title: Lung cancers attributable to environmental tobacco smoke and air pollution in non-smokers in different European countries: a prospective study.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Imperial College London, London UK. p.vineis@imperial.ac.uk
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.forename: Gerard
authors.initials: G
authors.lastname: Hoek
authors.forename: Michal
authors.initials: M
authors.lastname: Krzyzanowski
authors.forename: Federica
authors.initials: F
authors.lastname: Vigna-Taglianti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Luisa
authors.initials: L
authors.lastname: Airoldi
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Ole
authors.initials: O
authors.lastname: Raaschou-Nielsen
authors.forename: Francoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.forename: Jacob
authors.initials: J
authors.lastname: Linseisen
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-De-Mesquita
authors.forename: Petra H
authors.initials: PH
authors.lastname: Peeters
authors.forename: Eiliv
authors.initials: E
authors.lastname: Lund E
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.forename: Carmen
authors.initials: C
authors.lastname: Martinez
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: Lluis
authors.initials: L
authors.lastname: Cirera
authors.forename: J Ramon
authors.initials: JR
authors.lastname: Quiros
authors.forename: Goran
authors.initials: G
authors.lastname: Berglund
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.forename: Bertil
authors.initials: B
authors.lastname: Forsberg
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Day
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Key
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Saracci
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
mesh_terms: D000393:Air Pollutants; D000397:Air Pollution / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D015984:Causality; D015331:Cohort Studies; D017281:Cost of Illness; D005060:Europe / Q000453:epidemiology; D006801:Humans; D019570:Inhalation Exposure / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*
chemical_list: D000393:Air Pollutants; D014028:Tobacco Smoke Pollution