Abstracts/ Lung Cancer 12 (1995) 113-160 115

Smoking of hand-rolled cigarettes as a risk factor for small cell lung cancer in men: A case-control study fmm Uruguay De Stefani E, Fierro L, Leninaga MT, Balbi JC, Ronco A, Mc.ndilahatsu M. Registm National de Cancec Ministerio de S&d Publica, Institute National de Oncologia, 8 de Octubre 3265, Montevideo. Lung Cancer (Ireland) 1994;11:191-9. During the time period January 1989-December 1992, a case-control study involving 476 cases of lung cancer and 561 controls was carried out at the Institute NacionaI de Oncologia, Montevideo, Uruguay, in order to analyze the patterns of risk of the different cell types of lung cancer! associated with smoking manufactured and hand-rolled cigarettes. Lifelong smokers of hand-rolled cigarettes displayed a non- significant 30% increased risk, compared with smokers of commercial cigarettes, for all types of lung cancer combined. The analysis for cell- type disclosed a fourfold increase in the risk of small cell lung carcinoma associated with lifelong smoking of hand-rolled products, The possibilities of a chance finding and of misclassification of the disease appears to be an unlikely explanation of this strong and rather specific association.

Risk factors for lung cancer in Rio de Janeim, Brazil: A case-control study Suzuki I, Hamada GS, Zambonic Mh4, De Biasi Cordeiro P, Watanabe S, Tsugane S. EpidemiologyDivision, Nat. Cancer CenterRes. institute, 5-l-l Tsukji, Chuo-ku, T&w 104. LungCancer(IreIand) 1994;11:179- 90. The association between the risk of lung cancer and tobacco smoking, dietary factors and occupationaI exposures was examined in a hospital- based case-control study. The study involved 123 consecutive cases and 123 controls, matched by age (i 13). sex, and race. In this first study of lung cancer risk in Brazil, we found that tobacco smoking is the strongest risk factor with an odds ratio (OR) for current and former smokers of 22 (CI, 6.5-76) and 7.7 (CI, 2.2-27), respectively. An OR of 2.8 (CI, 1.0-7.7) was found for users of black tobacco (in the form of hand- rolled cigarettes) in combination with conventional cigarettes, after adjustment for life-time consumption of any kind of tobacco; users of conventional cigarettes only were considered as a reference group. Cessation of smoking had an important infhtence in reducing the lung cancer risk, whereas early initiation of smoking inc}eased the risk. Among dietary factors, frequent consumption of meat (P < 0.01) and pasta (P = 0.02) were positively associated with lung cancer risk after adjusting for smoking and income. No association was found with pn/ yellow vegetables or fruits. We were unable to detect any sign&ant association related to occupational exposures. This study wntirmed the association of lung cancer with smoking as the most important predictor of risk. It also indicates the increase in risk associated with the use of black tobacco in combination with conventional cigarettes,

A casc-cootml study of diet and lung cancer in Kerala, South lndia . Sankaranarayanan R, Wgkae C, Duffy SW, PW G, Day NE, Nair MK. Division of Cancer Epidemiology, Regional Cancer Centre, Trivandrum. 695 011 Kerala. Int J Cancer 1994;58:644-9. A total of 281 male lung-cancer patients were identiflcd from the hospital cancer registry in the Regional Cancer Centre in Trivandrum. The controls were selected from the visitors and patients’ bystanders in the hospital. The recruitment of cases and controls started in 1990, and the present study used the casea registered in the first year. The questionnaire administered to cases and controls wllected information on tobacco smoking and alcohol habits. Dietary data were wllected using a food frequency questionnaire and were analyzed by multiple logistic

regression producing odds ratio estimates of the relative risk and deviance chi-squared tests of significance. Analysis was done on the computer package, EGRET. AI1 models included age, education, religion and smoking to adjust for the effect of confounding. Green vegetables and bananas were found to have a protective association with lung cancer. The odds ratio associated with the highest quartile of vegetable consumption compared with the lowest was 0.32 (95% confidence interval 0.13, 0.78). Forward stepwise regression analysis indicated pumpkins and onions as the most consistently significant protective factors. Animal protein foods and dairy products were found to have a predisposing effect on lung cancer in this study. The expected influence of smoking on lung cancer (a considerable increase in risk among smokers) provided evidence of the reliability of the data. In conclusion the results from this study show that diet has a role in lung cancer aetiology, although the association is weak compared to the effects of smoking.

A study of autopsied lung cancer cases among retired workers of the Okuno-jima poison gas factory Macda A, Awaya Y, Iham Y, Yoshkla Y, Ishioka S, InamIzu T et al. SecondDept. ofInternalMedicine, Hiroshima Univ. School ofMedicine, Naka-ku, Himshima 730. Lung Cancer (Japan) 1994;34:525-30. We studied 45 autopsied lung cancer patients, who had been involved in manufacturing poison gas at Okuno-jima in Hiroshima Prefecture, Japan, during World War II. Ah patients, Including 3 with double cancers in the lung, were male and were autopsied between 1952 and 1990. The lung cancer mortality rate up to 1977 among retired workers at this factory was significantly higher than that among the general population of Hiroshima Prefecture, after adjusting the background mortality rate for sex, age, and year. We divided the subjects into two groups: group 1 consisted of 26 who died before 1978 and group II of 19 who died during or after 1978. The group I subjects demonstrated 2 characteristic features: 1) 58% of the tumors (I5 of 26) occurred in the trachea or main bronchi and 2) 45% of the tumors (14 of 31) were squamous cell carcinomas, 29% (9) were small-cell carcinomas, 16% (5) were large-cell carcinomas, and only 7% (2) were adenocarcinomas. These clinical features are compatible with the characteristics of occupational lung cancer and were not observed in the group II cases.

Human evidence: Lung cancer mortality risk fmm chrysotile eqmsurc Hughes JM. Ann Occup Hyg 1994;38:555-60. The linear, no-threshold model is wmmonIy used for estimating lifetime lung cancer risk from asbestos exposures. Studies of chrysotile workers have observed shallow slopes for the exposure-response relationship for miners/millers, friction products manufacturing workers and asbestoscement (primarily chtysotile) workers but a steeper slope (approximately 16 times higher) for textile workers. For chrysotile exposures in buildings, where short fibres constitute the great majority of the fibres, the shallow slope is judged more appropriate. Using this slope the data regarding exposure levels to building occupants and maintenance workers, the annualized risks of lung cancer would be approximately 0.01 and 0.6 per million for these groups, respectively. Using the higher slope would result in risks 16 times higher, still considerably lower than those commonly accepted. Contrary to the model’s assumption of increased risk for any amount of exposure, a number of studies have demonstrated evidence that lung cancer risk is not associated with years exposed to low exposure levels. Moreover, the accumulating evidence that asbestos-inducing lung cancer may require lung fibrosis suggests a practical threshold since detectable lung fibrosis