© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 9, 803,
May 5, 1999
© 1999 Oxford University Press
CORRESPONDENCE |
Re: Multicenter Case-Control Study of Exposure to Environmental Tobacco Smoke and Lung Cancer in Europe
Correspondence to: K.W.E. Denson, FRC Path., Thame Thrombosis and Haemostasis Research Foundation, Wenman Road, Thame, Oxon, OX9 3NY U.K. (E-mail: kdenson{at}cix.co.uk).
Boffetta et al. (1) in their multicenter study on exposure to environmental tobacco smoke (ETS) and the risk of lung cancer showed that the odds ratios for spousal and workplace ETS exposures were 1.16 and 1.17, respectively, with no clear dose-response relationships. Although they allowed for intake of fruits and vegetables, they did not allow for intake of saturated and unsaturated fats.
A recent meta-analysis of 51 studies showed that smokers have a statistically significantly (P
.0001) higher intake of saturated fat than nonsmokers (2).
ETS-exposed nonsmokers have a statistically significantly (P.001) higher intake of
fat compared with unexposed nonsmokers (3). Many studies have shown
an increased risk of lung cancer with increasing consumption of fat, for example Wynder et al. (4). Alavanja et al. (5), in a case-control study of
429 nonsmoking women with lung cancer (comparable in size to the study of Boffetta et al.),
showed that the relative risk (RR) for all histologic types of lung cancer comparing high quintiles
with low quintiles of saturated fat intake was 6.14 (95% confidence interval
[CI] = 2.63-14.4; P for trend = .0001). The RR for
adenocarcinoma comparing high quintiles with low quintiles of saturated fat intake was 11.38
(95% CI = 3.47-34.4; P for trend = .0001).
In the study by Boffetta et al., 78% of the case patients were female and 51% of the tumor histologic types were adenocarcinoma. In light of the evidence given by Alavanja et al., how can Boffetta et al. attribute this very small increased risk to ETS exposure?
REFERENCES
1
Boffetta P, Agudo A, Ahrens W, Benhamou E, Benhamou S,
Darby SC, et al. Multicenter case-control study of exposure to environmental tobacco smoke and
lung cancer in Europe. J Natl Cancer Inst 1998;90:1440-50.
2
Dallongeville J, Marecaux N, Fruchart JC, Amouyel P. Cigarette
smoking is associated with unhealthy patterns of nutrient intake: a meta-analysis. J Nutr 1998;128:1450-7.
3 Thornton A, Lee P, Fry J. Differences between smokers, ex-smokers, passive smokers and nonsmokers. J Clin Epidemiol 1994;47:1143-62.[CrossRef][ISI][Medline]
4 Wynder EL, Hebert JR, Kabat GC. Association of dietary fat and lung cancer. J Natl Cancer Inst 1987;79:631-7.cancerlit;88012005
5
Alavanja MC, Brown CC, Swanson C, Brownson RC. Saturated
fat intake and lung cancer risk among nonsmoking women in Missouri. J Natl Cancer Inst 1993;85:1906-16.
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