Lung cancer mortality among women employed in high-risk industries and occupations in Harris County, Texas, 1977-1980

Lung cancer is rapidly becoming the leading cause of cancer mortality among women. Interviews conducted with 259 women with lung cancer and 278 women without lung cancer or with their next-of-kin in Harris County, Texas from July 1, 1977 to June 30, 1980 revealed that 12 (4.6%) of the women with lung cancer had never smoked cigarettes. The odds ratio (OR) for current smoking was 15.7. Odds ratios for smoking for living women (OR = 17.5) were higher than for those who were deceased (OR = 12.6). Lifetime occupational histories were classified a priori into high- and low-risk categories. Data were stratified according to employment in a high-risk industry or occupation, a high-risk industry, a high-risk occupation, or both a high-risk industry and occupation. Although not statistically significant, odds ratios for employment in high-risk categories support earlier estimates that attributed 5% of lung cancer mortality in women to employment in hazardous occupations. Employment of a husband or household member in selected industries and occupations yielded significantly increased odds ratios. More cases (15.9%) than controls (6.9%) reported a family history of lung cancer (OR = 2.4). No significant increase in smoking-adjusted odds ratios was found for the use of hair spray, hand-held dryers, or alcohol, or for having lived with a household member who smoked cigarettes.     

Contextual analysis of breast and cervical cancer screening and factors associated with health care access among United States women, 2002

This research explored the relationships between race/ethnicity and area factors affecting access to health care in the United States. The study represents an advance on previous research in this field because, in addition to including data on rurality, it incorporates additional contextual covariates describing aspects of health care accessibility. Individual-level data were obtained from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). The county of residence reported by BRFSS respondents was used to link BRFSS data with county-level measures of health care access from the 2004 Area Resource File (ARF). Analyses of mammography were limited to women aged 40 years with known county of residence (n=91,492). Analyses of Pap testing were limited to women aged 18 years with no history of hysterectomy and known county of residence (n=97,820). In addition to individual-level covariates such as race, Hispanic ethnicity, health insurance coverage and routine physical exam in the previous year. We examined county-level covariates (residence in health professional shortage area, urban/rural continuum, racial/ethnic composition, and number of health centers/clinics, mammography screening centers, primary care physicians, and obstetrician-gynecologists per 100,000 female population or per 1000 square miles) as predictors of cancer screening. Both individual-level and contextual covariates are associated with the use of breast and cervical cancer screening. In the current study, covariates associated with health care access, such as health insurance coverage, household income, Black race, and percentage of county female population who were non-Hispanic Black, were important determinants of screening use. In multivariate analysis, we found significant interactions between individual-level covariates and contextual covariates. Among women who reside in areas with lower primary care physician supply, rural women are less likely than urban women to have had a recent Pap test. Black women were more likely than White women to have had a recent Pap test. Women with a non-rural county of residence were more likely to have had a recent mammogram than rural women. A significant interaction was also found between individual-level race and number of health centers or clinics per 100,000 population (p-value=0.0187). In counties with 2 or more health centers or clinics per 100,000 female population, Black women were more likely than White women to have had a recent mammogram. A significant interaction was also observed between the percentage of county female population who were Hispanic and the percentage who were non-Hispanic Black.     

Lung cancer in relation to environmental pollutants emitted from industrial sources

A case-control study of residents who lived in the vicinity of a primary zinc smelter and a large steel manufacturing plant in eastern Pennsylvania was undertaken to investigate the role of environmental pollutants in the etiology of lung cancer. Lifetime residential, occupational, and smoking histories were obtained from the next of kin of 335 white male lung cancer cases and 332 white male controls. Soil samples were collected and analyzed for content in ppm of arsenic, copper, lead, manganese, zinc, and cadmium. Relative risks were determined according to distance of residence from the zinc smelter and the steel plant, and according to residence in areas with heavy and light levels of various pollutants. Two-fold risks for lung cancer were associated with residence near the zinc smelter and with residence in areas with heavy levels of arsenic and cadmium, although the number of individuals living in these higher risk areas was small. These increases were not explained by the effects of cigarette smoking or by employment in the zinc or steel industry. No excess risk was associated with living near the steel plant. The limited size of the study precludes causal interpretation, but the findings suggest the need for further investigation of metallic air pollution and lung cancer.     

Lung cancer mortality among men living near an arsenic-emitting smelter

Etiologic factors for lung cancer were studied by the case-control technique among 636 men, including 212 with pulmonary carcinoma, who had died between 1961 and 1979 in a county in northern Sweden. Data on smoking habits, occupation, and residence were obtained from a next of kin to each study subject. Validation against data from other sources indicated that the exposure information was of high quality. A relative risk of 2.0 for lung cancer was seen among men who had lived within approximately 20 km from a large copper smelter. The increased risk, which is statistically significant (p less than 0.05), could not be explained by smoking habits or occupational background. Smelter workers and miners had relative risks for lung cancer of 3.0 and 4.1, respectively. No firm conclusions can be drawn on the cause of excess lung cancer risk in the smelter area, but it seems plausible that the very substantial emissions to air from the smelter, especially of arsenic, may have played a role.     

Menthol cigarettes and risk of lung cancer

The authors analyzed data from a multihospital case-control study in the eastern United States to evaluate the hypothesis that smoking menthol cigarettes increases lung cancer risk compared with smoking nonmenthol cigarettes. Subjects included cases with lung cancer and controls admitted for conditions unrelated to smoking who were aged 40-74 years, were interviewed from 1981 to 2000, and had smoked for >or=20 years. Information was available on the brand and type of cigarette smoked most recently and for the longest time. Analyses were based on 643 cases and 4,110 controls for whom brand information was available for >or=60% of the total duration of smoking. Logistic regression was used to estimate the relative risk of lung cancer according to number of years of menthol cigarette use (>15, 1-15, 0), adjusting for demographic and smoking-related factors. The lung cancer risk for long-term smokers of menthol cigarettes was similar to that for smokers of nonmenthol cigarettes (odds ratio = 0.97, 95% confidence interval: 0.70, 1.34). Odds ratios were also close to 1.0 in separate analyses of male, female, Black, and White subjects. The results of this study do not support the hypothesis that smoking menthol cigarettes increases the risk of lung cancer relative to smoking nonmenthol cigarettes.     

Risks of lung cancer, chronic bronchitis, ischaemic heart disease, and stroke in relation to type of cigarette smoked.

In a case control study of over 12 000 inpatients aged 35-74, risk of lung cancer, chronic bronchitis, and, particularly in those aged 35-54, ischaemic heart disease was positively associated with the number of manufactured cigarettes smoked daily and was negatively associated with long term giving up. Risk of stroke was not clearly related to smoking. Among manufactured cigarette smokers, lung cancer risk tended to be lowest in those who had always smoked filter cigarettes. This pattern was, however, evident only in men who additionally smoked pipes, cigars or handrolled cigarettes and in women, not being seen in men who smoked only manufactured cigarettes. Risk of lung cancer was not clearly related to time of switch to filter cigarettes. A markedly lower risk of chronic bronchitis was seen in men, but not women, who smoked filter rather than plain cigarettes. Heart disease risk did not vary by type of cigarette smoked 10 years before admission, but, compared with those who had never smoked filter cigarettes, those who had ever smoked filter cigarettes had a higher risk in men and a lower risk in younger women. Compared with the general population, markedly more controls were ex-smokers, suggesting incipient disease, whether or not smoking related, may alter smoking habits, thus affecting the interpretability of the findings. Control smokers were also relatively much more likely to report smoking plain cigarettes than expected. This comparison, not made in other studies relating risk to type of cigarette smoked, indicates that great care must be taken in verifying validity of reported smoking habits. While our findings are compatible with other evidence that risk of lung cancer and chronic bronchitis is probably reduced by switching from plain to filter cigarettes, they underline the difficulties in obtaining valid evidence from epidemiological studies.     

General air pollution and cancer in the United States

General air pollution may be defined as a body of contaminated air extending over a population area of appreciable size (a town, city, etc.). It excludes occupational, personal, or neighborhood pollution exposure to dusts or fumes. In the American Cancer Society's study of a half million men, subjects who had lived in the same neighborhood for at least 10 years were classified into various categories by place of residence, and whether or not they were occupationally exposed to dusts, fumes, or vapors. Lung cancer rates were computed standardized by age and smoking habits. Men who said they were occupationally exposed had mortality rates of lung cancer 14% greater than the nonexposed. Among those not exposed, there were little or no differences in mortality ratios by urban-rural place of residence, in Los Angeles and nearby counties; by whether they lived in cities with high, medium, or low levels of total suspended particulate matter or benzene-soluble organic matter. We conclude the general air pollution at present has very little effect, if any, on the lung cancer death rate.     

病因分值在病例对照研究中的应用──肺癌危险因素的交互效应

对广东省２００例原发性女性肺癌的现患病人作１：１配对病例对照研究，在Ｍａｎｔｅｌ－Ｈａｅｎｓｚｅｌ分层分析和条件ｌｏｇｉｓｔｉｃ回归分析的基础上，探讨女性肺癌危险因素的病因分值以及被动吸烟与其他各种危险因素间的交互效应。多因素条件ｌｏｇｉｓｔｉｃ回归分析结果显示：被动吸烟，厨房通风，喜吃咸食，慢性支气管炎、家庭肿瘤史，肺结核，。服和避孕药是女性肺癌独立的危险因素。     

Relationship between lung cancer and distance of residence from nonferrous smelter stack effluent

Because of a reported association between residence in counties, with nonferrous smelters and increased risk of lung cancer, we studied the relationship between distance of residence from nonferrous smelters and lung cancer. Patients with lung cancer and patients with other cancers not known to be associated with smelter effluent (breast, prostate, and colon) were compared. All patients lived within a 20-kilometer radius around one of 10 nonferrous smelters in five western states during 1970-1977. Data were obtained from cancer registries or death certificates and were examined separately for each area. Addresses at the time of diagnosis or death were plotted on U.S. Geological Survey maps to calculate distance from each smelter. The distribution of lung cancer near the smelters was not significantly different from the distribution of control cancers in any of the areas studied.     

Lung cancer in Florida. Risks associated with residence in the central Florida phosphate mining region

A case-control study that included 25,398 cases of lung cancer among Florida residents, first diagnosed in 1981-1983, was conducted to determine if residence in the central Florida phosphate mining region was associated with an increased risk of lung cancer. A twofold increase in lung cancer risk was observed among male nonsmokers who lived in the study area. Risks were elevated for all major lung cancer cell types, with the highest risks observed for small cell carcinoma of the lung. Among cigarette smokers, a slight, but not statistically significant, additional increase in risk was associated with residence in the study area. Among women, no significant elevations in risk were observed for persons who lived in the study area. The greatest increase in risk among women was for small cell carcinomas, but the elevations were not statistically significant.     

病因分值在病例对照研究中的应用──肺癌危险因素的交互效应

对广东省200例原发性女性肺癌的现患病人作1：1配对病例对照研究，在Mantel-Haenszel分层分析和条件logistic回归分析的基础上，探讨女性肺癌危险因素的病因分值以及被动吸烟与其他各种危险因素间的交互效应。多因素条件logistic回归分析结果显示：被动吸烟（丈夫）、厨房通风、喜吃咸食、慢性支气管炎史、家族肿瘤史、肺结核、服用避孕药是女性肺癌独立的危险因素（OR=2.16～40．55，P＜0．05）。它们的病因分值分别是0.535.0．432、0.252、0．124、0.115、0．072.0．069。分析被动吸烟（丈夫）与口服避孕药、家族肿瘤史、厨房通风、肺结核史、经常吃咸色或腌菜间交互作用，其病因分值分别为0．848、0．499、0．479、0.416、0．346.交互作用指数是0．906、0．543、0．578、0．427、0．441。研究提示被动吸烟是女性肺癌的重要危险因素，特别是丈夫吸烟，尤其是在与服用避孕药这一因素并存的情况下，增加女性肺癌的危险性。     

Dark tobacco and lung cancer in Cuba

A retrospective case control study of lung cancer was conducted in Havana, Cuba to investigate whether Cuban high lung cancer mortality rates could be explained by cigarette and cigar consumption habits, including the smoking of dark tobacco cigarettes. The cases were drawn from patients admitted from 1978 to 1980 to the city's 12 main general hospitals with a tentative diagnosis of lung cancer. Only patients whose final diagnosis was confirmed by cytology and/ or histology according to the World Health Organization's Classification of Lung Cancer were included. A hospital control selected from patients with a current admission for a nonsmoking-related disease was matched to each case by sex, age, hospital of admission, and admission date. Data on 826 confirmed lung cancer cases (219 females and 607 males), 979 hospital controls, and 539 neighborhood controls were analyzed with procedures for matched and unmatched studies. Lung cancer patients ranged in age from 23 to 89 years; approximately 1/2 were females and 2/3 of the males were 60 years or older at diagnosis. Education level was similar in all groups. 167 of the 219 female cases (76.3%) and 595 of the 607 male cases (98%) ever smoked regularly, compared with 31% and 80.3%, respectively, of female and male controls. The corresponding proportions for female hospital and neighborhood controls were 30.5 and 31.8%, whereas for males they were 80.5% and 80.1%. The overall relative risk (RR) of lung cancer in cigarette smokers was 7.3 for females and 14.1 for males. Most smokers consumed the local dark tobacco ciagrettes exclusively. There were increased risks of lung cancer in both sexes associated with smoking both tobaccos, but the excess was greater for dark tobacco. The differences were reduced after adjustment for amount smoked. With either dark or light tobacco, the longer the duration of smoking or the greater the total number of cigarettes consumed, the higher the risk, all trends being highly significant. Cigarette smoking was associated with all 4 histologic types of lung cancer. A separate analysis was done on the 216 male cases and 389 controls who smoked either cigars only or cigars plus cigarettes. The risk of lung cancer in both groups was greater than those in nonsmokers. Based on attributable risk, it is estimated that a maximum of 66% of female and 91% of male lung cancer cases in Cuba are due to smoking.     

Breast and cervical cancer screening practices among Hispanic and non-Hispanic women residing near the United States-Mexico border, 1999-2000

This study examined the breast and cervical cancer screening practices of Hispanic and non-Hispanic women (n = 3,568) in counties that approximate the US southern border region. According to the Health Resources Services Administration (HRSA), border counties are those in which any part of the county is within 100 kilometers (62.14 miles) of the border. The study used data from Behavioral Risk Factor Surveillance System (BRFSS) surveys of adults aged > or = 18 years conducted in 1999 and 2000. The study looked at recent use of mammography and the Papanicolaou (Pap) test. Hispanic women were less likely to have had a recent mammogram or Pap test as compared with non-Hispanic women in border counties, and as compared with Hispanic and non-Hispanic women in nonborder counties of Texas, New Mexico, Arizona, and California combined, and with other women in the United States. Results underscore the need for continued efforts to ensure that medically underserved women who live in the border region have access to cancer screening services.     

Marriage to a smoker and lung cancer risk.

As part of a population-based case-control study of lung cancer in New Mexico, we have collected data on spouses' tobacco smoking habits and on-the-job exposure to asbestos. The present analyses include 609 cases and 781 controls with known passive and personal smoking status, of whom 28 were lifelong nonsmokers with lung cancer. While no effect of spouse cigarette smoking was found among current or former smokers, never smokers married to smokers had about a two-fold increased risk of lung cancer. Lung cancer risk in never smokers also increased with duration of exposure to a smoking spouse, but not with increasing number of cigarettes smoked per day by the spouse. Our findings are consistent with previous reports of elevated risk for lung cancer among never smokers living with a spouse who smokes cigarettes.     

Female lung cancer and petrochemical air pollution in Taiwan.

To investigate the relationship between petrochemical air pollution and female lung cancer, we conducted a matched case-control study among women who had died in Taiwan from 1990 through 1994. Data about all eligible female lung cancer deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group included women who died from nonneoplasms and diseases that were not associated with respiratory problems. We pair-matched the controls to the cases by sex, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. We used the proportion of a municipality's total population employed in the petrochemical manufacturing industry as an indicator of a resident's exposure to air emissions from the petrochemical manufacturing industry. The subjects were divided into tertiles according to the above indicator. Women who lived in the 2 groups of municipalities characterized by higher levels of petrochemical pollution had a statistically significant higher risk of developing lung cancer than the group that lived in municipalities with the lowest petrochemical air pollution levels (after controlling for possible confounders). The linear trend was also statistically significant (p < .05). The results of this study shed important light on the relationship between the Taiwan petrochemical industry and the resulting risk to human health.     

Bladder cancer among workers in the textile industry: results of a Spanish case-control study

This paper presents results from a case-control study carried out in the county of Mataro, Spain. The study was designed to investigate the possible causes of an unusually high mortality rate from bladder cancer in Mataro county as compared to Spain as a whole, and this report focuses on occupational exposures. The study is based on 57 cases who were hospitalized for or died from bladder cancer between 1978 and 1981. Two controls per case were matched for sex, age, residence, and date of either hospitalization or death. Information was collected on smoking, coffee drinking, and occupation. Occupational histories were then evaluated and coded blind by a group of occupational health physicians. Analyses were carried out by means of conditional logistic regression. Among a group of common occupational sectors, an increased risk for past employment in the textile industry (OR = 2.2; p = .038) was found. Further analyses indicated that the risk is particularly elevated (OR = 4.41; 95% confidence limits; 1.15-16.84) for subjects who worked in dyeing or printing and who were most probably exposed to azo-dyes. Exposure in the textile industry may be responsible for 16% of the bladder cancers in the Mataro area. A list of dyes commonly used in the Mataro textile industries was compiled and cross-checked with lists of substances tested or evaluated for carcinogenesis.     

A population-based case-control study for examining early life influences on geographical variation in adult mortality in England and Wales using stomach cancer and stroke as examples

BACKGROUND: Geographical variation in mortality is influenced by factors operating in early life and in adulthood. The relative contributions of these factors may be examined by comparing the extent to which adult mortality is related to places of residence in early life and at death. We describe a population-based case-control design, in which all deaths are used as cases and the Office for National Statistics (ONS) Longitudinal Study (LS) survivors are used as controls. METHODS: Cases were all deaths from stomach cancer and stroke in England and Wales 1993-1995 amongst people born between January 1930 and September 1939 and for whom place of enumeration in 1939 could be imputed from the first three characters of their National Health Service number. Controls were all LS members born in the same period, enumerated in the 1991 census, resident in England and Wales in mid-1994 and for whom place of enumeration in 1939 could be similarly imputed. Logistic regression was used, adjusting for birth year, sex and social class. A previous mapping exercise by ONS generated comparable geographical units (counties) for 1939 enumeration and area of residence in 1991 or at death. 'Non-migrant' (i.e. 1939 'county' the same as county in 1991 or at death) case:control ratios were calculated to indicate background mortality risk in counties, with adjustment for imprecision using Bayesian smoothing methods. These ratios were then used in modelling risk for inter-county migrants. RESULTS: There were 2590 stomach cancer and 7778 stroke deaths and 28,400 men and 28,180 women as controls. For men, 64%, 61% and 67% of stomach cancer deaths, stroke deaths and controls respectively could be assigned a county of enumeration in 1939. The corresponding percentages for women were 76%, 72% and 75%. For stomach cancer, after adjustment for county of enumeration in 1939, a significant association with the non-migrant case:control ratio for county of residence in 1991 or at death was observed (P= 0.010), indicating an association between current area of residence and stomach cancer mortality. There was no evidence of an independent effect of county of enumeration in 1939. For stroke, there was a highly significant trend in relation to 1939 county (P = 0.0004)and a less significant association with county of residence in 1991 or at death(P = 0.016). CONCLUSIONS: The method described is able to detect the effect of place of residence in early life on geographical variation in adult mortality and will be useful for investigating specific characteristics of areas of enumeration in 1939 in relation to subsequent risk of mortality from a range of diseases.     

Expected indoor 222Rn levels in counties with very high and very low lung cancer rates

Counties in the U.S. with high lung cancer rates should have higher average 222Rn levels than counties with low lung cancer rates, assuming the average 222Rn level in a county is not correlated with other factors that cause lung cancer. The magnitude of this effect was calculated, using the absolute risk model, the relative risk model, and an intermediate model, for females who died in 1950-1969. The results were similar for all three models. We concluded that, ignoring migration, the average Rn level in the highest lung cancer counties should be about three times higher than in the lowest lung cancer counties according to the theory. Preliminary data are presented indicating that the situation is quite the opposite: The average Rn level in the highest lung cancer counties was only about one-half that in the lowest lung cancer counties.     

Mortality among residents of Uravan, Colorado who lived near a uranium mill, 1936-84.

A cohort mortality study was conducted of all adult residents who ever lived in Uravan, Colorado, a company town built around a uranium mill. Vital status was determined through 2004 and standardised mortality analyses conducted for 1905 men and women alive after 1978 who lived for at least 6 months between 1936 and 1984 in Uravan. Overall, mortality from all causes (standardised mortality ratio (SMR) 0.90) and all cancers (SMR 1.00) was less than or as expected based on US mortality rates. Among the 459 residents who had worked in underground uranium mines, a significant increase in lung cancer was found (SMR 2.00; 95% CI 1.39-2.78). No significant elevation in lung cancer was seen among the 767 female residents of Uravan or the 622 uranium mill workers. No cause of death of a priori interest was significantly increased in any group, i.e. cancers of the kidney, liver, breast, lymphoma or leukaemia or non-malignant respiratory disease, renal disease or liver disease. This community cohort study revealed a significant excess of lung cancer among males who had been employed as underground miners. We attribute this excess to the historically high levels of radon in uranium mines of the Colorado Plateau, coupled with the heavy use of tobacco products. There was no evidence that environmental radiation exposures above natural background associated with the uranium mill operations increased the risk of cancer. Although the population studied was relatively small, the follow-up was long, extending up to 65 years after first residence in Uravan, and nearly half of the study subjects had died.     

Mentholated cigarette smoking and lung-cancer risk

PURPOSE: Menthol smoking may lead to a greater increase in lung-cancer risk than smoking of nonmentholated cigarettes. Mentholation of cigarettes adds additional carcinogenic components to cigarette smoke and increases retention times for cigarette smoke in the lungs. Only two epidemiologic studies have been conducted on menthol smoking and lung cancer, and their results are conflicting. Of note, African American males have much higher rates of lung cancer than Caucasian males despite smoking fewer cigarettes per day. Because the consumption of menthol cigarettes is much more frequent among African Americans, it is of interest to examine the possible association between menthol smoking and lung-cancer risk in this population. METHODS: We examined the association between menthol cigarette smoking and lung-cancer risk among smokers by comparing 337 incident cases of lung cancer with 478 population controls enrolled in a case-control study of lung cancer. Information on smoking history and other known and potential risk factors for lung cancer, including dietary intake, was obtained by in-person interviews. RESULTS: The adjusted odds ratios did not differ appreciably between smokers of mentholated cigarettes versus exclusive nonmentholated cigarette smokers in the overall study group of smokers. The odds ratio (OR) for 32 pack-years or more of mentholated vs. nonmentholated cigarettes was 0.90 (95% confidence interval (CI) = 0.38-2.12) in African Americans and 1.06 (95% CI = 0.47-2.36) in Caucasians, and did not differ for either ethnic group (p = 0.98). CONCLUSIONS: Our results suggest that the lung-cancer risk from smoking mentholated cigarettes resembles the risk from smoking non-mentholated cigarettes. Our data do not support the hypothesis that the increased risk of lung cancer among African Americans is due to the increased prevalence of menthol smoking.