title: Environmental tobacco smoke and risk of respiratory cancer and chronic obstructive pulmonary disease in former smokers and never smokers in the EPIC prospective study.
abstract: OBJECTIVE
  To investigate the association between environmental tobacco smoke, plasma cotinine concentration, and respiratory cancer or death.
  
  
  METHODS
  Nested case-control study within the European prospective investigation into cancer and nutrition (EPIC).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Imperial College, London W2 1PG. p.vineis@imperial.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Vineis
authors.forename: L
authors.initials: L
authors.lastname: Airoldi
authors.forename: F
authors.initials: F
authors.lastname: Veglia
authors.forename: L
authors.initials: L
authors.lastname: Olgiati
authors.forename: R
authors.initials: R
authors.lastname: Pastorelli
authors.forename: H
authors.initials: H
authors.lastname: Autrup
authors.forename: A
authors.initials: A
authors.lastname: Dunning
authors.forename: S
authors.initials: S
authors.lastname: Garte
authors.forename: E
authors.initials: E
authors.lastname: Gormally
authors.forename: P
authors.initials: P
authors.lastname: Hainaut
authors.forename: C
authors.initials: C
authors.lastname: Malaveille
authors.forename: G
authors.initials: G
authors.lastname: Matullo
authors.forename: M
authors.initials: M
authors.lastname: Peluso
authors.forename: K
authors.initials: K
authors.lastname: Overvad
authors.forename: A
authors.initials: A
authors.lastname: Tjonneland
authors.forename: F
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.forename: H
authors.initials: H
authors.lastname: Boeing
authors.forename: V
authors.initials: V
authors.lastname: Krogh
authors.forename: D
authors.initials: D
authors.lastname: Palli
authors.forename: S
authors.initials: S
authors.lastname: Panico
authors.forename: R
authors.initials: R
authors.lastname: Tumino
authors.forename: B
authors.initials: B
authors.lastname: Bueno-De-Mesquita
authors.forename: P
authors.initials: P
authors.lastname: Peeters
authors.forename: G
authors.initials: G
authors.lastname: Berglund
authors.forename: G
authors.initials: G
authors.lastname: Hallmans
authors.forename: R
authors.initials: R
authors.lastname: Saracci
authors.forename: E
authors.initials: E
authors.lastname: Riboli
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003367:Cotinine / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000097:blood / Q000209:etiology* / Q000401:mortality; D008175:Lung Neoplasms / Q000097:blood / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000097:blood / Q000209:etiology* / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000209:etiology* / Q000401:mortality; D012907:Smoking / Q000009:adverse effects / Q000097:blood; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D014028:Tobacco Smoke Pollution; D003367:Cotinine