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Indoor Air Pollution, Environmental Tobacco Smoking, and Lung Cancer Zuo-Feng Zhang, MD, PhD Professor, Department of Epidemiology UCLA School of Public Health UCLA Center for Environmental Genomics The 5th International Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, Sichuan, P.R. China April 7-10, 2010

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Source: Peto J, 2001

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Age Standardized Incidence Rates (/100,000) USChinaWorld SiteMalesFemalesMalesFemalesMalesFemales Stomach7.23.341.419.222.010.3 Lung61.936.142.419.035.512.1 Liver5.52.037.914.215.75.8 Esophagus4.91.327.412.011.54.7 Colon/Rectum44.633.113.69.220.114.6 Breast101.118.737.5 Leukemia11.27.4 5.7 4.15.94.1 Pancreas8.36.33.92.64.63.3 Cervix07.706.8016.2 Brain6.54.53.92.83.72.6 Prostate124.801.6025.30 Source: GLOBOCAN 2002

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Age-standardized Incidence Rates For Lung Cancer Source: Figure 5: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

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Risk Factors for Lung Cancer Tobacco smoking Second hand smoking (passive smoking) Asbestos Radon exposure Occupational exposures Air pollution Other radiation Recurring inflammation Family history of cancer Insufficient diet and poor nutritional factors

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Fuzhou, Air Pollution and DNA Repair Genes and Lung Cancer: 600 cases and 600 controls Taiyuan, Air Pollution and Lung Cancer: 400 cases/ 400 controls China-UCLA Lung Cancer Consortium Jiangsu: Epidemiolo gy of Top 4 Cancers (Lung, esophagus, liver and stomach)

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Specific Aims of the China-UCLA Lung Cancer Consortium To identify novel environmental risk and protective factors To evaluate genetic susceptibility To assess potential environment-gene interactions

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Indoor Air Pollution in China, Preliminary Results

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TaiYuan Project Cases: 396 newly diagnosed patients with lung cancer from major cancer hospitals in this city between 2006-2007; Control: 465 healthy control from the same source population; Epidemiological data were collected by in-person interview using a standard questionnaire;

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Second Hand Smoking (SHS) and Lung Cancer Risk among Non-Smokers (Taiyuan) CaseControl AOR(95%CI) N % Male & Female 71 (40.1)129 (45.4)1 Household106 (59.9)155 (54.6)1.01 (0.67-1.51) 117 (66.1)198 (69.7)1 Workplace60 (33.9)86 (30.3)1.84 (1.17-2.88) Neither42 (23.7)91 (32.0)1 Household / workplace104 (58.8)145 (51.1)1.57 (0.99-2.49) Household + workplace31 (17.5)48 (16.9)1.64 (0.89-3.01) Female 57 (35.2)83 (38.3)1 Household105 (64.8)134 (61.8)1.20 (0.78-1.85) 113 (69.8)167 (80.0)1 Workplace49 (30.3)50 (23.0)1.86 (1.14-3.04) Neither38 (23.5)67 (30.9)1 Household / workplace94 (58.0)116 (53.5)1.54 (0.94-2.54) Household + workplace30 (18.5)34 (15. 7)2.09 (1.07-4.05)

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Household Second Hand Smoking Exposure and Lung Cancer Risk among Non-smokers RelationshipETSCaseControlAOR&95%CI No71129 AnyYes106 (60)155(54.6)1.18 (0.80-1.74) SpouseYes91(51)102(35.9)1.53 (1.00-2.34) Only othersYes15530.53 (0.28-1.01) Spouse + othersYes17300.94 (0.48-1.84)

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IndexCaseControlAOR (ALL)AOR(ADC)AOR(SCC) 069 (18.0)199 (43.0)111 1--2127 (33.1)157 (33.9) 2.13 (1.46-3.11) 1.76 (0.96-3.20) 2.61 (1.37-4.97) 3--5160 (41.7)99 (21.4) 4.52 (2.97-6.88) 4.04 (2.16-7.57) 3.58 (1.71-7.48) 6+28 (7.3)8 (1.7) 9.28 (3.79-22.72) 14.49 (4.93-42.63) 7.60 (1.63-35.53) P trend P

Indoor PM1 and Lung Cancer Risk AOR(Summer) AOR(Winter) Living room All*2.48 (1.15-5.37)1.8 (0.89-3.63) Non-smoker4.06 (1.17-14.13)3.18 (0.87-11.64) Per 10ug/m 3 1.28(1.23-1.45)1.31(1.17-1.47) Bed room All2.52 (1.4-4.52)1.82 (1.03-3.23) Non-smoker3.37 (1.31-8.7)3.68 (1.22-11.08) Per 10ug/m 3 1.26(1.16-1.37)1.30(1.19-1.42) Kitchen All2.43 (1.35-4.39)1.76 (0.98-3.17) Non-smoker3.41 (1.32-8.78) 2.5 (0.86-7.28) Per 10ug/m 3 1.28(1.17-1.39)1.38(1.24-1.54) * : PM1: High (>50%) vs Low (