Cardenas V M, Thun M J, Austin H, Lally C A, Clark W S, Greenberg R S, Heath C W
Epidemiology Division, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Cancer Causes Control. 1997 Jan;8(1):57-64. doi: 10.1023/a:1018483121625.
Environmental tobacco smoke (ETS) has been classified as a human lung carcinogen by the United States Environmental Protection Agency (EPA), based both on the chemical similarity of sidestream and mainstream smoke and on slightly higher lung cancer risk in never-smokers whose spouses smoke compared with those married to nonsmokers. We evaluated the relation between ETS and lung cancer prospectively in the US, among 114,286 female and 19,549 male never-smokers, married to smokers, compared with about 77,000 female and 77,000 male never-smokers whose spouses did not smoke. Multivariate analyses, based on 247 lung cancer deaths, controlled for age, race, diet, and occupation. Dose-response analyses were restricted to 92,222 women whose husbands provided complete information on cigarette smoking and date of marriage. Lung cancer death rates, adjusted for other factors, were 20 percent higher among women whose husbands ever smoked during the current marriage than among those married to never-smokers (relative risk [RR] = 1.2, 95 percent confidence interval [CI] = 0.8-1.6). For never-smoking men whose wives smoked, the RR was 1.1 (CI = 0.6-1.8). Risk among women was similar or higher when the husband continued to smoke (RR = 1.2, CI = 0.8-1.8), or smoked 40 or more cigarettes per day (RR = 1.9, CI = 1.0-3.6), but did not increase with years of marriage to a smoker. Most CIs included the null. Although generally not statistically significant, these results agree with the EPA summary estimate that spousal smoking increases lung cancer risk by about 20 percent in never-smoking women. Even large prospective studies have limited statistical power to measure precisely the risk from ETS.
美国环境保护局（EPA）已将环境烟草烟雾（ETS）归类为人类肺癌致癌物，这一结论基于侧流烟雾与主流烟雾的化学相似性，以及与非吸烟者结婚的从不吸烟者相比，配偶吸烟的从不吸烟者患肺癌的风险略高。我们在美国对114286名女性和19549名男性从不吸烟者进行了前瞻性评估，这些人与吸烟者结婚，并与约77000名配偶不吸烟的女性和77000名配偶不吸烟的男性从不吸烟者进行比较。基于247例肺癌死亡病例进行多变量分析，对年龄、种族、饮食和职业进行了控制。剂量反应分析仅限于92222名女性，这些女性的丈夫提供了关于吸烟和结婚日期的完整信息。在调整了其他因素后，当前婚姻期间丈夫曾吸烟的女性的肺癌死亡率比与从不吸烟者结婚的女性高20%（相对风险[RR]=1.2，95%置信区间[CI]=0.8 - 1.6）。对于妻子吸烟的从不吸烟男性，RR为1.1（CI = 0.6 - 1.8）。当丈夫继续吸烟（RR = 1.2，CI = 0.8 - 1.8）或每天吸烟40支或更多（RR = 1.9，CI = 1.0 - 3.6）时，女性的风险相似或更高，但与吸烟者结婚的年限并未增加风险。大多数置信区间包含无效值。尽管这些结果通常没有统计学意义，但与EPA的总结估计一致，即配偶吸烟会使从不吸烟女性患肺癌的风险增加约20%。即使是大型前瞻性研究，精确测量ETS风险的统计能力也有限。
