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I PASSIVE SMOKING IN ADULTHOOD AND CANCEA RiSK overill relationship of passive exposure to lung cancer risk, the relative risk among women married to smokers was in the same direction. Relatively few women ia Farfin- kel's cohort were under age 50 years, which might expjain these inconsistent results. In a study reportedby Correa et al. (10), a twofold relative risk was seen among non- smokers married to smokers. The risks were similar for males and females, al- though-the number of nonsmoking males with lung cancer was very smalL Among smokers, males who were light smokers with wives who were heavy smokers had a relative risk of 1.5. Trichopoulos et al. (7, 8) also reported an overall twofold lung cancer risk which was statistically signifi- cant among nonsmoking women married to smokers. The studies reported! by Trichopoulos et al. (7, 8), Correa et aL (10), and Hirayama (9) all suggest a dose-response relationship, although different measures of dose were employed in the three studies. In our study, there was no apparent dose-response using either years married to a smoker or average amount smoked by spouse as the measure of dose, but the number of lung cancer cases may be too small to expect a consistent trend Evaluation of dose is not straightfor- ward and depends on factors which we did not measure, such as room ventilation and smoking "style" of the spouse. We found a twofold cervical cancer risk, which persisted after adjustment for level of education~ among women whose hus- bands smoked; We did not collect data on sexual activity of cases or spouses. We also see an increased risk of breast cancer. Since the sociodemographic risk factors for these two sites are not the same, this supports the conclusion that the apparent excess cervical cancer risk is not entirely due to confounding by social class. Buckley et al. (22) reported a fourfold risk of cervical cancer among women whose husbands smoked, but after adjustment for number of sexual partners of the husband, the re- sulting twofold relative risk was not signif- 47 icant. Similar results were reported by Brown et aL (23). Hirayama (9) did not find elevated cervical cancer risk among women whose husbands smoked This may relate to differences in the ages of the women studied or to differences in risk from other factors. No previous study has reported a positive association between breast cancer and either passive or direct exposure to ciga- rette smoke (24-26): In a recently reported study by Rosenberg et al. (27), the relative risk for breast cancer was approximately 1.0 for exsmokers, current smokers, and heavy smokers as compared: with non- smokers. The crude odds ratio of 2.2 that we report is not reduced by adjustment for a number of potential confounding varia- bles. Risk is not seen among women older than age 50 years or among women with less than a high school education, but is fairly constant across all other groups. Pe- trakis (28) has detecte& nicotine in breast fluid of nonlactating women who smoked, which may lead to alterations in breast tissue. This would support a possible role for passive smoking if passive exposure also caused such an effect One other site for which we find an as- sociation with passive exposure, endocrine glands, is not generally thought to be smok- ing-related. The number of tumors here is sma11, of which 11 are thyroid tumors. In summary, passive exposure to smok- ing by spouse is related to an overall risk of cancer in our data. This association per- sists after adjusting for possible confound- ing factors. Associations with several spe- cific tumor sites are also statistically sig- nificant, including some which are not ordinarily regarded as smoking-related; Further studies are required to confirm this broad spectrum of carcinogenicity by pas- sive smoking and to explore the unexpected site-specific findings. RtrXREr+ct.s 1. Harlap S. Davies AM.Infant admissions to hos- pital and maternal smoking. Iancet 1974;1:529- 32 2 Tager IB, Weiss ST.?dunoz A, at al. Longitudinal

48 SANDLER ET AL study of the effects o(` maternal smoking on puf monarv function in children. N EngJ J Med 1981309:699-703. 3. Cameron P. Kostin JS. Zaks JM, et al. The health of smokers' and nonrmokers:'children. J Allergy 1969a3:336.41. 4. Norman-'Taylor N; Dickinson V.A. Dangess for children in smoking fanulies. Community Med 1977;1'28:32-3. S Cameron P. Robertson D. Effect of home environ- ment tobacco smoke on family health. J Appi P syc hol 19'73:57:1 4Y-7. 6. H'hite JR. Froeb HF. Small airways dysfunction in non-smokers chronically exposed to tobacco smoke. N Engl •1 {tfed 19A(f;30'2 ;20-3. 7. Trichopoulos D: Kalandidi A. Sparros L, et al. Lung cancer and passive smoking. Int J Cancer 1981 .2a1-1. & Trichopoulos D. Kalandidi A, Sparros L Lung cancer and passive smoking, conclusion of Greek study. Lancet 19832:6 -,.-8. 9. Hiravama T. Non-smoking wives of heavy smok- ers have a higher risk of-lung caneer. a study from Japan. Br Wted J 1981:282:183-5. 10. Correa P„Pickle LW, Font ham E, et ai: Passive smoking and lung cancer. Lancet 1983t2:595-7. 31. Garfinkel IL. Time trends in lung cancer mortality among nonsmokers and a note on passive smok- ing. JNCI 1981:66.1061-6. 12 United States Department of Health and Human Services. Smoking and health: a report of the Surgeon General. DHHS publication no. (PH5) 79-50066. 13. United States Department of Health and Human Services. The health consequences of smoking- cancer- a report of the Surgeon General. DHHS publication no. 1PHSI 8'2•30179. 14. W..~nd'er EL. Goodman SiT. Smoking and lung cancer. some unresolved issues. Epidlmiol Rev 1983:5:17, -207. 15. Mantel N. Haenszel, W. Statistical aspects of the anai}sis of data from retrospective studies. JNCI 19592'2:7,19-38. 16. Gart JJ. Point and interval estimation of the common odds ratio in the combination of' 2x2 tables with fixed' marginala. Biometrika 1970;57:4 71-5. 17. Bos RP, Theuws JLG, Henderson PT. Excretion of mutagen in human urine after passive smoking. Cancer Lett 1983;19:85-90. I8. Manchester DiC, Jacoby EH. Sensitivity of human placental monooxygenase activit7* to maternal smoking. Clin Pharmacol Ther 1981:30:687•91 19. Manhall JR. Graham S, Byers T. et al. Diet and smoking in the epidemioiogy of cancer of the cervix. JNC1I1983;70:847-51. 20. Trevathan E. Layde P. Webster Lk et aL Ciga- rette smoking and dy~•splasia and carcinoma in situ of the uterine cetvi:. JAMA 1983:250:499-502 21. Lyon JL, Gardner JW, West DW. Smoking and carcinoma in situ of the uterine cervix. Am J' Public Health 1983:73;558.62 22. Bucklev JD, Harris RWC. Doll R, et al! Case- control study of the husbands of women with dysplasia or carcinoma of the cervix uceri: Lancet 1981;2:1010-15. 23. Brown DC, Pereira L Garner JB. Cancer of the cervix and the smoking liusbaad: Can Fam Phy- sician 1982•:38:499-502. 24. Vesaey MP. Doll R. Jones K. et al. An epidemio- logical study of oral contraceptives and breast cancer. Br 54ed J 1979;1:1757-60. 25. Doll R, Gray R, Haffner B, n al. Mortality in relation to smoking: 22 years' ' observations on female British doctors- Br Med J 1980;2.80:96:- 7L 26. Porter JB. Jick H. Breast cancer and cigarette smoking /letterl. N Engl J Med 1983,309:186. 27. Rosenberg L. Schwingl PJ, Kaufman DW. et aL Breast cancer and cigarette smoking. N Engl J Med 1984:310:92-4. 28. Petrakis N3.. Nicotine in breast fluid of nonlac- uting women. Science 19LB:199:303-5. 29. SandlerDP, Everson RB, Wilcox AJ-et al. Cancer risk in adulthood from early life exposure to par- ent s smoking. Am J Public Health, in press.