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A case–control study of lung cancer and environmental tobacco smoke among nonsmoking women living in Shanghai, China

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Abstract

Introduction: The incidence of lung cancer in women living in China is among the highest in the world but it does not appear that tobacco smoking is a major risk factor for lung cancer. As tobacco smoking is highly prevalent in Chinese men, exposure to environmental tobacco smoke (ETS) may play an important role in the development of lung cancer in Chinese women who never smoked. We conducted the present investigation because previous studies did not account for dietary habits or indoor air pollution from Chinese-style cooking and they did not assess the effect of occupational exposure to ETS.

Methods: A population-based, case–control study was conducted to evaluate the relationship between lung cancer and exposure to ETS among nonsmoking women living in Shanghai, China. Five-hundred and four women diagnosed with incident, primary lung cancer between February 1992 and January 1994 were identified through the population-based Shanghai Cancer Registry. A control group of 601 nonsmoking women was selected randomly from the Shanghai Residential Registry, and was approximately frequency-matched to the age distribution of the lung cancer cases. Information on lifetime domestic and occupational exposure to ETS was obtained through face-to-face interviews. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated by unconditional logistic regression.

Results: The OR for ever exposed to ETS from spouses was 1.1 (95% CI: 0.8–1.5), and the OR for ever exposed to ETS at work was 1.7 (95% CI: 1.3–2.3). Furthermore, the OR increased with increasing number of hours of daily exposure to ETS in the workplace and with increasing number of smoking co-workers. No associations were found for exposure to ETS during childhood.

Conclusions: The main findings of the present study are that long-term occupational exposure to ETS, both alone or in combination with exposures at home, conferred an increased risk of lung cancer among women who never smoked. The inconsistency of the results regarding exposure to ETS at home and at work may have been due to lower exposures at home.

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References

  1. US Department of Health, Education, and Welfare (1964) Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Rockville, MD: US Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, PHS Publication no. 1103.

    Google Scholar 

  2. US Department of Health and Human Services (1982) The Health Consequences of Smoking: Cancer. A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Public Health Service, Office on Smoking and Health, DHHS Publication no. (PHS) 82-50179.

    Google Scholar 

  3. International Agency for Research on Cancer (1986) IARC Monographs on the Evaluation of Carcinogenic Risk of Chemicals to Humans: Tobacco Smoking (Volume 38). Lyon: World Health Organization, International Agency for Research on Cancer.

    Google Scholar 

  4. National Research Council (1986) Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: National Academy Press.

    Google Scholar 

  5. US Environmental Protection Agency (1992) Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Office of Research and Development, Office of Health and Environmental Assessment. (EPA 600/6-90/006F) Washington, DC: US EPA, Office of Research and Development RD-689, December.

    Google Scholar 

  6. International Agency for Research on Cancer (1986) In: Muir C, Waterhouse J, Mack T, et al., eds., Cancer Incidence in Five Continents. IARC Scientific Publication no. 88, Vol. V. Lyon: International Agency for Research on Cancer.

    Google Scholar 

  7. Jin F, Devesa SS, Zheng W, Blot WJ, Fraumeni JF Jr, Gao YT (1993) Cancer incidence trends in urban Shanghai, 1972–1989. Int J Cancer 53: 764-770.

    Google Scholar 

  8. Gao YT, Blot WJ, Zheng W, Fraumeni JF Jr, Hsu CW (1988) Lung cancer and smoking in Shanghai. Int J Epidemiol 17: 277-280.

    Google Scholar 

  9. Deng J, Gao YT (1985) Prevalence of smoking among 110,000 adult residents in Shanghai urban area. Chinese J Prev Med 19: 271-274.

    Google Scholar 

  10. Wu-Williams AH, Dai XD, Blot WJ, et al. (1990) Lung cancer among women in north-east China. Br J Cancer 62: 982-987.

    Google Scholar 

  11. Ko YC, Lee CH, Chen MJ, et al. (1997) Risk factors for primary lung cancer among nonsmoking women in Taiwan. Int J Epidemiol 26: 24-31.

    Google Scholar 

  12. Koo LC, Ho JH, Saw D, Ho CY (1987) Measurements of passive smoking and estimates of lung cancer risk among non-smoking Chinese females. Int J Cancer 39: 162-169.

    Google Scholar 

  13. Le Marchand L, Wikens LR, Hankin JH, et al. (1991) Dietary patterns of female nonsmokers with and without exposure to environmental tobacco smoke. Cancer Causes Control 2: 11-16.

    Google Scholar 

  14. Sidney S, Caan BJ, Friedman GD (1989) Dietary intake of carotene in nonsmokers with and without passive smoking at home. Am J Epidemiol 129: 1305-1309.

    Google Scholar 

  15. Kalandidi A, Katsouyanni K, Voropoulou N, et al. (1990) Passive smoking and diet in the etiology of lung cancer among nonsmokers. Cancer Causes Control 1: 15-21.

    Google Scholar 

  16. Qu YH, Xu GH, Huang F (1986) Ames test in the emissions of heated edible oil. Cancer (In Chinese) 6: 58-60.

    Google Scholar 

  17. Chinese Academy of Medical Sciences (1981) Food Composition Tables (In Chinese). Beijing: People's Health Publishing Co.

    Google Scholar 

  18. China Report (1985) 10 percent sampling tabulation on 1982 population census of the People's Republic of China. Foreign Broadcast Information Services.

  19. Levin LI, Zheng W, Blot WJ, et al. (1988) Occupation and lung cancer in Shanghai: a case-control study. Br J Ind Med 45: 450-458.

    Google Scholar 

  20. Levin LI, Gao Y-T, Blot WJ, Zheng W, Fraumeni JF Jr (1987) Decreased risk of lung cancer in the cotton textile industry of Shanghai. Cancer Res 47: 5777-5781.

    Google Scholar 

  21. Breslow NE, Day NE (1980) Statistical Methods in Cancer Research: The Analysis of Case-Control Studies. IARC Scientific Publications no. 32. Lyon: International Agency for Research on Cancer, pp. 192-246.

    Google Scholar 

  22. Hastie TJ, Tibshirani RJ (1993) Generalized Additive Models. New York: Chapman & Hall.

    Google Scholar 

  23. Fontham ETH, Correa P, Reynolds P, et al. (1994) Environmental tobacco smoke and lung cancer in nonsmoking women: a multicenter study. JAMA 271: 1732-1739.

    Google Scholar 

  24. Wu AH, Henderson BE, Pike MC, Yu MC (1985) Smoking and other risk factors for lung cancer in women. J Natl Cancer Inst 74: 747-751.

    Google Scholar 

  25. Shimizu H, Morishita M, Mizuno K, et al. (1998) A case-control study of lung cancer in nonsmoking women. Tohoku J Exp Med 154: 389-397.

    Google Scholar 

  26. Boffetta P, Agudo A, Ahrens W, et al. (1998) Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe. J Natl Cancer Inst 90: 1440-1450.

    Google Scholar 

  27. Nyberg F, Agrenius V, Svartengren K, Svensson C, Pershagen G (1998) Environmental tobacco smoke and lung cancer in nonsmokers: Does time since exposure play a role? Epidemiology 9: 301-308.

    Google Scholar 

  28. Wells AJ (1998) Lung cancer from smoking at work. Am J Public Health 88: 1025-1029.

    Google Scholar 

  29. Friedman GD, Petitti DB, Bawol RD (1983) Prevalence and correlates of passive smoking. Am J Public Health 73: 401-405.

    Google Scholar 

  30. Coultas DB, Samet JM, McCarthy, JF, et al. (1990) A personal monitoring study to assess workplace exposure to environmental tobacco smoke. Am J Public Health 80: 988-990.

    Google Scholar 

  31. Muramatsumm M, Umemura S, Okada T, et al. (1984) Estimating of personal exposure to tobacco smoke with a newly developed nicotine personal monitor. Environ Res 35: 218-227.

    Google Scholar 

  32. Tomatis L, ed. (1990) Cancer: Causes, Occurrence and Control, Vol. 100. Lyon: International Agency for Research on Cancer.

  33. Siemiatycki J (1991) Risk Factors for Cancer in the Workplace. Boca Raton, FL: CRC Press.

    Google Scholar 

  34. Brackbill R, Frazier T, Shilling S (1988) Smoking characteristics of US workers, 1978–1980. Am J Ind Med 13: 5-41.

    Google Scholar 

  35. Stellman SD, Boffetta P, Barfinkel L (1988) Smoking habits of 800,000 American men and women in relation to their occupations. Am J Ind Med 13: 43-58.

    Google Scholar 

  36. Cardenas WM, Thun MJ, Austin H, et al. (1997) Environmental tobacco smoke and lung cancer mortality in the American Cancer Society's cancer prevention study II. Cancer Causes Control 8: 57-64.

    Google Scholar 

  37. Brownson RC, Alavanja MC, Hock ET, Loy TS (1992) Passive smoking and lung cancer in nonsmoking women. Am J Public Health 82: 1525-1530.

    Google Scholar 

  38. Copeland KT, Checkoway H, McMichael AT, Holbrook RH (1977) Bias due to misclassification in the estimation of relative risk. Am J Epidemiol 105: 488-495.

    Google Scholar 

  39. Brownson RC, Alavanja MCR, Hock ET (1993) Reliability of passive smoking exposure histories in a case-control study of lung cancer. Int J Epidemiol 22: 804-808.

    Google Scholar 

  40. Coultas DB, Peake GT, Samet JM (1989) Questionnaire assessment of lifetime and recent exposure to environmental tobacco smoke. Am J Epidemiol 130: 338-347.

    Google Scholar 

  41. Pron GE, Burch DJ, Howe GR, Miller AB (1988) The reliability of passive smoking histories reported in a case-control study of lung cancer. Am J Epidemiol 127: 267-273.

    Google Scholar 

  42. US National Institute for Occupational Safety and Health (1991) Environmental Tobacco Smoke in the Workplace: Lung Cancer and Other Health Effects. Cincinnati, OH: NIOSH Publication no. DHHS (NIOSH) 91–108.

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Authors and Affiliations

  1. Joint Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada

    Lijie Zhong & Mark S. Goldberg

  2. Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People's Republic of China

    Lijie Zhong, Yu-Tang Gao & Fan Jin

Authors
  1. Lijie Zhong
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  2. Mark S. Goldberg
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  3. Yu-Tang Gao
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  4. Fan Jin
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Correspondence to Mark S. Goldberg.

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Zhong, L., Goldberg, M.S., Gao, YT. et al. A case–control study of lung cancer and environmental tobacco smoke among nonsmoking women living in Shanghai, China. Cancer Causes Control 10, 607–616 (1999). https://doi.org/10.1023/A:1008962025001

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