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, ..:.t. fr Grundhm.nn (ed.1 r Cancea(:amp»Rn. V'ul.6. Canocr Epidcm1ub1qtp Guuar Fischet V'erlJg - stucptarr •Nc+.• York • 1982 Lung Cancer in Non-Smokers in Hong Kong W. C: Ctm and S: C. FuN c Introduction Bronchial cancer is an important health problem in Hong,Kang causing an increasing number of deaths annually. The increase is particularly rapid among men. The death toll increased 50% (802: 12!17)between 1976-1980: The increase among womem was slight (332-5811) (~HongKong, 1981U)i Material and Method In a recent survey of bronchial cancer (ICxaN er al., 1979), among 208 male patients onl+• '_ were non-smokers and among 1'89 female patients 8+were non-smokers: These forrnthe subiects of this investigation. Matched controls were selectedlfrom orthopaedic patients. 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 tumours were obtainedi ResUltS The age distributions of the non+smoker patients and'of the:matehed controls are shown in Table 1: The,highest incidence is in the group above 70. The histological types of the non-smoker's cancers are shown in Table ?'. It can be seen that adenocarcinorna is the prevalent type. The two male cases are too few to be significant. In a, previous study (CHAN' and NIACLENNAN, 1971 this histological type was also high among males although not as high as among,females where it w•as 34.3 "o among 277 cases. In Table 3, it,is seen thartthere are less passive smokers among patients than the controls: .tnd more non-smoking patients have nonrsmok;ing spouses. This tinding is at variance with orharof Dr. HIa:tYart.v's (1'981),. He found tiharmurtalit.• from lung cancer of non-smoking %vomen exppsed to cigarette smoke of their husbands was increased two folds. The histo- logical typesot'their cancers were not given: The present group is of course verv small in comparison to Dr. HtxAYawA's material. The cooking hahitsiof non-smrnking,women are shown in T:+ble 4.

TJfile 1,: .#ge Distribution ot Von-snrokers in a Lung Cancer C.tsr,C:unorul Study. Mal'e Agc Gruup C.tve Control C.»e, 3Y 6 6 atD-~9 6 13 1 3' 19 6U-6'Si I 19 2 30 84 Frmale Cuntro ? 1 42 •0 . 139 T.ible 1: Ccll Tvpes of \on-smokers' Lung Cancer Cases.. Coll a~pe Mak Female Squamous orepidermotd t l5 Small cell anaplnsric 1 4 Adenocarcmuma 38 Laree crll 2 CJthersanJ'unspecihed 10 No histological rertitication 15 34 Table 3:,\umberoE Passive Smokerramong \onrsmoking;Female Lung C:ancer Patients.~ Case Cun[rul 1'.tisn•e smoker 34 (i0:.i "u). or, ; 4-:5 \on+passivr smoker i0 ~ i59.5 '03 -3 :)1..i~ 34 139 fablr 4: Female Nun-vmukcrs' Cooking Habits. Total Nover cook No. Nuvcr cook ~ tth Kerosene NtY., Never cuuk with t;<rro,a Ur qps NoJ.. l:.tse Y; iG (2'2.i'"u) 23 t_'.-.4 "o) 1!S 121.3"" (:untrul 1.34 29 (10"b) ?6 i4U:3°`a) 4,3 130i0"., "{'"o claimed they nrvrr cuunkCCi, 2'.;"•°e nr.rrcookcYl with krrwsrnr, and 2L F"''o nc ,:.x)krd with kerosrncvr }.as.,Thrrr appears to bt less people who never cook with krros, comparing to the control. The differrnce is found to Eir insitiniticanr.+•hrn non-smok :untruis were considrredl (\=' 1.92; 0:11 < P'< U:2).

The interests ofthisstudv, arc: 1. The hilsh incidence rate of female cancer among Southern Chinese (imainln- Cantonese women). Table i shonc•sthc hiehpropornon ot,l:antonese. This fearure has been reporred, from Singapore. San Francisco and I Haacaii. 2. The high proprnrtion of non-smoker cancer among wiunen. 3. The high proportion of adenocarcinoma in this region and partricularle in non-smoker cancer of females. T.rble 5l• Ethnic Groups of 1*lon-snrokrng Fernalr L'ung Crncar Patrenrs, Controls an Hong 6:unR General Female Popuh-tion. Cantonese 68 (81°a) a- (70"b) , i•- ChiuChau 5 i6V 14 :10%1 9.3" Elsewhere in Ke•angtuntt Province 6 `5°o1 b"o Elsewhere in China and others .i (6"0) 21 (15!"0) 91a Theaeoiology of the adenocarcinoma among non-smokers has been the subject of specula.- tion. In the present survey no conelusioncan be made on the part played by the cookine habit. The association ofcarcinoma with tuberculosis was postulated' by STEtNtrz (1972)'. MoK et aL (19-8) recently studied the association of active tuberculosis and lung cancer: They concluded that there was no causal relationship as both tti•ere quite common diseases ~ and chance association was quite probable: The high incidence of female •ancer, particularly ademtkarcinoma. among Southern (:hinese awa'itc further elucidation. There may he a common factor in this res;ion for the high incidence of adenocarcin o,ma lioth inmcn and!tt•omen.As inis nr,tconnected %vith cooking and smoking, th_ dietary nihir, liasso-be furtherstudieul. In an experimental studv. FONG and C.HAN (1977) produced adenv- carinoma of lung in the rats by feeding them nitrite and aminopyrnne. two precursors or .dimethn-l-nlrrosamine. It is possible that precursursmac occur in the Cantonese diet which Irad!'to in vivo nitrosamine formation. lir the Cantonese diet, large amounts of grren veee- taMles may he present. The possii+elitv of a high nitniternitrste content may account for the high incidL•nce of lung cancerinjependent of ciearetce smuking and air pollution. The two l.tnter factors are supposed to lead to squamous carcinoma andl small crll carcinoma. Inve:tigatiitn is heine undertaken to estimate the nitrate conoencof vrLerabl'es in the South. Prchnunars results showa hight nitratecontent about 4 times that oflettu.e from California. A report willihe puhlished later Fo*4c; I981. personal comimrinicationu.

CHAN, \C'. C.,,Cutevt R.e. NT. J., Fes(;: S.C:. Hb. H.C. ; P979):, Bronchial cancer in Honl;' Kuar 1y,-6-1N?%.,Br.,J. Cancer. 39. lY?. CHAN, W:C., FoNG. 1. Y. ' 19--` :.\hcurbic acid'.prevents liver rumour production b.' aminpvrunc ar n¢rite in the rat. lht. J, Cancer. 20. 268. CwA'\„W.C_„NIACLENxA.N. R. ! Lung iancerin Hong I:on¢ Chinese: mortaht.• and histologic types, l`/6Y)-I'y"_. Br. I. Cancer. 35. 226. HIR1YAEtA, T. i 1961i) :\on-s'.mokme"ivesof hcas•vsmokers han•e.a.highcrrisk.ot'lung.cancer: a ctu, trom Japan. B. \L J.. '12. IRIi: Hong Kong (1'Y;A)1:,Ann: Re.p:,Medicai and Health Department. Hong KongLovernment Prinrer. N7or, C.K., VA'Not. P.. VNG. G. B.. I'9-31: Co-esistenrbronchogenic carcinoma and acrive'pulmona: rubcrculosis:,/. Thurax& Cardio-V'.tscuLhrSurgcrv, 76, 469. SzEINnrz: R. ('I%5lc Pulmonary tuberculosis and carcinoma oi~theJunge Ann. Rev. Rcsp. D,is..3-.- .#urhors' addresses: W.C.CHA%: M!B,, B.S,. ;H.1:. . Ph'iD. Lundon)„F.R'.C. Path., Cunsultant:Patholo¢ist, St.Tore..t Hospital! Kowloon. Hong Kung: S.C. FUNG. Research Fellow. Dcpartmenrof Community Ntedir;ine, University of Hong Kong. Hmn I:on¢.