Environmental Tobacco Smoke and Lung Cancer
Following several reports of the Surgeon General on the consequences of involuntary smoking, the U.S. Environmental Protection Agency (EPA) released a report in 1993 in which environmental tobacco smoke (ETS) was labeled a human carcinogen. The report was based on 30 epidemiologic studies from around the world, including a large multicenter case-control study involving SEER registries. The study used a questionnaire specifically designed to evaluate the role of ETS exposure in the development of lung cancer among lifetime nonsmokers. The study revealed that any exposure from a spouse who smoked was associated with at least a 30 percent excess risk. Findings from the first 3 years of the study contributed the greatest individual study weight to the relative risk estimates for lung cancer in the EPA report. After completion of 2 additional years of subject accrual in 1994, the investigators confirmed excess risk among women exposed to ETS in the household, in the workplace, and in social settings. Another interesting finding was the predominance of a particular histology, adenocarcinoma, supporting the theory that sidestream smoke differs in character from mainstream smoke and that the type of inhalation, nasal rather than oral, can affect the deposition of vapor and particles in the lung.
At the same time, researchers were examining other health outcomes of exposure, and studies were done in the workplace to measure nicotine concentrations in office air where smoking was permitted. The cumulative results of these investigations motivated the American Medical Association to review the evidence and join with other organizations in a call for the health community and government regulatory agencies to deal with this threat to public health. Since that time, smoking policies have been developed for workplaces, transportation, and other public sites to prevent the involuntary inhalation of tobacco smoke.
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Fontham ET, Correa P, Reynolds P, Wu-Williams A, Buffler PA, Greenberg RS, Chen VW, Alterman T, Boyd P, Austin DF, Liff J. Environmental tobacco smoke and lung cancer in nonsmoking women: a multicenter study. JAMA 1994;271:1752-1759.
National Cancer Institute. Health Effects of Exposure to Environmental Tobacco Smoke. Smoking and Tobacco Control Monograph No. 10. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. 1999.