A case-control study of air pollution and tobacco smoking in lung cancer among women in Athens.

Background: A case-control study exploring the role of smoking and outdoor air pollution in the causation of lung cancer, by histologic type, in nonsmoking women, was undertaken in Athens between 1987 and 1989.

Methods: One hundred one women with lung cancer and 89 comparison women with fractures or other orthopedic conditions, all permanent residents of Greater Athens, were included in the study. Smoking habits were ascertained through interviews, whereas lifetime exposure to air pollution was assessed by linking blindly lifelong residential and employment addresses of all subjects with objectively estimated or presumed air pollution levels.

Results: The age-adjusted relative risk and 95% confidence intervals for lung cancer among current smokers compared with nonsmokers was 3.40 (1.75-6.61); it was 7.43 (2.88-19.13) among those smoking for more than 30 years and 7.46 (2.40-23.17) among those smoking more than 20 cigarettes per day. The age-adjusted relative risk was 1.70 (0.75-3.89) for adenocarcinoma and 6.45 (2.73-15.25) for other histologic types of lung cancer; statistically significant dose-response trends were evident for both histologic groups. Air pollution levels were associated with increased risk for lung cancer but the relative risk was small and statistically not significant. However, when both air pollution and duration (or quantity) of tobacco smoking, as well as their interaction, were introduced in a multiple logistic regression model, the interaction term was significant at the suggestive level of 0.10.

Conclusion: Whereas there is no effect of air pollution among nonsmokers, the relative risk contrasting extreme quartiles of air pollution among smokers of 30 years duration was 2.23. The interaction was almost exclusively accounted for by the nonadenocarcinoma lung tumors.