Journal of J Occup Health 2006; 48: 329Ð331 Occupational Health
Estimation of Annual Incidence of Lung Cancer Associated with Work Place Exposure to Passive Smoking in France
Shahryar ALIPOUR1, Frederic DESCHAMPS1, Francois-Xavier LESAGE1 and Francois LEBARGY2
1Department of Occupational Health, Faculté de Médecine and 2Department of Respiratory Diseases, Hôpital Maison-Blanche, France
Abstract: Estimation of Annual Incidence of Lung was to estimate the excess number of new lung cancer Cancer Associated with Work Place Exposure to cases from occupational ETS exposure in France. Passive Smoking in France: Shahryar ALIPOUR, et al. Department of Occupational Health, Faculté de Methods Médecine, France—This study attempted to estimate The number of new lung cancer cases from workplace the number of annual new cases of lung cancer from ETS exposure in France was estimated considering three workplace exposure to Environmental Tobacco Smoke factors. (ETS) in France. The number of new lung cancer cases attributable to workplace ETS exposure in France was estimated with regard to the following factors: excess Excess risk risk of lung cancer from workplace ETS exposure, All studies concerning excess risk of lung cancer from incidence of lung cancer in non-exposed non-smokers, ETS exposure were identified through online literature and number of French workers exposed to passive searches (e.g. Medline and Toxline). We searched meta- smoking. The excess risk of lung cancer from analysis and review articles which were published workplace ETS exposure was estimated as from 0.12 between January 1995 and March 2004. Six meta-analyse to 0.39 by different references. The French workforce, and one review article were accepted for our study with regularly exposed to ETS in their workplace is about regard to international publications11Ð17). Furthermore, 3.2 millions. The incidence of lung cancer of non- published reports of authoritative organizations, such as smokers without exposure to ETS is between 3.7 to 10 the International Agency for Research on Cancer per hundred thousand. If these three factors are (IARC)18), the Environmental Protection Agency (EPA)1) combined, it is estimated that exposure to workplace passive smoking causes around 14 to 125 new cases and the Scientific Committee on Tobacco and Health 19) of lung cancer each year in France. New lung cancer (SCOTH) were also collected. cases from workplace exposure to ETS represent a few percent of all occupational lung cancers, and a Lung cancer incidence minuscule number in regards to the whole lung cancer Lung cancer incidence in non-smokers who were not annual incidence (14 to 125 for 23,000 lung cancers in exposed to ETS was determined by Medline search and France=0.06% to 0.54%) data collection from other studies (e.g. SCOTH report). (J Occup Health 2006; 48: 329–331) We have accepted the incidence rate applied by SCOTH19) for the high hypothesis, and the one declared by Boffetta Key words: Lung cancer, Environmental Tobacco et al.20) for the low hypothesis of our study. Smoke, Incidence Exposed population Only a few studies have examined the relationship We defined the exposed population, as only non- between occupational environmental tobacco smoke smoking workers regularly exposed to inhalation of ETS (ETS) exposure and lung cancer1Ð10). The aim of this study at their workplace (all commercial or industrial branches were concerned). Low frequencies of ETS exposure, for example, two or three times a year were neglected. The Received Sep 1, 2005; Accepted Apr 20, 2006 information about the active French population exposed Correspondence to: F. Deschamps, Department of Occupational Health, Faculté de Médecine, 51 rue Cognacq-Jay, 51100 Reims, to ETS in their workplace was estimated from the latest 21, 22) France (e-mail: [email protected].) French publications . 330 J Occup Health, Vol. 48, 2006
Table 1. Annual new cases of lung cancer attributable to workplace ETS* exposure in France
Estimation Exposed French Incidences of lung Lung cancer excess Annual new cases of lung non-smoker cancer in non-ETS risks from workplace cancer from workplace workers exposed population ETS exposures ETS exposure in France (A)(B)(C)(A × B × C)
High Estimation 3,200,000 10/100,000 0.39 125 Low Estimation 3,200,000 3.7/100,000 0.12 14
*Environmental Tobacco Smoke.
Methodology calculation (total French working population is 25 millions). Annual incidence of lung cancer from workplace ETS Therefore we estimated that about 3,200,000 of French exposure was estimated with this equation: (Excess risk workers are regularly exposed to occupationally passive of lung cancer from ETS exposure in the workplace) × smoking. (Risk of lung cancer in non-exposed non-smokers) × (French active population exposed to workplace passive Lung cancer incidence attributable to workplace ETS smoking). exposure As mentioned previously, according to different Results and Discussion investigations, excess risk of lung cancer from ETS ETS exposure and lung cancer exposure in the workplace has been estimated as being A statistically significant increased risk of lung cancer between 12% and 39%, and the incidence of lung cancer of 12% to 39% in non-smokers exposed to second hand in non-exposed non-smokers has been determined as tobacco smoke at the workplace was found23, 24). being between 3.5/100,000 and 10/10,000, yearly. Considering 3,200,000 French non-smoker workers who Risk of lung cancer in non-exposed non-smokers are regularly exposed to ETS in their workplace, we This incidence was estimated as being from about 3.7/ estimated that: 100,000 to 10/100,000 by other studies19, 20). The 3,200,000 × (3.5/100,000Ð10/100,000) × (12%Ð incidence of lung cancer in non-smokers without exposure 39%)=14Ð125 new cases of lung cancer are found yearly to ETS is 10 per 100,000. An increased risk of lung for the reason of workplace ETS exposure in France cancer from 12 to 39% in exposed non-smokers would (Table 1). give a lung cancer incidence of 11.2 to 13.9 cases per It is estimated that approximately 50% of the daily 100,000 per year. In other words we could expect an ETS exposure is attributed to workplace exposure28). additional 1.2 to 3.9 lung cancer cases each year per The principal limitation of our study is the number of 100,000 non-smokers regularly exposed to ETS in their French workers who are exposed to workplace passive workplace. smoking. As mentioned above, there is no precise figure for this number. We determined this number using Exposed French population existing data. The number of French persons, regularly exposed to The total number of lung cancers due to occupational occupational ETS, has not been calculated precisely. exposures among men in France is estimated to be about Kauppinen et al.25) declare that ETS is the most common 2,713Ð6,051 new cases, yearly29). In other words, the occupational respiratory carcinogen in European Union estimated number of lung cancer for occupational ETS countries such as France, in which about 1.2 million of exposure in France is only a few percent of the total workers are exposed to ETS. The authors of the above- number of occupational lung cancers (0.2% to 4%). mentioned investigation only considered workers who With regard to the fact that ETS is the most common were exposed to ETS for more than 75% of their working occupational exposure to group 1 respiratory carcinogens time. This is why the real number of French workers in European Union countries (e.g. France), the necessity who are exposed to ETS in their workplace must be more of approving a more effective and appropriate law seems than 1,200,000. obvious. For our estimation (data obtained, as occupational References practitioner, from a sample of 2,000 workers) we have assumed that about 20% of French non-smoker workers 1) US Environmental Protection Agency. Respiratory are regularly exposed to occupational ETS. The French health effects of passive smoking: lung cancers and non-smoker active population is about 16 millions26, 27) other disorders. Washington: Office of Air and Shahryar ALIPOUR, et al.: Lung Cancer and Passive Smoking 331
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