Philip Morris
Ets Issues Binder Ets and Lung Cancer in Nonsmokersvolume I.
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- Tewes
- Thompson, W.D.
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- Voropoulou, N.
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- Wuwilliams, A.H.
- Wynder, E.
- Xiao, H.P.
- Xu
- Xu, Z.Y.
- Yamamoto, M.
- Yasumitsu, T.
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- Yu, S.F.
- Zaman, M.B.
- Zang
- Zhang, A.Y.
- Zhang, R.
- Zheng, W.
- Alderson, M.R.
- Master ID
- 2023382094/2668
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Document Images
Individual papers
Rylander, 1990.................. ..................
Katzenstein, 1990 ...............................
Chen, et al., 1990..............................
Anonymous, 1986/deSerres and Matsushima,
1986 ...........................................
Geng, et al., 1988............. ..................
Mumford, et al., 1987 ...........................
Chapman, et al., 1988.......... ..................
Du and Ou, 1990 .................................
He, et al., 1990/Liu, et al., 1991 ..............
Wang, et al., 1989............. ..................
Wu-Williams, et al., 1990 .......................
Xu, et al., 1989 ................................
Shimizu, et al., 1988 .........................
Sobue, et al., 1990............ ..................
Gao, et al., 1987 ...............................
Koo, 1984, 1989/Koo, et al., 1988 ...............
Tewes, et al., 1990 .............................
Sidney, et al., 1989/Wa11er and Smith,
1991 ...........................................
Holst, et al., 1988 .............................
META-ANALYSIS .............................................
Introduction ...................
(Table 1)
p. 1
References ....................... p. 4
Individual papers
Wald, et al., 1986.......
Blot and Fraumeni, 1986.
Wells, 1988..............
Letzel and Uberla, 1990 ..............
Fleiss and Gross, 1991/Spitzer, 1991.
RISK ESTIMATES BASED UPON MODELING .................
Introduction ..................... p. 1
References ....................... p. 4
Individual papers
Repace and Lowrey, 1985 ..................
Arundel, et al., 1986 ....................
111
TAB
1
2'.
3
18
19
E
F
European Studies
Six studies on spousal smoking and nonsmoker lung cancer
were conducted in Europe (Table 3).2,7,13,,19,23,26 Statistical
significance was reported in two studies, both by the same research
group.2'26 No major cohort study has yet been~conducted in~Europe.
The cohort studied by Gillis, et al., and Hole, et al., although
large, has few lung cancer deaths.7
4
i
Asian Studies.
In contrast, 13 epidemiologic studies on spousal smoking
and lung cancer in nonsmokers (one cohort, twelve case-control)~
have been conducted in China and Japan (hereafter, "Asian studies")
(Table 2),1,4,10,12,15,17,18,20-22,27,28,29 Of this group, several
studies report statistically significant relative risks. However,
none of the reported relative risks is greater than 2.5; relative
risks under 3.0 have been described as "weak" (see Criticisms
section in this notebook). Of particular interest is the 1990
paper by Wu-Williams, et al., conducted in northeastern China.28
This paper reports a statistically significant negative risk
associated with ETS exposure. Other factors (particularly indoor
air quality) were reported to be associated with an elevated risk
of lung cancer in the Wu-Williams, et al., study; such confounders
were not always accounted'. for in the other Asian studies
section on Confounders in this notebook).
(see
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Table 1. United States Studies of Spousal Smoking in Women
Study Risk Estimate(s) Comment
Garfinkel, 1981 1.27 (95% CI 0.85-1.89) Large cohort study; results
1.10 (95% CI 0.77-1.61) contrast with Hirayama
Correa, et al., 1983 2.07 (no CI; n.s.) Extremely small sample size
Buffler, et al., 1984 0.78 (95% CI 0.34-1.81)
Kabat and Wynder, 1984 not given No significant differences
between cases and controls
e at hom
re
ardin
ETS ex
osu
Garfinkel, et al., 1985
1.23
(95% CI 0.94-1.60) g
g
p
r
e
Numerous odds ratios presented
Wu, et al., 1985 1.2 (95% CI 0.5-3.3) Adenocarcinoma only
Brownson, et al., 1987 1.68 (95% CI 0.39-2.97) Hours per day as exposure
category; adenocarcinoma only
Humble, et al., 1987 1.8 (95% CI 0.6-5.4)
Varela, 1987 numerous No statistically significant
point estimate was presented
Janerich, et al., 1990
0.93 (95% CI 0.55-1.57)
in 73 different measures of
spousal smoking
Published data for subset of
Varela, 1987
Kabat, 1990
0.90 (95% CI 0.46-1.76)
Study in progress; surrogate
is "exposed in adulthood at
home"
s©VI'OAeM%Oz
cancer in nonsmokers. The studies are arranged chronologically in~
the table. The abbreviation "n.s.'" stands for "not significant."
Table 3. European Studies of Spousal Smoking in Women
Study Risk Estimate Comment
Trichopoulos, et al., 1981
Trichopoulos, et al., 1983 2.4 (no CI)
2.4 (no CI)
3.4 (no CI) Greece; small case-control
study; has been heavily
criticized
Additional cases and controls
added since first paper
Gillis, et al., 1984 not given Scotland; cohort study; very
few lung cancer death (4 cases,
4 controls in women)
Hole, et al., 1989 2.41 (95% CI 0.45-12.83) Continuation of Gillis,
al., 1984
Lee, et al., 1986 1.00 (95% CI 0.37-2.71) England
Pershagen, et al., 1987 1.2 (95% CI 0.7-2.1) Sweden
Svensson, et al., 1989 1.2 (95% CI 0.4-2.9) Sweden; surrogate is "exposure
as adult at home or at work"
Kalandidi, et al., 1990 1.92 (95% CI 1.02-3.59) Greece; related to Trichopoulos
study
OTTZ8CEZ02:
Study Point Estimate(s)
Sobue, et al., 1990 0.94 (95% CI 0.62-1.40)
Wu-Williams, et al., 1990 0.7 (95% CI 0.6-0.9)
Liu, et al., 1991 0.77 (95% CI 0.30-1.96)
Comment
Point estimate is statistically
significantly negative
Presence of at least one smoker
in household used as surrogate
soTzSCCzo%
Childhood Exposure to ETS and Adult Lung Cancer in Nonsmokers
When the Janerich, et al., paper was published in 1990,
the media focused on a sin le statistically significant risk ratio
(OR) reported by the authors, i.e., an estimated OR of 2.07 (95% CI
1.16-3.68) for "household exposure to 25 or more smoker-years
during: childhood and adolescence.."24 This OR is the only
statistically significant estimate out of 13 exposure categories
in the paper. A single statistically significant point estimate
could have easily occurred by chance alone in a set of analyses this
large.
Only a few other studies have included questions
concerning exposure to ETS during childhood, i.e., parental smoking.
5,9,11,12,15,23,25,27 Regarding these studies, Ernst Wynder and~
Geoffrey Kabat wrote in a 1990 publication:
No consistent association has been reported
for lung cancer and exposure to ETS in
childhood, which might be expected to exert a
greater effect, especially when followed by
exposure throughout adulthood. Of course,
recall of ETS exposure in childhood is more
difficult than recall of such~ exposure in
adulthood.
(Wynder, E.L. and Kabat, G.C., "Environmental Tobacco Smoke and
~
Lung Cancer: A Critical Assessment," Indoor Air Quality, ed. H. ~
Kasu
a (Berlin~ Heidelberg: Springer-Verlag, 1990): 5-15.)
g , ~
Table
4 presents the reported risk
estimates from the W
C.J
~
studies (9 to-date) which discuss childhood ETS exposure and lung N
i
5
Table 4. Childhood Exposure to ETS and Adult Nonsmoker Lung Cancer Risk
Study Point
Estimate Statistical
Siqnificance
Correa, et al., 1983 not given n.s.
Garfinkel, et al., 1985
females
0.91
(95% CI 0.74-1.12)
n.s.
Wu, et al., 1985
females
0.6
(95% CI 0.2-1.7)
n.s.
Akiba, et al., 1986 not given n..s.
Gao, et al., 1987
females
1.1
(95% CI 0.7-1.7)
n.s.
Svensson, et al., 1989
females, father's smoking 0.9 (95% CI 0.4-2.3) n.s.
females, mother's smoking 3.3 (95% CI 0.5-18.8) n.s.
Janerich, et al., 1990
1-24 smoker/yrs exposure 1.09 (95% CI 0.68-1.73) n.s.
_ 25 smoker/yrs exposure 2.07 (95% CI 1.16-3.68) significantly positive
Kabat, et al., 1990
males
0.73
(95% CI 0.34-1.59)
n.s.
females 1.68 (95% CI 0.86-3.27) n.s.
Sobue, et al., 1990
father's smoking 0.60 (95% CI 0.40-0.91) significantly negative
mother's smoking 1.71 (95% CI 0.95-3.10) n.s.
other household members 1.13 (95% CI 0.69-1.87) n.s.
CTT%SMZ0%
Exposure to ETS in the Workplace and Lung Cancer in Nonsmokers
The issue of ETS in the workplace is currently a focus
of public interest, as evidenced by the 1990 draft Guide to
Workplace Smoking Policies prepared by the United States
Environmental Protection Agency. This document is based on the
EPA's draft risk assessment, which used~ data from epidemiologic
studies which assessed ETS exposure in terms of spousal smoking,
not smoking in the workplace.
The current epidemiologic data on workplace exposures to
ETS and lung cancer in nonsmokers are reported in eleven studies
which examined workplace exposure via questionnaire.8'9,11,13,
17,22-26,28 None of these studies provides adequate support for
an increased risk of lung cancer associated with ETS exposure in
the workplace. Only one study reports a single marginally
statistically significant risk. The point estimates of the studies
(in chronological order) are presented in Table 5. (In the table,
"n.s." stands for "not significant.")
- 7 -
