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Lung cancers attributable to environmental tobacco smoke and air pollution in non-smokers in different European countries: a prospective study

Paolo Vineis1,32 email, Gerard Hoek2 email, Michal Krzyzanowski3 email, Federica Vigna-Taglianti4 email, Fabrizio Veglia4 email, Luisa Airoldi5 email, Kim Overvad6 email, Ole Raaschou-Nielsen7 email, Francoise Clavel-Chapelon8 email, Jacob Linseisen9 email, Heiner Boeing10 email, Antonia Trichopoulou11 email, Domenico Palli12 email, Vittorio Krogh13 email, Rosario Tumino14 email, Salvatore Panico15 email, H Bas Bueno-De-Mesquita16 email, Petra H Peeters17 email, Eiliv Lund E18 email, Antonio Agudo19 email, Carmen Martinez20 email, Miren Dorronsoro21 email, Aurelio Barricarte22 email, Lluis Cirera23 email, J Ramon Quiros24 email, Goran Berglund25 email, Jonas Manjer26 email, Bertil Forsberg27 email, Nicholas E Day28 email, Tim J Key29 email, Rudolf Kaaks30 email, Rodolfo Saracci31 email and Elio Riboli1 email

Imperial College London, London UK (Paolo Vineis: and University of Torino, Italy)

Department of Environmental and Occupational Health, Utrecht University, Utrecht, The Netherlands

World Health Organization, European Centre for Environment and Health, Bonn, Germany

ISI Foundation, Turin, Italy

Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

INSERM, (Institut National de la Santé et de la Recherche Médicale), ERI 20, EA 4045, and Institut Gustave Roussy, Villejuif, F-94805, France

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

author email corresponding author email

Environmental Health 2007, 6:7doi:10.1186/1476-069X-6-7

Published: 15 February 2007

Abstract

Background

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.

Methods

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.

Results

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.

Discussion

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.


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