BMJ  2005;330:277 (5 February), doi:10.1136/bmj.38327.648472.82 (published 28 January 2005)

Paper

Environmental tobacco smoke and risk of respiratory cancer and chronic obstructive pulmonary disease in former smokers and never smokers in the EPIC prospective study

¹ Imperial College, London W2 1PG

Objectives To investigate the association between environmental tobacco smoke, plasma cotinine concentration, and respiratory cancer or death.

Design Nested case-control study within the European prospective investigation into cancer and nutrition (EPIC).

Participants 303 020 people from the EPIC cohort (total 500 000) who had never smoked or who had stopped smoking for at least 10 years, 123 479 of whom provided information on exposure to environmental tobacco smoke. Cases were people who developed respiratory cancers or died from respiratory conditions. Controls were matched for sex, age (plus or minus 5 years), smoking status, country of recruitment, and time elapsed since recruitment.

Main outcome measures Newly diagnosed cancer of lung, pharynx, and larynx; deaths from chronic obstructive pulmonary disease or emphysema. Plasma cotinine concentration was measured in 1574 people.

Results Over seven years of follow up, 97 people had newly diagnosed lung cancer, 20 had upper respiratory cancers (pharynx, larynx), and 14 died from chronic obstructive pulmonary disease or emphysema. In the whole cohort exposure to environmental tobacco smoke was associated with increased risks (hazard ratio 1.30, 95% confidence interval 0.87 to 1.95, for all respiratory diseases; 1.34, 0.85 to 2.13, for lung cancer alone). Higher results were found in the nested case-control study (odds ratio 1.70, 1.02 to 2.82, for respiratory diseases; 1.76, 0.96 to 3.23, for lung cancer alone). Odds ratios were consistently higher in former smokers than in those who had never smoked; the association was limited to exposure related to work. Cotinine concentration was clearly associated with self reported exposure (3.30, 2.07 to 5.23, for detectable/non-detectable cotinine), but it was not associated with the risk of respiratory diseases or lung cancer. Frequent exposure to environmental tobacco smoke during childhood was associated with lung cancer in adulthood (hazard ratio 3.63, 1.19 to 11.11, for daily exposure for many hours).

Conclusions This large prospective study, in which the smoking status was supported by cotinine measurements, confirms that environmental tobacco smoke is a risk factor for lung cancer and other respiratory diseases, particularly in ex-smokers.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Environmental tobacco smoke and mortality in Chinese women who have never smoked: prospective cohort study

Wanqing Wen, Xiao Ou Shu, Yu-Tang Gao, Gong Yang, Qi Li, Honglan Li, and Wei Zheng
BMJ 2006 333: 376. [Abstract] [Full Text] [PDF]

Evidence is unfavourable for passive smoking
BMJ 2005 330: 0. [Full Text] [PDF]

Questions and answers

Kamran Abbasi
BMJ 2005 330: 0. [Extract] [Full Text] [PDF]

More evidence on the risks of passive smoking

Ichiro Kawachi
BMJ 2005 330: 265-266. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Brown, C. H., Baidas, S. M., Hajdenberg, J. J., Kayaleh, O. R., Pennock, G. K., Shah, N. C., Tseng, J. E. (2009). Lifestyle Interventions in the Prevention and Treatment of Cancer. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 3: 337-348 [Abstract]  
• Tse, L. A., Yu, I. T.-s., Au, J. S. K., Yu, K. S., Kwok, K. P., Qiu, H., Wong, T.-w. (2009). Environmental Tobacco Smoke and Lung Cancer Among Chinese Nonsmoking Males: Might Adenocarcinoma Be the Culprit?. Am J Epidemiol 169: 533-541 [Abstract] [Full text]  
• Vainiotalo, S., Patja, K., Laatikainen, T., Kuusimaki, L., Peltonen, K., Vartiainen, E. (2008). Exposure to Environmental Tobacco Smoke at Work, at Home, and During Leisure Time: Personal Exposure Measurements by Diffusive Sampling of Airborne 3-Ethenylpyridine. Indoor and Built Environment 17: 442-448 [Abstract]  
• Gorlova, O. Y., Weng, S.-F., Zhang, Y., Amos, C. I., Spitz, M. R., Wei, Q. (2008). DNA Repair Capacity and Lung Cancer Risk in Never Smokers. Cancer Epidemiol. Biomarkers Prev. 17: 1322-1328 [Abstract] [Full text]  
• Molina, J. R., Yang, P., Cassivi, S. D., Schild, S. E., Adjei, A. A. (2008). Non-Small Cell Lung Cancer: Epidemiology, Risk Factors, Treatment, and Survivorship. Mayo Clin Proc. 83: 584-594 [Abstract] [Full text]  
• Taylor, R., Najafi, F., Dobson, A. (2007). Meta-analysis of studies of passive smoking and lung cancer: effects of study type and continent. Int J Epidemiol 36: 1048-1059 [Abstract] [Full text]  
• Gowani, S. A., Memon, S. S., Khan, J. A. (2007). A Major Cause of Death in COPD and Risk Factors for Lung Cancer a Dilemma or a Mistake?. Am. J. Respir. Crit. Care Med. 176: 624-625 [Full text]  
• Vineis, P, Veglia, F, Garte, S, Malaveille, C, Matullo, G, Dunning, A, Peluso, M, Airoldi, L, Overvad, K, Raaschou-Nielsen, O, Clavel-Chapelon, F, Linseisen, J., Kaaks, R, Boeing, H, Trichopoulou, A, Palli, D, Crosignani, P, Tumino, R, Panico, S, Bueno-De-Mesquita, H., Peeters, P., Lund, E, Gonzalez, C., Martinez, C, Dorronsoro, M, Barricarte, A, Navarro, C, Quiros, J., Berglund, G, Jarvholm, B, Day, N., Key, T., Saracci, R, Riboli, E, Autrup, H (2007). Genetic susceptibility according to three metabolic pathways in cancers of the lung and bladder and in myeloid leukemias in nonsmokers. Ann Oncol 18: 1230-1242 [Abstract] [Full text]  
• Vineis, P. (2007). First steps in molecular epidemiology: Lower et al. 1979. Int J Epidemiol 0: dyl291v2-3 [Full text]  
• Hill, S. E., Blakely, T., Kawachi, I., Woodward, A. (2007). Mortality among Lifelong Nonsmokers Exposed to Secondhand Smoke at Home: Cohort Data and Sensitivity Analyses. Am J Epidemiol 165: 530-540 [Abstract] [Full text]  
• Wakelee, H. A., Chang, E. T., Gomez, S. L., Keegan, T. H., Feskanich, D., Clarke, C. A., Holmberg, L., Yong, L. C., Kolonel, L. N., Gould, M. K., West, D. W. (2007). Lung Cancer Incidence in Never Smokers. JCO 25: 472-478 [Abstract] [Full text]  
• Subramanian, J., Govindan, R. (2007). Lung Cancer in Never Smokers: A Review. JCO 25: 561-570 [Abstract] [Full text]  
• Manuguerra, M., Matullo, G., Veglia, F., Autrup, H., Dunning, A.M., Garte, S., Gormally, E., Malaveille, C., Guarrera, S., Polidoro, S., Saletta, F., Peluso, M., Airoldi, L., Overvad, K., Raaschou-Nielsen, O., Clavel-Chapelon, F., Linseisen, J., Boeing, H., Trichopoulos, D., Kalandidi, A., Palli, D., Krogh, V., Tumino, R., Panico, S., Bueno-De-Mesquita, H.B., Peeters, P.H., Lund, E., Pera, G., Martinez, C., Amiano, P., Barricarte, A., Tormo, M.J., Quiros, J.R., Berglund, G., Janzon, L., Jarvholm, B., Day, N.E., Allen, N.E., Saracci, R., Kaaks, R., Ferrari, P., Riboli, E., Vineis, P. (2007). Multi-factor dimensionality reduction applied to a large prospective investigation on gene-gene and gene-environment interactions. Carcinogenesis 28: 414-422 [Abstract] [Full text]  
• Zhou, W., Heist, R. S., Liu, G., Asomaning, K., Miller, D. P., Neuberg, D. S., Wain, J. C., Lynch, T. J., Christiani, D. C. (2006). Second Hand Smoke Exposure and Survival in Early-Stage Non-Small-Cell Lung Cancer Patients. Clin. Cancer Res. 12: 7187-7193 [Abstract] [Full text]  
• Gerbase, M. W., Schindler, C., Zellweger, J.-P., Kunzli, N., Downs, S. H., Brandli, O., Schwartz, J., Frey, M., Burdet, L., Rochat, T., Ackermann-Liebrich, U., Leuenberger, P., on behalf of the SAPALDIA Team, (2006). Respiratory Effects of Environmental Tobacco Exposure Are Enhanced by Bronchial Hyperreactivity. Am. J. Respir. Crit. Care Med. 174: 1125-1131 [Abstract] [Full text]  
• Wen, W., Shu, X. O., Gao, Y.-T., Yang, G., Li, Q., Li, H., Zheng, W. (2006). Environmental tobacco smoke and mortality in Chinese women who have never smoked: prospective cohort study. BMJ 333: 376- [Abstract] [Full text]  
• Jaakkola, M. S., Jaakkola, J. J. K. (2006). Impact of smoke-free workplace legislation on exposures and health: possibilities for prevention.. Eur Respir J 28: 397-408 [Abstract] [Full text]  
• Samanic, C., Kogevinas, M., Dosemeci, M., Malats, N., Real, F. X., Garcia-Closas, M., Serra, C., Carrato, A., Garcia-Closas, R., Sala, M., Lloreta, J., Tardon, A., Rothman, N., Silverman, D. T. (2006). Smoking and bladder cancer in Spain: effects of tobacco type, timing, environmental tobacco smoke, and gender.. Cancer Epidemiol. Biomarkers Prev. 15: 1348-1354 [Abstract] [Full text]  
• Boffetta, P., Clark, S., Shen, M., Gislefoss, R., Peto, R., Andersen, A. (2006). Serum cotinine level as predictor of lung cancer risk.. Cancer Epidemiol. Biomarkers Prev. 15: 1184-1188 [Abstract] [Full text]  
• Loft, S., Svoboda, P., Kasai, H., Tjonneland, A., Vogel, U., Moller, P., Overvad, K., Raaschou-Nielsen, O. (2006). Prospective study of 8-oxo-7,8-dihydro-2'-deoxyguanosine excretion and the risk of lung cancer. Carcinogenesis 27: 1245-1250 [Abstract] [Full text]  
• Eagan, T M L, Hetland, J, Aaro, L E (2006). Decline in respiratory symptoms in service workers five months after a public smoking ban. Tobacco Control 15: 242-246 [Abstract] [Full text]  
• Matullo, G., Dunning, A.M., Guarrera, S., Baynes, C., Polidoro, S., Garte, S., Autrup, H., Malaveille, C., Peluso, M., Airoldi, L., Veglia, F., Gormally, E., Hoek, G., Krzyzanowski, M., Overvad, K., Raaschou-Nielsen, O., Clavel-Chapelon, F., Linseisen, J., Boeing, H., Trichopoulou, A., Palli, D., Krogh, V., Tumino, R., Panico, S., Bueno-De-Mesquita, H.B., Peeters, P.H., Lund, E., Pera, G., Martinez, C., Dorronsoro, M., Barricarte, A., Tormo, M.J., Quiros, J.R., Day, N.E., Key, T.J., Saracci, R., Kaaks, R., Riboli, E., Vineis, P. (2006). DNA repair polymorphisms and cancer risk in non-smokers in a cohort study. Carcinogenesis 27: 997-1007 [Abstract] [Full text]  
• Hedley, A. J., McGhee, S. M., Repace, J. L., Wong, L.-C., Yu, M. Y. S., Wong, T.-W., Lam, T.-H. (2006). Risks for Heart Disease and Lung Cancer from Passive Smoking by Workers in the Catering Industry. Toxicol Sci 90: 539-548 [Abstract] [Full text]  
• Carpagnano, G. E., Foschino-Barbaro, M. P., Mule, G., Resta, O., Tommasi, S., Mangia, A., Carpagnano, F., Stea, G., Susca, A., Di Gioia, G., De Lena, M., Paradiso, A. (2005). 3p Microsatellite Alterations in Exhaled Breath Condensate from Patients with Non-Small Cell Lung Cancer. Am. J. Respir. Crit. Care Med. 172: 738-744 [Abstract] [Full text]  
• Airoldi, L., Vineis, P., Colombi, A., Olgiati, L., Dell'Osta, C., Fanelli, R., Manzi, L., Veglia, F., Autrup, H., Dunning, A., Garte, S., Hainaut, P., Hoek, G., Krzyzanowski, M., Malaveille, C., Matullo, G., Overvad, K., Tjonneland, A., Clavel-Chapelon, F., Linseisen, J., Boeing, H., Trichopoulou, A., Palli, D., Peluso, M., Krogh, V., Tumino, R., Panico, S., Bueno-De-Mesquita, H. B., Peeters, P. H., Lund, E., Agudo, A., Martinez, C., Dorronsoro, M., Barricarte, A., Chirlaque, M. D., Quiros, J. R., Berglund, G., Jarvholm, B., Hallmans, G., Day, N. E., Allen, N., Saracci, R., Kaaks, R., Riboli, E. (2005). 4-Aminobiphenyl-Hemoglobin Adducts and Risk of Smoking-Related Disease in Never Smokers and Former Smokers in the European Prospective Investigation into Cancer and Nutrition Prospective Study. Cancer Epidemiol. Biomarkers Prev. 14: 2118-2124 [Abstract] [Full text]  
• Rundle, A. G., Vineis, P., Ahsan, H. (2005). Design Options for Molecular Epidemiology Research within Cohort Studies. Cancer Epidemiol. Biomarkers Prev. 14: 1899-1907 [Abstract] [Full text]  
• Katz, J E (2005). Individual rights advocacy in tobacco control policies: an assessment and recommendation. Tobacco Control 14: ii31-ii37 [Abstract] [Full text]  
• Cetti, E (2005). Further evidence on the dangers of exposure to second hand tobacco smoke. Thorax 60: 473-473 [Full text]  
• (2005). From the Library. Br J Ophthalmol 89: 646-646 [Full text]  
• (2005). Smoking Could Kill Your Baby . . . Years Later!. JWatch Pediatrics 2005: 13-13 [Full text]  
• (2005). New Data on Secondhand Smoke. Journal Watch Cardiology 2005: 9-9 [Full text]  
• (2005). Smoking Could Kill Your Baby . . . Years Later!. JWatch Women's Health 2005: 1-1 [Full text]  
• Kawachi, I. (2005). More evidence on the risks of passive smoking. BMJ 330: 265-266 [Full text]  

Rapid Responses:

Read all Rapid Responses

Defective and misleading: authors know EBM but overlook Single Patient Based Medicine.

Sergio Stagnaro
bmj.com, 4 Feb 2005 [Full text]

COPD v Emphysema

James F Malone
bmj.com, 4 Feb 2005 [Full text]

Let us redirect our efforts

Anand B Palamarthy, et al.
bmj.com, 6 Feb 2005 [Full text]

Governments need to act on tobacco industry misinformation on second-hand smoke

Nick Wilson
bmj.com, 7 Feb 2005 [Full text]

Cuba: A new ban on smoking follows Vineis et al paper

Pedro O Ordúñez-García, et al.
bmj.com, 9 Feb 2005 [Full text]

Prevention strategies for environmental tobacco smoke related prominent problems in the world

Ediriweera B.R., Desapriya, et al.
bmj.com, 10 Feb 2005 [Full text]

The need for education and public policies for second-hand smoking

Nickolas Collins, et al.
bmj.com, 2 Mar 2005 [Full text]

Is environmental tobacco smoke the real problem?

Adrian K Watson
bmj.com, 4 Apr 2005 [Full text]

Online poll

Find out more on doc2doc >>