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fIG. 7.1. 1S!"G cMcEu NrtS) IwKn.RE Maew: SeUAge: cate ArWriss (vistrlct): 1100 toey4' Ox: Oom in ID llung Kong Q Chip• In Ibnq Konq for _yrs. Di+loct fo. _ Occulw lla,:. .- for . xrs. Scriooliny 0 4 6 yr. (~>iyr• lleriGT 5tatus: U Stnqle Q/lsrried []' Midowed r's. Ilusbaw': eccuystian - i!'DK11i0: non-eeokor M •s-swoker yrs. Cj awker L] elparaltas Q Mnd•ev1i.J Cj'l v.tOr•plip .....Jdlay a tASSIrE tKX1HL: ,. Ikwa: S 1 n o f Nowo t Nun•saukar ..._..._. r....r M.~. Othors (I 6ether cl m ICC IqCF1tSE HWeI1M4: CJ Yct ~ No fer _,r yrs. L 1 Datty V rastlrals only l:J Ms,Ur house j= Ovca+dr 1wusW HISIUKY tlk ptA,MIJMAtK 18: No. fo.SI y...icrrlI tlo m Yes C:] Cbest a-rsyt (No. ~ /4nther

riovomv.r 1863, abd ho adviava tt1rt it nrould'bu boat to pwt.gorisue •xDosure as porLtive and aslative only witM qo further kttsanyts at qunatlt.tioa. Thf #tiQnilioawoe levol tort the risk ratios are onloulat.d tor 2 1Lrts, Test A and Tout B. Tost A is whethor tt,w rirk•rstiu is r.a11q gr.attr than one, uainS the Aapealan weru too 111 to' LV intorvierroa, and wo failed to arraate 14eotinA tlioir relxtives, Roci thuy wsre •xcluded troe the stwdy.' Of thu 185 c:uatrols, 80 wura treot.d for frxatures, 17 for indactive bucd sntii joint disriusas (includtaat tuberculosis), 1s for ostwuarttYr+asia, d for rbow.aCoid arthritts, and 6s for other orthonaedic aoaditionr. D.mvsraphic cbxracEerletics of the cases and oontrols aru coaeDared ia Table 7.1. Twd groups aro siwilar iA as., as ~~ N CD

lndicuted by the distributioa In Tabl• 7.1, and wediwn• ot 07.5 years tor esasss and 60 yonrs Zor controls. aocioeoonomic atuttid (ae wawwurud by ocroupitlvn, year.t ot schooling) and recent reoidaricso are also sirnil1r in botli groupr. It is therutora tonatiilorud not auurksary to stratlty thssu variibles In the xnxlyaLs. The cases a.n4 controls' smoking habit ims obtain+rd f.u detail a.s duYaribwt oA pp 86-87, Cbuptor S, xasi the rnsuits .rsro prusuatsd In Tai)i• 5.8, pp 80, .hicb ia rvproducsd turrd as : -OriLhi- 7-2 tur nLL;rv'.'ratArands.`: ThuiruruiCrc wurik dLrnuAtad in •rihItpttlr~~3. w ~ dr~ ` ~ w* `.'tborir.+~r~are a total o! 78.Aon-smokor,i ir~ th• aases and .... ` t1w uuutroln,:. and tbdy_ torm ths 144 Aoa-amokwri - poi>ulation Zor the proront aAalrsis.. Ro atteAptY at quautitatioa (except for Test A) Mas aade ar described above In tSethods. Thon passivo smokin8 (r), ksrosoao (1C) and incensu (Y) were eoasidetroct together, three tatersn4tLnS oircles own be drawn Whowiur savsa possible combinatioas oI expwstzre, and onar isolated circle (N) indioating thcrse who had never boon lxposud to any ot thoso- aourca (?ig. 7.Z). Passive w.oking includes exposure Eo smoking husbands, aohabi tiait relativos, or wurkmatos. - 144 -

TaLE 7.2. t'ELL TYPE OF LUNG GNCEB ]WD S?lO1CM S)tBI?-IN 163'FP•ltNLB P.%TIp+TTS WITN TYP£S I-IV LONG'CANCEIt;*1981-1984 'c p; < 19 padc•-yr S (18) 20-39 pack-yr 8 (29) s 40 pack-yr 8 (29) A.,s.. J ~.:. 1.0 ...+..ti.~...~3~ JLtii. ,' i 14 (8) B (4) 41 I . c~ (22) a A ias

Tic. 7.2. EXl'OSURS GZ'LGORIES TO PASSIVffi sMOKINC,. KEi1OSEN: AN© INCENS6 I NO $XPOS41t3 CLAIPlED . - 147 - ~ zV N ~G~

Tbu au,ubar o! Aon-smc>kind aases with typu:l 1(squamoou,t eell), Z(sm.till asll) and 4(lar=o 4el1) lunar canoer are smail - baiag se.rua, Chreu and tive rra2ructively (Table 7.d ), and did not thurotora attord auaniaUful etati,rtiual anulyois. ?ur type 3 adunur.+crcinoiaa, tUu patho6onosis of wtslelr we kre s,ost intsrwetud in, tharo wor• 60 eioo-aqkrkere, wud the proportions of ditfuruut wxpoeurv uatvrorles are Yubutated In Tabin 7.4. Yhe oasns uro utratitivd lntv vsutral and psriphurxt tumoura to o=oine tliw uontunti*u tltxt our propoqd*ranaa of cantral sdoaouarcinoma midrit be related to inhalud carclnugons. - Tho`''. - •-_'- - ~=risk ratlos (aod tchair-~+44nlticsacu toval) for .:Nrp.; • : •. . JC- . .. , , ... . . . . . .. _~ ~.. . . •. r .-. ~, . :.K . puurivn ,rawkin6 hwroreno and iooonno In our non-smokvr :--.adenucrresiaoms~ team.lo patiet1ts are stiorn iA t able ToCal._;. pnsQtvu ymofcina and passive amokiag'dus to smoking husband alUae .. „- . ..... ~ .. . ._ .... .. _ ~ !-T - .. . . . . . _. . . .. ..._. .i ~,~. aru usamined soParataly. 7.4. DI scussion Tho problem pusod brrtoru us is the preponddraave ot adauocaroinoma o[ luag, usuaily In non-swvkvra, presIowinutftiy oM,itrally Niturtsrl, in uur IIsmais poPulwCioa. This cass-oontrcrl study wxs warried out to oo+npurod oxpusura of oaaoi-acd controls to thruo onviroqment,cl, ini,rled subst,ancas, namely passivQ smokLnd, kerugane atavu cvokind Zumva and home incensd burning tusus. The rasultr sl:orrod that (Tabie 7.5) kwrwwono anct incanso - 1Q3 ..

TABLE 7.3. DI?FSRENT lXPOSURE CATLGORZES !OR TYPCS 1, 2 i 4 LUNG CANCER IN NON-S!lOKIl1G MfOMEN • Ko, of cases Cat~egory squamous csll small ceYl large cell controls (1) (2) (4) * ploase roPer to Fiq.?.ti. I

9'AF3LE 7.4. DZPFERL'NT EXPOSUItE CATEGOfiIZS. F'OZ ADLNOCAJtCINOMA Op LUNG IN NON•SHOKINO WdMLN ExposurQ '~ No. of oasee No. o: CatdOorY C.ntral Periyhoral controls PI 1 3 7 5 32 * pioase rtFer to Ytq.7.2. 3 1 6 1 13 7 21 6 . 17 ; 3S 8 40 9 28 144 . i

eti aru oot ooutriLutcrry tactors tor adacouarcinoma, Central or periphural. Although th4 risk ratio ol pasRive vwul;iat in gruutrr thin oao tor ceutral adunocu.rc1noraa, the levot pi siguitlcanom ia only nbout 10 par cent by Test A. There La howevur sugl{owtion ot puyy4ve smolcind useocLxted •lth peripharul adonocxrclAomri, partLaularly Naesivs tiAokinr duu to emokiag uuavunds. Ths di2turunoae botwofln TeMts A and A ta Table 7.5 could Lw duu to a non-liaear LoKistLc dose-respotico curve or to rrpvrr Lu weunifi+Ilad th+ 1dv41 si oMpuuuro tluv to Lnoomplet• l ti t : oruu a un M ap lva uvlixhcI.A1 rs Therct Isaa beun onl ouw wrt wt r~ p y l , pn ~. . < ~a,uukinL ,iu Nmalo luug Catiuer patiento in fiong 1Cung` (Koo at at, . . " 'ji' . A¢1'F.`+k.~.~== "~1083). „Koo••tuund ttaat paabive ymvkurs &a a!Sroup ha4 a relative riuk or lueti than uuu. 40 vt tbo 56 non-smokur patients (71.4%) aad 63 ot thu 85 cou-amoktar c:crntrulv (74.1%) have boon oxuosoA -' to puteive swAiag, which iu aot istutLatically dltlsreat. The aktientn howervdr lnclueiucl all oell typea and were hotsroge4eoue in ttala rctaos. In additioa, the autbor did not distinsulsh csntrYl and lwrlipheral tumours. The assvolat[un ut pYSUivu rrouktn3 and tund cancsr ~ wuoulal bu further pareoed. Thure kr good tfseoretical support CD tue LUu neeociatioo. Aeccretly, it was rMl>ortvcl that, like W rctlvc auaokore, tlio pasaLvo smoker L* exposed to the snato ~ N

radioelsments in the tobacco, as 50 to 70 per cont of the 210po appeara In sidestreaca sraoke (lintsrs & DiFreaza, 1983). In addition, the exposure of ths pa.ssivs smoker to naturally oocurrins radon dau;hters is incres.sad In a smoky environment. It eas estimated that radon daughte:,exposure could account for 20 to 100 per cent of lun= CaAcars seen In non-smokers (1tarley i~ Paaternack, 1981; •inters L Dihren=a, 1983). The contlicting findinRr of tbe Japanese (H:rayama, 1981) and American (GarSiakle, 1981) studies mirnt be aue to diftarenoes in .methodolosy (xeizz et al, 1083). A potentially important factor is that the American study lacked saokin= data on 135 of the husbanda of nonscoking romen in comparison to only 28% in the =Japanese study, phich may have created biases in the data. A . ~ ~ .: _ : .. ., . - greater number of working women, larger bolnes and a higher :.__ _.. ---.-..,. .. , . divorce rate in tbe Onited 3tatos a.e other factors that could serve to'accosnt for the differences in results b.treon those studies. ia Hon; lCong, the Drobiem of overcrowding is notorious, with many families living In houses/Slats of area 400 to 800 square fset onSy, and this would increase the inhaied dose oZ any potential inhaled carcinogen prssent in home environment« previous estimates would have sstimated the attributable risk of 1un2 cancer due to passive smokias to be 30% greater in non-sraoksrs •xposed regularly to passive smoke -153-