Tobacco Documents Online

. ..~ . . ; ..4 ,- ~ , 8. Grundmann 'cd.": Cancer Cam; aign, \'o1i 6, Cancer li,+idemioloF} liestP Fnrhrr t'tr1aF •Srurtpr • `ewYork • 19S2 Luna Cancer in Non-Smokers in Hong Kong n.C. Cr.AN and'S.C. FUNG Introduction Bronchial cancer is an important health prohltm in Hong 1Cong causing an increasing number of dearn< annuallr. The increase is parricularly rapid among men. The death:toll increased 30°0 '502-]2l-) between 19' ~6-19S0. The increase among women was slight (533-=S]?'Hong Kong. ]980). Asaterial and Method In a recent sur+•e% of bronchial cancer (Ctvix et aL, l9%9); among 208 male patients only 2 were non-smokers and'amonE ]g9 female patients 84 were non'smokers. These form the subjects of this investigation. Matched controls were selected from orthopaedic patients. ?Ill patients and controls were inten•iewed' and questions asked about smoking habit of their spouses and their cooking habits, including the t.Tes of fuel used. Histological diag- noses of the rumours were obtained. Results The age distributions of the non-smoker patients and of the matched controls are shown in Tab1e 1. The higher. incidence is inshe group abotY 70. The histological t.-l+es of the non-smol:er's cancers are shown in Tablc 2. It can be seen that adenocarcinoma is the prevalent nje. The two male cases are too few to be significant. In a pre.•ious study (CtuX and l1aCLENNxN, 197, '; this histological r.Te was also high among ma)ts although nor as high as among females where it w•as .i;.3 A among 2-,, cases. In Table 3, it is seen that there ue kss passive smokers among patients than the controls; and' more non-smoking patients have non-smoking sl+ouses. This finding is at.•ariance w-ith that of Dr. HituVA.SsA's (l9Sl): He found that mortality from lung cancer of non-smoking w•om_:, exro,ed totiFarene smoke of their huchandc .vas increased t.+•o fo13s. Tne histo- logic:: :y}+cs of their cancers werr no, git•en. The rresent group is of course vrr.• sma11 in cc*n:rartf-cm to Dr. HtR.a.Nt+'s ma:rrial. Tic cookinF'ta!%ts of non-smoking women arc shown in Tablt 4. 199

Tabli 1_ ARc Distribution of 14ow-amaFtn in a Lung Cancer Case Conirol Studs. /1ge Group Case liialc~ r Control' Case 39 6 6 •0-49 6 13 S0-S9 I 3 19 60-69 I 7 19 70- 6 27 2 30 64 Ferr.ak Control 7 21 42 30 39 ]39' Table 2: Cef1 7vpes of tPOn-smukers' Lung Cancer Cases. Cell nype Male Female Squ:ASous or epidermoid Small ccll anaplassir Adrnocsrcinoma Lrge csl9 Others and unspecified :4o histoloFical .•erti6cation I I 1S 4 36 2 10 3 S 2 64 Tablr9: \um:+rr of Passi.c Srnokcrs among Non-smol:in; Femak Lung Cancer Patients. Case Control Passive ssioker Non-passi.Y smoker 34 (+103 °.) SO (59.5':, 66 (4'.S'.) 73 (52.5'e) 94 159 Table 4: Female \on-smokers" Cooking Habits. Total Nover cool: No. Norer cook with Kerosene !:o. Nc.ar cook with Kerosene or Itas No. Case 9/ 1.5 G2.4 '.;' 23 '".4 %,, I F;a s A1, Control 139 29 (20°.) 36 140.360.1 43 t30.b A! 2? 4 A claimed the%• nesxr cooked, 2-.4 °o never cooked with kerosenc. and 21.4 'C never cooked a•ith I crocenr or gas. Thcic appcars ro be less peoTlt who never cook with kcrosrnc comparing to the control. The dl':,-rente ic found to be insignificant ..-hcn, non-smokrng controls ..ere considered. (X==;.9'_; 0:3 < P< 0'?): 200 202351ti61.8 ( j ~ ,

f Discussi€rn r TFie inrcrests of this srudk are: ]. The high incidence rate of female cancer among Southern Chinese (mainly Cantonese a•omen). Tablr S shows the high proportion of Cantonese. This feature has been reported from Singapore, San Francisco and Hawaii. .. 2 The hiFh proponion of non-smoka cancer among ..•omcn. 3. The hiF!: proFortiol of adenocarcinoma in this region and particularly in non-smokes cancer of fema les. Table 5: Ethnic GrouTs of No+.-smqiiwi Fraealr Lain fincer lai:rets, Controls an Hong kon& GencaJ Fcrsair Population. Case Control Hong Kong General Population E'antot,cKe 6C (SI °.), 97 r-O A) 15.1 °A Chiu Ciuu S(6 :; " 14 (1Q°•o; 9.3 » ElseM'here in KM•anFcunj~ Prol'In:e 6G:; ?(5°e) 6°.: El.iea•herc in China and o:iers S(6'.)' 21 (1S`or 9°10 14 139 Io0 °~ The aetiology of the adenoarcinotna among non-smokers has been the subject of specula- tion. ln the present survc% no conclusion can be raadr on the part played by the cooking habit. The association of carcinoma with tuberculosis -as postul'ated by STv:-m (1F, 2). Uot: e•.• al. recently sn:died the associstion of active tuberculosis and lung cancer. They concluded that there was no causal relationship as both were quite common diseases and chance associarion was quite probable. The high incidence of fstnak cancer, particularly adenocarcinoma, among Southern Chinese awaits further elucidarion. There may be a common factor in this region for the high incidence of adenocarcinoma both in men and +*•omen. As it is not connected a•itis cooking and smoking; the dietary habit has to bc further srudied! }a amexpetimental srudy, Fo~G and Ctttir: (I 7,,)produced adeno- ureinorna of )vng in the rats by feeding them nitrite and uainop, rine, two precursors of dimerh4t-nitrosaminen It is possible that precursors may occur, in the Cantonese diet x hich, kad to in .iro nirrosamine forrnation. In the Cantonese diet, large amounts of grren sege- tables may be present. The possibility of a high niiriteMirrate content may account for the high incidence of lung nncer, indcpcndent of cigarette smoking and air pollution. The two laater factors are supposed to kad to squamous carcinoma and small eell carcinoma. Investigation is being undertaken to estimate the nitra*e content of .•cEetables in the South. Prcliminar.• resul'ts sho.k a highrnicrate content about 4 times that of ltttuce from California. A report u•il1 be published later (Fo.NG, 1981, personal eommurticarion). 201 I 1

. . 0 1 s References CMa.., VC'. C., Cot.ioui<ra, M. J., Fuwc, S. C.,, Ho, H. C. (19"9) : Bronchisl canccr in Hong Kong. 19' 6-19' . Br. J. Cancer, 39. 152. Gu-,. a'. C..-Fo.c, Y. Y., (197,): Ascorbic acid prcvrnts fi.er tumour produaion by aminpyrinc and' nitrire in the rat. lnt. J. Cancer, 20, 265:, CwcN, a.C., Alad.iN.Nr:, R. (19-'+): Lung cancer in Hong KonF Chirie.e: morulits and hisroloFical nZ+cs,1960-19"2. Br. T. Cancer, 35. 226. Haaara w, T. (1951); Komtmoking M-irss of ]iea- smol:en halc a hiFhc: risk of IunF cancer: a ctud% from Jap:r_ B. M. J., 2b2,' 163. HonF Kong (1980; : Ann. Rep. Medical and Hcalrh Dcp artmcnt. Hong Kong GovernmenrPrintcr. Nfot:. C. K., XAxDt: P., O.c, G.B. (I9"8; : Cv-exisrem bronchoFcnic carcinoma and aaivc pulmonar% tut+erculosis. J. Thorax 6: Cardio-Vascular Surpcry; 76,4.)9. STrj-.rrz. R. (1965): Pulmonary tuberculosis and carcinoma of the lung. Ann. Rev. Resp. Dis., 6', :SS. Authori addresses: X.C.C++.+x, M.B., B.S.. (H.K.), Ph.D. (London), F.R.C Path., Consultant Pathologist,,St.Terw's Hospital. i:o«loon, Hong Kong. S. CFL-vG, Research Fe11oN•, De, arrment of Community Medicine. University of Hong Kong. Hong KonF. t L 202 t