title: Lung cancer due to passive smoking--a review.
abstract: OBJECTIVE
  Even from the scientific literature it is difficult to conclude whether the increased risk of lung cancer due to exposure to environmental tobacco smoke (ETS), as reported in many epidemiological studies, is based on sound data from reliable studies, or rather on passionate assertions derived from unsound investigations. To shed some light on this matter the differences between cigarette mainstream smoke (MS)--inhaled by the smoker- and ETS--inhaled by everyone exposed-, the concentration of ETS under real life conditions, the internal dose of toxic compounds due to ETS exposure, and the risk of lung cancer as found in epidemiological studies are discussed.
  
  
  RESULTS
  MS and ETS differ considerably in their physical, chemical and toxicological characteristics because of the different conditions under which they are generated, the dilution in air, and the degree of ageing. Based on toxicological data, a very low internal dose of potentially genotoxic compounds can be measured in people after ETS exposure. The epidemiological data suggest a slightly increased risk of lung cancer in non-smokers chronically exposed to ETS. However, it is equally well known, that none of these studies is free from bias and confounding effects.
  
  
  CONCLUSIONS
  The average intake of toxic and genotoxic compounds due to ETS exposure is that low that it is difficult, if not impossible, to explain the increased risk of lung cancer as found in epidemiological studies. The uncertainty is further increased because the validity of epidemiological studies on passive smoking is limited severely by numerous bias and confounding factors which cannot be controlled for reliability. The question of whether or not ETS exposure is high enough to induce and/or promote the carcinogenic effects observed in epidemiological studies thus remains open, and the assumption of an increased risk of lung cancer due to ETS exposure is, at present, more a matter of opinion than of firm scientific evidence.
authors.affiliation: Stiftung VERUM, Munich, Germany. prof.adlkofer@verum-foundation.de
authors.forename: F
authors.initials: F
authors.lastname: Adlkofer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015982:Bias; D015415:Biomarkers; D016022:Case-Control Studies; D002648:Child; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D003367:Cotinine / Q000032:analysis / Q000633:toxicity; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005060:Europe; D005260:Female; D005858:Germany; D006801:Humans; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009538:Nicotine / Q000032:analysis / Q000633:toxicity; D016017:Odds Ratio; D012307:Risk Factors; D012906:Smoke / Q000032:analysis; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000032:analysis; D017132:Workplace
chemical_list: D015415:Biomarkers; D012906:Smoke; D014028:Tobacco Smoke Pollution; D009538:Nicotine; D003367:Cotinine