Trichopoulos D, Hatzakis A, Wynder E, Katsouyanni K, Kalandidi A
Department of Hygiene and Epidemiology, University of Athens Medical School, Greece.
Environ Res. 1987 Dec;44(2):169-78. doi: 10.1016/s0013-9351(87)80225-6.
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.
雅典是一个空气污染问题严重的城市，这一问题已存在20多年。为评估空气污染是否影响了雅典人口的肺癌发病率（进而影响死亡率），我们比较了雅典与希腊其他地区的标准化肺癌死亡率，同时考虑了各地区人群的烟草消费趋势，并假设潜伏期在0至20年之间变化。没有证据表明空气污染对肺癌死亡率有独立或交互（与吸烟）作用；经烟草调整后的死亡率在雅典似乎比希腊其他地区更低，而且雅典和希腊其他地区肺癌死亡率随烟草消费的变化趋势几乎相同。相比之下，相同的数据表明吸烟对肺癌死亡率有很大影响，这种影响似乎不仅涉及早期致癌阶段，还涉及一些后期阶段。本分析结果不支持以下假设：至少在1980年之前的雅典，空气污染使肺癌发病率升高到了在生态关联分析中能够检测到的程度。然而，这些方法固有的局限性表明，对其结果的解释应谨慎，且只能作为逐步理解这一复杂问题的一个步骤。
