Introduction

1. The COC undertook a detailed review of the evidence regarding the association between exposure to environmental tobacco smoke (ETS) and lung cancer during 1997. The review was requested by the Scientific Committee on Tobacco and Health (SCOTH). The full transcript of the COC statement can be found in the 1997 Annual report1 on the COC internet site

(http://www.advisorybodies.doh.gov.uk/coc/1997ar.pdf)1

The COC was asked to consider a new report of a cohort study2 at its June 26 2003 meeting.

Consideration of publication by Enstrom and Kabat British Medical Journal 17 may 2003, volume 326, 1057-1066.2,3

2. The Committee considered the information presented in the paper, the editorial regarding this paper, commentaries published by the American Cancer Society, and the British Medical Association, and a number of papers published since the COC review in 1997.

3. The Committee agreed there was evidence that exposure to ETS of individuals in the Cancer Prevention-1cohort could not be adequately assessed and thus no definite conclusions could be drawn with regard to the study by Enstrom and Kabat.

Additional evidence on ETS and lung cancer considered by the COC at 26 June 2003 meeting.4-9

4. The Committee noted the results of an additional systematic review4 published since the COC review in 1997 which were consistent with previous evaluations and suggested an increased risk in never smoking women exposed to ETS from spouses compared to never smoking women unexposed to ETS of 1.29 (95% CI 1.17-1.43).

5. The Committee noted additional evidence of exposure to carcinogenic tobacco-specific nitrosamines derived from ETS.5

COC conclusion

6.

i) The available additional data submitted to the 26 June 2003 COC meeting do not suggest that a full review of the literature since 1997 on this topic is required.

ii) The evidence from a recent systematic review (meta-analysis)4, and information regarding excretion of tobacco-specific nitrosamines in urine in individuals exposed to ETS5 support the conclusion reached in 1997.

iii) The evidence from a recent cohort study2 should be reviewed with caution in view of inadequacies in assessment of exposure to ETS in this investigation.

iv) The COC concluded there was no reason to change the conclusion reached in 1997, namely:

"Taking all the supporting data into consideration we conclude that passive smoking in non-smokers exposed over a substantial part of their life is associated with a 10-30% increase in the risk of lung cancer which could account for several hundred lung cancer deaths per annum in the UK."

 

July 2003

References

1. Department of Health (1997). Annual report of the Committees on Toxicity, Mutagenicity and Carcinogenicity.

2. Enstrom JE and Kabat GC (2003). Environmental Tobacco smoke and tobacco-related mortality in a prospective study of Californian, 1960-1998. British Medical Journal, 326, 1057-1068.

3. Davey-Smith G (2003). Editorial. Effect of passive smoking on health. More information is available, but controversy still persists. British Medical Journal, 326, 1048-1049.

4. American Cancer Society (2003). Statement dated 15/05/03, Atlanta, USA.

5. British Medical Association (2003). Statement. Response to BMJ paper "Effect of passive smoking on health", 16/05/03.

6. TaylorR et al (2001). Passive smoking and lung cancer; A cumulative meta-analysis. Australian and New Zealand Journal of Public health, 25, 203-211.

7. Anderson KE et al (2001). Metabolites of a Tobacco-specific lung carcinogen in non-smoking women exposed to Environmental Tobacco smoke. Journal of National Cancer Institute, 93, 378-381.

8. Bennet WP et al (1999). Environmental Tobacco smoke, Genetic susceptibility, and risk of lung cancer in never smoking women. Journal of National Cancer Institute, 91, 2009-2013.

9. Malats N et al (2000). Lung cancer risk in non-smokers and GSTM1 andGSTT1 genetic polymorphisms. Cancer Epidemiology, Biomarkers and Prevention, 9, 827-833.

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