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.. ~- ., ~ ~r. ..,4, L Grund:nann Cancer Camp aiFn, \'ol. 6, Cancer Ej+idemiolog! Grsti% fe.cher N'er* • SrurtFart •NeM York • I9S2 Lung Cancer in Non-Smokers in Hong Kong W. C. Cs•.:AN and S. C. Ft.rNG Introduction Bronchial cancer is an impoctartt health problem in Hong Kong causing an increasinF nu:nber of dcaths annuall.: The increasc is parricuiarhy rapid among men. The death toll in:reaced 30 •o U^_=72]-) berween I976-I9S0. The increase among women was slight (332-5SI;, •:Hong Kong. I960). A4aterial and Method In a recent survn of bronchial cancer (Ctu!: er al!, 1979;, among 208 male patients onh• 2 were non-smokers and'among ]E9 female patients 84 were non•smokers. These form the subjects of this in.•estigarion. Matched conrrols were selected from orthopsedic patirnu. All patients and controls were interviewed and questions asked about smoking habit of their spouses and their cooking habits, including the types of fuel used. Histological diag- noses of the rumours were obtained. ResuIts The age dis:riburions of the non-smoker patients and of the matched controls are shown in Table l. The highes: incidence is in the group above 70. The histological n-l+es of the non-smoker's cancers are shown in Table 2. !t can be seen that adenoearcinorna is the preralenr tvpe. The tvvo male cases are too fe.w to be si;nificant. In a pret•ious study (CrtAs and MAeLa..Nan, 197; this hisroluFical mT-e was also high among malcs although not as high as among females where it ..•as .i;.3 "e amonF 277, cases. !n Table 3, it is seen that there are less passive smokers among patients than the controls;. and more non-smoking patients have non-smoking spouses. This finding is at rariance e-•rth that of Dr. HMturA+u's (19S]). He found that mortality from lung cancer of non-smoking w•omr.. ea7+o.ed to eiFarene smoke of their huchands was inereasrd't.co folds. The histo- k,gi,a: ;.~ of thcir cancers were no; given. The rresrnt group is of course .erv smaRin e"aarascm to Dr. HtR..a-wMA's material. T~,c .ookinF ha$iu of non-smoking women are shown in Table 4. 199

a TabAr 1 e AEe Dieribution of hon-taro+kr.r in a Lung Cancer Casc Control Studti. s AEe Group C+u Ala1e . j •'~ Control. Femalc Case Cwrcrol 39 6 6 7 40-49 . 6 13 21 30-59 1 3 19 42 60-69 1 7 19 30 70 - a 27 39 2 30 &t 139 T.b:r 2': Cell Types of l:on-amokers' LunE Cancer Cases. GeA npe ASsle Female $quaasous or epidcrmoid 1 1 c 5inall ceA inaplastic 3 4 Ade:ro"rarwmi 39 LrEe cd! 2 Othen and unsyxcibed 30 No hiaoloFital rerti6carion 15 2 ia Tibk 3:Kum!,er of Passive Smokers among \on•smolin; Female LunF Cancer Patients. Case Control Passive smokcr Non•pauive smoker 34 (40.5'+) SO (:S9 S +) 66 tK".S%.; 73 (52.3'.) $4 139 T.ble4: Female ICon-anakers' Cookin6 Habits. Total Pio.er eoolt 1:0. No.er cool with Kerosersc No. I:erw ooo3: with Kerosene or Ras No. Case 64 15 CZ4'.; 23 t.'".1 '*! 16 2 1.4 %l ~ Control 139 29 (20'+) 36 (403'.) 43 t30.0'.' ~ 22.1 » claimed the.• never cooked, 2'.4 °L never cooked' with kerosene, and 21.a "o never ~ eooked with kerosrno or gas. T}xi c sppcars to be kss people w- ho never cook w-ith kerosrnc comparing to the control. The di':rence is found to be insignificant when non-smol:ing ~ controls were considered! (X;.92; 0. 1 < P < 0.2). N N

Discussion ' . , TIx inrerests of this srud% sre: 2. The high incidence rate ar female cancer among Southern Chinese (mainli Cantonese women). Table 3 shows the high ptoportion of Cantonese. This fearure has been ttported' from Singapore, San Francisco and Hawaii_ . 2. The high proportion of non-smoker cancer among w•otAm.. 3. The hig!: proportion of sdenoarcinoma in this region and particularly in nonatnoker cancer of females. Tadle 3: fr)mic Grours of Non-.watiw= iFrarrle fr.j f.w.n Tarie.r4 Cont.oh an }ior>< KoeE Ge=a) Frmak Popu)acioei. Case Control HonE ICon; General Population. Canroneu 68 (Sl w) r, G0%) TS.7''~. Chiu Chau S(6'.) ' 14 (10`:, 9.3'. E1ur•bcre in 1:..•an;runF Pro.•irue 6V %) 7 i3 %y 6''~ EknA-bere in China and or?xrs S t6 +1 21 (1S°.) 9% ia ]39 100'. The acrioloFyof the adeno:arcinoma among non-smokers has bern rthe subject of specula- tion: In the present sur.-ey no conclusion can be made on the pan played bM• the cooking 3iabit_ The associarion of carcinoma with tubereulosis ..as postulated by Stwmrz (19:2): 1Sot: er a1. i19-6', reccntl.-studied the association of active tuberculosis and lung cancer. They eoncluded rhat there was no causal relationship as both were quite common diseases and chance association was quite probable. The high incidence of femak cancer, particularly adenocarcinoma, among Southern Chinese a..•aits further elucidation. There may be a common factor in this region for the high incidence of adenoearcinoraa i-oth in men and,women. As it is not eortnectcd with eouking and smok ing., tl'ie dietary habit has to be funher studied: ln an ezperitnental srud+•, Fo-eG and CHAx (1971) produced adeno- earcinoma of lung in the rats by feeding them nitrite and sminopprine, two precursors of dimethyl-nitrosamine. It is possible that precursors may occur in the Cantonese diet which 3ead to in .-i.•o nicrosamine formarion: In the Cantonese dict, large amounts of grren rege• z,bles ma•• I+e present. The possibility of a high nicriie!nirrate content may account for the high incidence of lung cancer independent of cigarette smokinF and air pollution. The two latter factors are supposed' to Iead to squamous carcinoma and small cell carcinoma. Imestigation is being undertaken to estimate the nirra+e content of argctabks in the South. Frel'iminar.• results show a hight nitrate content about 4 times that of lettuce from California. A report w•t71 be published later (Fo.e,19S3, personal communication). 201

._ ~ •- . . ..~~.} . ^ 0 . A i © Ref'ercnces CH..., R. C., Cot..ouan-a, )M(. J., Fuuc, S. C_ Ho, H. C. (14"9) :B"wbchW cwbn in Han; Koet;. ?9%6-19r. Br. J. Cancer, 39. )l:2. Cw... V. C_~Fwsa, Y. Y. (19: 7): Ascorbic acid yrewen(s liv.er sumour producrion by atninpyrine and nirrire in the rat. {nt. J. Canca,20, 265: 'Of' (I9"7): LonF cancer in Hon; Kong Chinese: aortslirv and liiookrFical -Csu. Alat:Ltx%-Ar: R C . . . , . .. , tp{+cs, l960-19'2. Br. J. Cancer, 35.21'6. Hiuvaw., 7. (7961): AonamokinE vira of bcar. smokers have a highe: risl of 4a; uncer: a aud. from Jaluz. B. M. J., _'d2, 163. HonF Kon; (1980: : Ann. Rep. Medxal and Health De, arttnent. HonE Kong Go.•ernrnent Printer. !Uot:. C. K'., \ xNat P.,,O.6, G.B. (29'6; : Coo-cxistent bronchoFenic carcinoma and activc pulmonarY tuberculosis. J. Thoni & CGrdio-VascuFar Surgery, 7 6,459. , Srtjxm. R. (1965) : Pulmnnarr ruberculosis and carcinoma of the lung. /lntL Rev. Resp. Dis» L,: SS. Authors' addresses: W.C.CH...; Nl:S., B.S..,(,H.K .1, Ph.D. (London), F.,R.C Path., Consultant Pnho)uFist, St.7cresa's Hospital. Ko..-loon, HonF KonF., S.CFtN-e, Research Fellow, Dn,anment of Comrnunir.• Aledicine. University of Hong Kong. Hong Kong. I 202