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r 0' 1988 Elsevicr Science Publishers Ib.Y. (Biomedical Division) Smoking and health 1!987: M. Aoki'ct al, editors PASSIVE SMOKING AND LUNG CANCER IN 4fOMEN REIKO INOWE, TAKESHI HIRAYAMA* ~. Kanagawa Cancer Center, Asahi-ku. Yokohama 241`, Jbpan in mem. The iincreaxe in lung cancer rrortality iin,women, however, is diff'icu0't':,,to". Institute of Preventive Oncoliogy,.Shiinfuku-ku, Tokyou, 162, Japan* "" INTRODUCTION 283 A case-control'study on smoking and liung'•cancer was:conducted iin two.cities:in Kanagawa prefecture Japan dis'tinctly different in'social-environment ( Kamakura A'sign'ificant dose-res'ponce rela'tionship-~was observed between the number"of~ciga-~f rettes smoked daily and the risk'of llung, cancer. The risk of lung cancer was sig- . nificantly' higher, the earl ier;;:t'he a9e at~.s!tart of. smoking,.Theses resul ts c1!early and Miurai, featured by residentfal community and;fishery.., indwstry 'respectivel'y). e21" la~ni the reason of the rap"lid ~nc ease in lung caneer mortalit ex in recent s r p y y 1} ;. be expl'ainedi by the influence of active smo'king only,'becausie the majority of '' has come to be suspected as the possible causa'tive factor of lung cancer in women. Epidemiolbgical studies t'fius for reported since 1'981 mostly suggest,such'-possibi. . ~(i.:: lity ('1-7'). Therefo're the role:-of~passiversmoking:vniAung cancer' iin'women wa s ex-. . . ;:,~ ,.... . ; _ amined in the present case-coritrol study lung cancer patients are non-smokers in case of ti;romen: Therefore passive*smoking , <. MATERIALS AND METHODS Miura (13 cases in Kamakura, 1980L1!983and 24 .cases in.Miura, 1973-1981Y were; Husbands smoking habit of 37 cases of-women d'ied`of 1'ung cancer in Kamakura t: . 2:S years)' and the di'strict: ~ Cereb'rovascular.'~dislease.'cas~es were seJected~ax I cont- The cases and the controls were_matched to age"^(year of birth);'year':if dea'th'(t compared with 74 cases d'iied of:'cerebrovascular disease during;the same:period;: wives using s:andard qpestionnaires:'tlantel Nae'nsz'eli~odds,"ratio was cal'culated.for, : ~.~ :..•.. rols because the disease is~known to be.reliaRed'°neither to acti've ner•to passiive satoking. I'nterviews were conductedi by=trained_loca1lipublic health nurses and.inid- . re]lative ris'k. (ir.r.)'wit'h 90% ' con-fidential ~intervals. RESULTS Active smoking (d'irect, smokiing , :-, 24.3%' of' women smaked 'in case "arouo ( smoker's, 9., non-smokers ~ 28) . and^'16.2V:`smo= 1 •>: ked in control group (smokers l2;jnon-.sm~a,,okers~~7~7';62), relati've'risk (odds` ratio) being 1.66 ( 0. 73-3. 76) .:.::., Passiwe smoking (indirect smoking)r:;,_ The.husbands smoking status was'availabl_e;

1 i 284 54'cases out of 74 controls„Before conducting the analysis a survey was made • for 133 smoking,men to study how'roany:,cigarettes were smoked'daily at home. The result showedithat none:of the.smokers of less than four cigarettes a day smoked at home. Since the purpose*of_our study is to examine the effects of passive smoking at home, the smokers kho'snaked at least five ciigdrettes a day were con- sidered as "smokers at home" in the present study. When the lung cancer risk for.:.non-:smoking,women was observed according.to the. smoking habit of their husbands~L.:f+;The:relative"ri'sk,(r.r:).(M.H.odds ratio) was t~ lLrI7 - ... . - ' . 1.A ' 1 t ' 2.25 (0.91-7.10) for:non smoking;w,f1ve•s:.with smoking:husbands compared to nonrsmo-; king wives with non~smokling.~usband, ervat3on;by..number:°of cfigarettes smoke per day revealed that r for'"less than 1'9 cigarettes" was :1:.16 (0.28-4.84)(P> 0.0'5)~ (cases 3, cont. 111);:4ndf for "more` than 20 cigarettes" 3.35 ('1.17-9,67)(P= .-~ ~~:: : 0.051)(cases 15, cont 1,9)',(chi square value;for trend..4.,06:•P<0.05). The'relati-':. ve risk of lung cancer iln °women:who themselves.. smoke was 4.25 ('1.:22-1!4.8'3)i (P= 0.059)(cases7, cont.7). (chi square value for'trend•5.46) '(P<b105). When stratified by',age groups the relative,riisk was 1.39;-(0.294.91) in nonr ~ smoking women. with husbands~smokiing4~",less than: 19 cigarettes a day": It was 3.16 :. .~ . a c .. . (1.06~-9.60) when husband''~s smoked,"hare-tha&*:20 ciga!rettes .a day", chi-square va-~ lue for trend being 0.05), (M:H.odds":ratio) for "smoking women" ,> ,.. was 4.73 (1.22-1'9.35;)(p<0.05) ,.The chi-square`valve for trend iincluding smoking,, women was 5,48 (PC0:05) ~ ,' ' When both age-groups and;d,Kstri'cts were stratified, r.r. (MM.odds ratio) was 2',58 (0.44-5.70) when husbands smoked "'less than 19:ciigarettes"=and13.09 (1.04-: 111.81) when'husbands',amokedo"20 or more':cig'arettes.Aaily"._7he;,chi=square va1ue .:~ for trend was 4 25 (PCO OS): ~,The rellative risk, for"smoking;women: was 5. 50, (11:06- , . I7'.30''. The chii=square:vallue:for•'trendt.including,smoking.women'was 5.17 ('PC0.05):. OISQLISSTOH A case-control' study on"passive"smokiing andilung cancer iin women was conducted_ in, two cities dnistinctly'di.fferent with, regard,to, social environment. When both.: districts (social environment) and age=group:were stratifiedi, relative risk of lung cancer iin'non-smoking wivesriras shown to:be 2.58.,when•.husbands smoked "less: .'.~ :...•'q -. . .,than 1'9 cigarettes a day" andf3 09; when:.hus.ban.ds s.moked "20' ort mare cigarettes a " as day". The rellati ve riskkof.:active smoking (dhrect slrioking) . `was 5.50 which w .,. ..Y higher than the effect of,passive.;srtaking Although study size'.is qu4lte small,the a wI~ present study.might.to considered:to `providqran another evidence°favoring the pa-.• ssive smoking and lung cancer hypothesis.: Smoking at homer shul'd therefore be re- stricted strictly in oder~Ao{,preventtnon:smok,ing family members.from s!ufferingi from lun unnecessaril ~caocer and:'oth w~s lect d di ea ~ y g e e s ses e ' ~ .. . ~•~ ~"~r~ Fr}'''''~+~c~c~''~..' ._ . . _ ..r _ ,. *: ~' . .. , r: ~

6~ 6 r M 65 9 0 0 , ,:- .. ' , n ., , I.01 Oi11:0 r--rr-,nvv, - h:. • ,.: 5-l'9Jd Smokin8 --------------------------------------- ----------- oatslvr: " incl!udinp - ------------------- - - smokinP _ active smokiin2. _ ~. crude, .- 4 O6_ 5 46~. .. . ... . . ~ _aEK-sYratifi'ed---- - 3 90_ :_5_48,----- _ __age_distri_ct-strartified,- -4 20 _ _5,17_----- ,-- ---- ---- . , Fig. Relative Risk for Lurng Cancer in Non smoking, Wives by Husbands;Smoki`in Habiit,'- ~. :. . ~ A casr-control.studxi_Kamakura and kliura.~ . • KanaEawa oreiceture.:Jaaarn REFERENCES 1. Hirayama T(1981'): Nonrsmoking.wives-ofi heavy,'smokers have a higher risk of _ lung cancer; a study from Japan. Br Med J.282 ;183 185 , r ; ~ - Hirayama T(1i9841): Cancer mortality-!in non smokirig•wamen with smoking husben= ds based on a large-scale cohort•stwdy iin`Japan :`Prev Ned, 13: 680-690 . _ , Akiba A, Kato H, Blot WJ (1!986): Passive'smoking `and,liung cancer among •Japa~-~' nese women. Cancer Ries: 4i6:.4'804-4807 Correa P, Pickle LW, Fontham: E, Lin Y, Heanzel F! (1983)/: s Passive Smoking"ri,' and lung cancer; Uancet.'i'i• 59'5-597.. Tirichiopoulos D, Kaliandidi A,-:sparros L(1983 ), Lung cancew an( j pa5sive smok=, li677=676 ingl; concuson of Greek study; .Lancet, ii:'.Piersha!glen G, Hrubec Z, Swensson C(1987) `-Passive:smokirig'aratl .]ung:cancer SMedishi women. Am J Epidemiol.,-"125:; ]7 24." ::. <r.. Garfinkel L,i Auerbach 0, Jouipert L'. ('1985) :`InvoJuntary".smokiin9;and lung ,can- cer, ai case-control study, J Natl eancer Iinst, 75 463 469 ;r fin ty+ f '!i : i , Passive Smoking Active SMOkirnF ~ 3.4