Lung cancers attributable to environmental tobacco smoke and air pollution in non-smokers in different European countries: a prospective study
1 Imperial College London, London UK (Paolo Vineis: and University of Torino, Italy)
2 Department of Environmental and Occupational Health, Utrecht University, Utrecht, The Netherlands
3 World Health Organization, European Centre for Environment and Health, Bonn, Germany
4 ISI Foundation, Turin, Italy
5 Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
6 Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
7 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
8 INSERM, (Institut National de la Santé et de la Recherche Médicale), ERI 20, EA 4045, and Institut Gustave Roussy, Villejuif, F-94805, France
9 Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
10 German Institute of Human Nutrition, PotsdamRehbücke, Germany
11 Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
12 Molecular and Nutritional Epidemiology Unit, and Molecular Biology Laboratory, CSPO-Scientific Institute of Tuscany, Florence, Italy
13 Department of Epidemiology, National Cancer Istitute, Milan, Italy
14 Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy
15 Dipartimento di Medicina Clinica e Sperimentale, Università Federico II, Naples, Italy
16 Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
17 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
18 Institute of Community Medicine, University of Tromso, Norway
19 Department of Epidemiology, Catalan Institute of Oncology Barcelona, Consejería de Sanidad y Servicios Sociales, Spain
20 Andalusian School of Public Health, Granada, Spain
21 Department of Public Health of Guipuzkoa, San Sebastian, Spain
22 Public Health Institute, Navarra, Spain
23 Department of Epidemiology, Regional Health Council, Murcia, Spain
24 Public Health and Health Planning Directorate, Asturias, Spain
25 Malmö Diet and Cancer Study, Lund University, Malmö, Sweden
26 Dept of Surgery, Malmö University Hospital, Malmö, Sweden
27 Department of Public Health and Clinical Medicine, University of Umeå, Sweden
28 MRC Dunn Human Nutrition Unit, Cambridge, UK
29 Cancer Research UK Epidemiology Unit, University of Oxford, UK
30 International Agency for Research on Cancer, Lyon, France
31 "IFC-National Research Council, Pisa, Italy"
32 Department of Epidemiology and Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
Environmental Health 2007, 6:7 doi:10.1186/1476-069X-6-7Published: 15 February 2007
Several countries are discussing new legislation on the ban of smoking in public places, and on the acceptable levels of traffic-related air pollutants. It is therefore useful to estimate the burden of disease associated with indoor and outdoor air pollution.
We have estimated exposure to Environmental Tobacco Smoke (ETS) and to air pollution in never smokers and ex-smokers in a large prospective study in 10 European countries (European Prospective Investigation into Cancer and Nutrition)(N = 520,000). We report estimates of the proportion of lung cancers attributable to ETS and air pollution in this population.
The proportion of lung cancers in never- and ex-smokers attributable to ETS was estimated as between 16 and 24%, mainly due to the contribution of work-related exposure. We have also estimated that 5–7% of lung cancers in European never smokers and ex-smokers are attributable to high levels of air pollution, as expressed by NO2 or proximity to heavy traffic roads. NO2 is the expression of a mixture of combustion (traffic-related) particles and gases, and is also related to power plants and waste incinerator emissions.
We have estimated risks of lung cancer attributable to ETS and traffic-related air pollution in a large prospective study in Europe. Information bias can be ruled out due to the prospective design, and we have thoroughly controlled for potential confounders, including restriction to never smokers and long-term ex-smokers. Concerning traffic-related air pollution, the thresholds for indicators of exposure we have used are rather strict, i.e. they correspond to the high levels of exposure that characterize mainly Southern European countries (levels of NO2 in Denmark and Sweden are closer to 10–20 ug/m3, whereas levels in Italy are around 30 or 40, or higher).
Therefore, further reduction in exposure levels below 30 ug/m3 would correspond to additional lung cancer cases prevented, and our estimate of 5–7% is likely to be an underestimate. Overall, our prospective study draws attention to the need for strict legislation concerning the quality of air in Europe.