explain the tumour distribution seen in smokers. The partidcs in ETS arc smaller and do not grow in sizc. One wvuht therefore expect them m be deposited more peripherally and a different pattern of pathukry!v to be evident. I lowtver. in sume studies (c a. K,tar cr References r tVald N1.17enchnbal K.llnnnp.nn SG &('udk NS. (lon brcarbinf aher pcopk. rulur.ca armrkr nuu hm/ r.nctr? Hrirua Af.rln.!lrru.nnl IYIK: 291: 1217-21. ° Letzd H,hlnnnm•r E& Uherla K. kleta-snalyset an passrve snK+kint and luna cancer effecu of ualy+eknion and mia,da>•ilknkm M eapreure. fmvrunmrnrd Trrh.aloay Lnrer{AVan;l: W1--VMi. s Lee PN. An,hanaiw eeplanadon for the ineNaad d+k of lana cannr in mm-.mokcn merdcd W amnkan In: Indoee and Amhicm Air Quanq, eda R rcrry k rW Kirk. pp 1.9-Hrr. L-nrlun: Selprr. 19:q1. e O6dcn MW 8 Mankr KC. Colknian and analysis of el."), the nme lumour types were seen in pa.sive smokers as occur ia aaive smoken. Many persan ate sensitive to ambient mh,cco +hnoke and Ilnd Its preserax nbjectionahlc: the con• rrnl of exposure may be justified on thcac pounds akrne. buw whether unpleeoantnen and irritariun are rnarkrn of rmne serious effrcn wr he:drh 1. uucer tain.On the one hand, if the miarun: uf nrmpmvmr in [lfi is as rnsie as some of the dntn wt7cu. ihen the imldieal4ma IM the enntnJ nf ndrer 'crtkt:nk' in both the workplace and the environmenl need tn be taken more serioudy than at preaenL On Ihe other hand, if the loxicity of E7S has been eaakcrated. ehcn It 7s prnJble that efferts which are pre.entlr bclnl atlrRuted lo eaptaure lo ETS arc in raality duc to exposrre toaherefiemicafs at wotk or to uthcr enviraunenrsl faaon at prescm ra6arded as aafe. In view ef the inaportanee d dt8 subject it is to be hoped that more wwork nn the drnimetry nature and effects of ETS w•ill he suppnrted and that rhe pto- amt snd•tabaao lobbies will allow• it to be reputed calmly. R. C. Ar~wn• MXC Tnnenh+Fiecl Gnie. tV(NhlntYn\lrntl lfrNlll• Cmtduhan. \wrey wlanard as a tracer of eminmm.•nwl roha~n,.m.kr. en: Indwr and Amhitm Air OuaMr, ed. R 14rrr k rW Kirk. pp. 77-WI. Lnrrrkut: Srllr,r, IWA ~ Irani S. HI/mhi E& Shimitu V. Srmdrenerwa ninvinr aml CrniMne le.eh In nlafma aad nrine ax an indea of rnrinnrmenul Wha[cn sm$e uprake. 1.. Inddrn >nd Amhrem Air Olli~htytds R Perry A 1'W Kirk• pp zW-lre. I.omkn: Sctper Iwut. " Ko-. I.C. Hu JH-C & Ltt N. An analYtia ur W,ns rnt factors kr lung ancer in Fhne Kuna. hnnnwiortef Jcwrwsi o/Canrer IY/lx; 73: 119-33.