Trédaniel J, Boffetta P, Saracci R, Hirsch A
Unit of Analytical Epidemiology, International Agency for Research on Cancer, Lyon, France.
Eur Respir J. 1994 Oct;7(10):1877-88. doi: 10.1183/09031936.94.07101877.
Exposure of nonsmokers to environmental tobacco smoke (ETS) is widespread in European countries, the most serious exposures occurring at home and in the workplace. Epidemiological studies available up to 1986 have been reviewed by several international and national authorities, which agreed in concluding that ETS exposure is causally related to lung cancer. A number of epidemiological studies have been published since then, and have confirmed this association. The possibility of positive results due to bias has been envisaged; it seems, however, that such bias could not explain the whole excess of lung cancer. Few data are available on confounders, such as diet and previous history of lung disease, that might be responsible for the association; however, there is no evidence that they play an important role. Moreover, the biological plausibility of a causal association is supported by the similarity of the composition of ETS and active smoke. The causal association between ETS exposure and lung cancer now seems well-established; however, its public health impact is still debated. Estimates are available from the United States, Canada, Australia, New Zealand and England.
在欧洲国家，非吸烟者接触环境烟草烟雾（ETS）的情况很普遍，最严重的接触发生在家中和工作场所。截至1986年的流行病学研究已由多个国际和国家权威机构进行了审查，这些机构一致得出结论，即接触ETS与肺癌存在因果关系。自那时以来，已经发表了许多流行病学研究，并证实了这种关联。已经考虑到由于偏倚导致阳性结果的可能性；然而，似乎这种偏倚无法解释肺癌的全部超额病例。关于可能导致这种关联的混杂因素，如饮食和既往肺部疾病史的数据很少；然而，没有证据表明它们起重要作用。此外，ETS与主动吸烟成分的相似性支持了因果关联的生物学合理性。现在，接触ETS与肺癌之间的因果关联似乎已得到充分证实；然而，其对公共卫生的影响仍存在争议。美国、加拿大、澳大利亚、新西兰和英国都有相关估计。
