Tobacco Documents Online

' ~II6 BUFFET-f.aETAL Ts1t1.E t-E\POSLRETO ETS FROM CIGARS CIG.SRILLOS a}DPIPES SMOKED 8Y THE HLSU+ND+ND RLSK OF LL\G Ct~YER ~>IO.%O w'0xEN E~r'~•ur< in ETS ~wiecrorc~r+ ~nJ cnntrol. OR' ria CI No expo>ure to any tobacco product 155276 IIH1 Ret. Any empo•ure to ETS from ci_sars. ciga- 53185 1.0? . 0.68-1.55 reHes. pipa. 1-'_59 ?/sears from cioars. cigarillus, 21156 0.6'- 0.36-1.08 pipes 260 + o/yean from ciears, cigarillo+, 18/19 1.60 080-32a pipes 'OR. odds ratio adjusted for age and centre: Ref. reference category. REFERENCES BECHER. H., Z.>TONSKI. W and JOCKEL. K.-H.. Passive smoking in Germany and Poland' comparl>on of exposure levels, sources of exposure. %alidiry. and perception. Epfdemiolo,gt~ 3.509-51J (1992). BOFTErTa. P Imd 76 OTHERS. Multifenter ca5<-conlrol study of 9.lposure to environmental tobacco smoke and luna_ cancer in Europe. J. nar. Cnncer /nrr.. 90, 1114-1150 (1998) . BOFFETT.a. P.. PERSHnGE.,. O.. JOCKEL. K.-H.. EORASTIERE. E.. GABORIEAL. V., HEtrvR/CH, 1.. J.+HN, I.. KREUZER. A'L, MERLETTI. F., NYBERG, F. ROSCH. F. and Su+nn'aTo. L- Cioar and pipe smnkin2 and lung cancer risk': a inullicenter studv from Europe. J. nur. Cancrr bnr.. 91, 697-701 (1999). CARDEN.aS. V.NI.. THUN. M.1.. AUSTIN. H.. LALLY. C.A.. CLARK. W.S.. GvEEIRER<t. RS. and HEATH. C.W. Environmental tobacco smoke and lung cancer monality in the American Cancer Society's Cancer Prevention Study II. Cnncer Cnuses Control. 8, 57-61 (1997). FOrvTH.SM, E.T.H.. CORREA. P.. REYNOLDS, P.. WU-WILLIA.bS. A., BC)TLER, PA., GREENBERG, RS.. CHEN. b'.W., ALTER>Iwu. T., BOYD. P. AL'sTiN. D.F. and LtFE, J.. Environmental tobacco smoke and lun_ cancer in nonsmoking women: a multicenter stud-v. J. nme,: med. AsrnC.. =71. 175'_-1759 (199d) GARFINKEL. L., AUERBACH. 0- and IOUBERT- L.. Involuntary smoking and lung cancer: a case-control study. J. nar. Cancer lnsL. 75, 463-469 (1985). IARC. Tubucco vunking. IARC monographs on the evaluation of carcino- genic risk of chemicals to humans, Vol. 38, pp. 203-206. International Agency fur Research on Cancer. Lyon (1986).

I lne. l. Cancer: SJ, 805-806 (19991 ~ 0 1999 Wiley-Liss. Inc. LETTER TO THE EDITOR Oear Sir. vuoieaoon rn ae ime~~ann~ai unan..gansr Cancer ~fCC vuoi¢amn Oe i un,on •nie,nauanaie Contre ie Lancer Risk of lung cancer from exposure to environmental tobacco smoke from cigars. cigarillos and pipes Cigar smoking is becoming increasinglv popular in the United States, and a similar trend nright take place in Europe. Smoking of cigars. cigarillos and pipes has been considered to entail a smaller risk of lung cancer than smoking of cigarettes (fARC, 1986). We have published the results of a large Euro- pean study suggesdng that the lower risk of lung cancer among cigar and pipe smokers compared to cigarette smokers is due main(y to their lower average cumulative amount of tobacco smoked (Boffetra et al., 1999). Three studies from the United States have reported results suggesting a risk of lung cancer following exposure to environmental tobacco smoke (ETS) from cigars, cigarillos or pipes similar to that found following exposure to ETS from cigarettes (Cardenas et al.. 1997: Fon- tlram et al., 1994; Garfinkel et al., 1985). To our knowledge, no such results have been reported for Europe. We have conducted a large case-control stutlc of ETS and lung cancer among non-smokers in 12 European centres (Bof- fetta et al., 1998). Within thar snrdy, we collected information on the type of tobacco product smoked by the spouses of cases and controls. All smoking wives consumed cigarettes, precluding an analy.sis of male non-smokers. Some non-smoking women en- rolled in 8 of the centres (3 from Germarnt 2 from Italy and I each from Spain. France and Sweden) trere nrarried to a smoker ofcigars, cigarillos or pipes. We calculated the cunudm tive exposure to ETS as the number of grams of tobacco smoked daily by the husband in the presence of his spouse multiplied by the number of years of exposure. In calcrdating ETS exposure frnnt non-cigarette products, we used equivalence weights of 2 g for one cigarillo and 4 g for one cigar: direct information on amount of pipe tobacco smoked was available. We calcndated odds ratios (ORs) of lung cancer and 95% confidence intervals (Cls) after adjustment for age and study centre. We divided the exposed subjects into 2 categories separated bv the 75th percen- tile of the distribution among controls since it has been sug- gesred that misc(assification of ETS exposure is less at high e.rposure levels (Becher et al., /992). The OR of lung cancer in women for ezposure to ETS from any type of tobacco product was 1.11 (95e7o CI 0.88-1.39) (Boffetra et al., 1998). The OR for exposwe to ETS from cigarettes only was 1.05 (95% CI 0.82-1.J5). After excluding the 4 centres withour eaposure to ETSfrom products other than cigarettes, the OR for esposrere to ETS from cigm:s and pipes, alone or in combination srith cigarettes, was 1.02 (95% CI 0.68-155, Table I). In Table 1, we also report the results of the analv.ris by cumulative ecpo.sure to ETSfrom cigars and pipes: e.eposure to less than 260 g/vears of tobacco fhom c'igar, cigarillo or pipe (equivalent to 13 pack(eeaes of cigarenes) t~as eeot associated rrir/r a)i inerease•d risk of lung concer Eepraee-e rtboce th/u le•sel entailed a non-significant increase in Lurg cancer risk. Thirteen exposed cases and 10 exposed comrols reported e.rposure without specifying level of exposure to cigar. cigarillo or pipe ETS. Concomitant exposure to ETS from cigarette smoking br the husband was reported by most ezposed subjects (40 cases and 58 controls). Adjustment for this factor did not affect the excess risk among subjects exposed to ETS from cigars and pipes (e.g., the ratio of ORs between the high and the low categories of exposure shown in Table I increased from 2.6 to 2.8). Our results are consistent with the hypothesis that, similar to exposure to ETS from cigarettes, high exposure to ETS from cigars and pipes mac be associated with lung cancer risk. Yours sincereh•, Paoln BoFFETUt;, Fredrik NYeeeGt-'. Antonio AoLrotrt. Ellen BErvtia,you'• Karl-Heinz IoCK£GS, Michaela KREl.•ZEx''. Franco-. MERCernr. Gdran PexSN.AG[,v2, Hermann POx£aeEUVS. Loren:o 51aroNnToy, H.-Erich WtCHmAnrvs and Rodolfo Sawtccrl10 'lnternational Agency for Research on Cancec Lyon, France 'lnstitute of Environmental Medicine, Karolinska Institute, Stock- holm,Sweden 3lnstinrte for Epidemiological and Clinical Research. Barce- lona. Spain aGustave Roussy Jnstirute, Paris, France slnsritate for Medical Informatics, Biomerrv and £pidemiologt Essen, Germany °GSF Institure for Epidemiology, Munich, Germanp 'Unit of Cancer Epidemiologyt University of Turin, Turin, Italy aBremen Institrete for Prevention Research, Bremen. Germany gVenetian CancerRegistrv, Padua, Italy 10National Research Council. Pisa, Italy Grant sponsor: European Commission; Grant number: EV5V-CT94- 0555: Grant sponsor: Association pour la Recherche sur le Cancer: Grant number: 90CVV01018: Gtant sponsor: Caisse Nationale d'Assurance Maladie des Travailleurs Sociaux; Grant sponsor: Federal Ministry for Education. Science. Research and Technology; Grant number: 01 HK 546: Grant sponsor: Federal Ministry of Work and Social Affairs; Gnnt number: tllb 7-27/13: Grant sponsor: Federal Office of Radiation Prottction; Grant numbers: St Sch 1066: St Sch 4047; St Sch 4074/1: St Sch 4006: St Sch 4112: Grant sponsors: MURST: Italian Association for Cancer Research: Regione Piemonte-Ricerca Finaliztata: Grant sponsor: National Research Council (Italy): Grant number: 91.00327.CT04: Grant sponsor: Spanish Minisny of Health: Grant number: 89002300, Grant sponsor: Suedish ytatch; Grant number: 8913/9004/9109/9?17: Grant sponsor. Sv.edish Ert.iroomemal Protectton Agencv; Grant number: 5330071-I. "Correspondence to'. fnternatiunal Agency for Research on Cancer. 150 cours Albert-Thomat F-69008 Lyon. France Fzs- +33-a-72738312 Emailbofteva@iarc.tr RecnVed 30April 1999:Re%iud 19 1une 1999