Time trends of tobacco smoking, air pollution, and lung cancer in Athens.

Athens is a city with a serious air pollution problem which has existed for more than 20 years. To evaluate whether air pollution has affected lung cancer incidence (and hence, mortality) in the population of Athens we have compared standardized lung mortality between Athens and the rest of Greece taking into account the tobacco consumption trends in the respective populations and varying the postulated latency between 0 and 20 years. There is no evidence for an independent or interactive (with tobacco smoking) effect of air pollution on lung cancer mortality; the tobacco-adjusted mortality appears, if anything, lower in Athens than in the rest of Greece and the slopes of lung cancer mortality on tobacco consumption are almost identical in Athens and in the rest of Greece. By contrast, the same data are compatible with a strong effect of tobacco smoking on lung cancer mortality, an effect which appears to involve not only the early carcinogenic stages but also some of the later ones. The results of the present analysis do not support the hypothesis that air pollution, at least in Athens until 1980, has increased the incidence of lung cancer to an extent large enough to be detectable in ecological correlation analyses. Nevertheless the inherent limitations of these methods indicate that their results should be interpreted with caution and only as a step toward the gradual understanding of a complex issue.