Does environmental tobacco smoke cause cancer?

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This page was last updated on March 3, 2004. F.W. Grannis Jr. MD

Yes. Multiple studies have shown that the risk of lung cancer in patients who have never smoked, but have been exposed to environmental tobacco smoke in the home or at the job, have a statistically significant increase in the frequency of lung cancer compared to people who have not had such environmental exposure.

During the past year (1997-8) a number of critically important studies were published that conclusively prove that environmental tobacco smoke not only causes cancer, but is also responsible for approximately 50,000 deaths each year in the U.S, according to the results of a long term study (The Boston Nurses Study) of the mortality in a group of RNs who did not smoke, but who lived with persons who did smoke. Such deaths are the result of cancer, heart disease and stroke. Another critically important study was published in the January 14, 1998 issue of the Journal of the American Medical Association The Atherosclerosis Risk in Communities (ARIC) Study This report demonstrates that people who are exposed to ETS develop atherosclerosis (hardening of the arteries responsible for heart attack and stroke) at a rate 20% greater than people not exposed to ETS. This was proven in a multi-institution, prospective study, by serial visualization of the thickness of the carotid (neck) arteries using non-invasive techniques in more than 10,000 people.

A third recent study documents the presence of a carcinogen found only in cigarette smoke (NNK) in the urine of non-smokers who had been in contact with cigarette smoke, providing non-controvertible evidence that ETS exposes non-smokers to risk of cancer causing chemicals.

If you are looking for further information on health effects of involuntary smoking or on ways to ensure smoke-free air to breath, there is an entire issue of the British Medical Journal/Tobacco Control on this topic. Abstracts of articles are available at the following link. Supplement to Tobacco Control http://tc.bmjjournals.com/content/vol13/suppl_1/#ARTICLES

More information on ETS

Environmental Tobacco Smoke

In summary, John Banzhaf has concluded that "Secondhand tobacco smoke kills more people each year than automobile accidents, all crimes (including those involving guns), and AIDS."

The following letter from a noted epidemiologist and pharmacologist provides a brief but comprehensive summary of the problem of ETS.

To: Senate Committee on Environment and Public Works
Senate Hart Building, Room 407, Washington, D.C. 20510

From: K.H. Ginzel, MD,
Professor of Pharmacology and Toxicology Emeritus
University of Arkansas for Medical Sciences

jdunaway@nmsu.edu

Re: Written testimony for the Senate Hearing on ETS, April 1, 1998

The present focus of projected federal tobacco legislation is on smoking, in particular smoking in children, while the hazard of breathing the smoke of others, i.e., environmental tobacco smoke (ETS), is largely ignored.

Since 1992, when the Environmental Protection Agency designated ETS as a Class A Human Carcinogen (like asbestos, arsenic, benzene, etc.), additional evidence for the deleterious effects of ETS has accumulated at an increasing rate.

Most importantly, one of the major lung carcinogens in tobacco smoke, NNK, has been identified in the body of individuals who were exposed to ETS. This finding complements and strengthens the host of epidemiologic studies that have established incontrovertible proof of a cause-effect relationship between ETS exposure and disease. After active smoking and alcohol, ETS now ranks as the third leading preventable cause of death in our society.

Although lung cancer is the most dreaded consequence, heart disease exceeds the former in the sheer number of cases, boosting the latest estimate of ETS-related fatalities in this country alone to about 60,000 per year, according to a recent comprehensive analysis by the California EPA. A study published in the Journal of the American Medical Association > presented evidence that active as well as passive smoking leads to an irreversible thickening of arteries, an indicator of atherosclerotic progression. Two alarming reports even implicate both active and passive smoking in the causation of breast cancer in about half of Caucasian women due to protracted detoxification of certain aromatic amines hitherto only associated with bladder cancer.

Smokefree air is especially important for children, born and unborn. Passive smoking during pregnancy inflicts two thirds of the harm caused by active smoking, which consists, among others, in low birth weight, perinatal death, and cognitive and behavioral deficits . During infancy respiratory disease is significantly increased. ETS-exposed children also have a 2-4 fold higher incidence of leukemia and may die later in life from lung cancer as a consequence of the exposure in childhood. There is no question that smoking, i.e., 'voluntary' smoking, kills about seven times as many Americans as does involuntary smoking: 430,000 as compared to approximately 60,000 each year. But we have to look beyond priorities in numbers.

Involuntary, or passive, smoking is not just a health issue. Inevitably, it also invokes ethical as well as legal aspects. Obviously, it is one thing for a smoker to die from lung cancer or any other smoking-related disease, but quite another for a nonsmoker to succumb to an illness, fatal or otherwise, that was inflicted by someone else. People harmed by ETS on the job may seek redress for the injuries to their health from employers who have allowed smoking in the workplace. The case of restaurant employees is especially serious as their exposure to tobacco smoke has been found to be far greater than in any other occupational setting.

Admittedly, even in the case of the smoker voluntariness must be qualified. Since almost 90% of all adult smokers started as children, who may have been lured by the deceitful promises and the slick imagery of advertising, compacted into what is amiably called 'peer pressure', the buzzwords 'adult choice' are dubious at best. However, since addiction does NOT compel smokers to smoke indoors in the presence of nonsmokers, they do have the choice not to expose others. Hence, there is no valid > excuse to involve innocent bystanders, especially children and pregnant women, when the outdoors is vastly bigger than all enclosed areas put together.

Regrettably, because smokers are constantly provoked by the tobacco industry and its front groups to insist on their so-called right to smoke anywhere and anytime, nonsmokers still depend on government to protect them from ETS exposure. In fact, being exposed to the smoke of others differs from actively smoking only in intensity of exposure. Thus, not granting a smokefree environment is tantamount to making smoking mandatory for everyone. Indeed, there are few adults or children who do not have nicotine and other poisons present in smoke in their blood. If smokers claim a 'right' to smoke indoors, such 'right' obviously harms the nonsmoker. On the other hand, the right of nonsmokers to air unpolluted by tobacco smoke does not harm the abstaining smoker. In short, smoking hurts nonsmokers, but nonsmoking does not hurt smokers. Actually, indoor smoking bans benefit smokers in two ways. Those who are struggling to give up will be less tempted to relapse in an environment that is smoke-free, while smokers who continue to smoke can at least avoid the hazard of breathing the sidestream smoke of their own and their fellow > smokers' cigarettes or cigars.

But there is more to ETS than physical harm. First, the pervasive visibility of smoking in public places as well on TV and in movies portrays smoking as a normal social behavior, modeling negatively for the growing child and adolescent who learn by imitating adults. This is why the nonsmokers' rights movement was rightly judged by Big Tobacco as "the most dangerous development to the viability of the tobacco industry that has yet occurred" (1978 Roper Report). Here is the link between involuntary and voluntary smoking, the former leading to the latter. Smoking in public view helps program and procure the next generation of smokers, smoking feeding on smoking, literally perpetuating the vicious circle.

Another sequel to permitting public smoking is the loss of a valuable opportunity to signal to the smoker that both active smoking and passive smoking are harmful. Parents who cannot light up in restaurants may think twice before doing so in their home or car. The fact that smoking is still allowed in many indoor environments implies for adults and kids that it really cannot be that bad. "Say NO to drugs, but say YES to tobacco" has been the perennial message of the cigarette pushers AND, until now, of the establishment as well.

Thus, smoking in public not only recruits the young, but also assures that current smokers remain loyal consumers. It opposes our efforts and diminishes success in smoking prevention and smoking cessation. The need to provide a smoke-free environment is therefore not less important than the need to treat the smoker and prevent children from starting to smoke. Both are integral parts of one and the same problem and should not be separated from each other.

The main obstacles to ban smoking indoors are 1) concerns that, despite ample evidence to the contrary, business could suffer, as in the case of bars and restaurants, and 2) the continued denial, fostered by the tobacco industry, that ETS is a serious health hazard. It is this denial that makes the smoker, especially the militant smoker, insist on the fictitious right to smoke wherever (s)he pleases. We have failed to educate the general public about the full range and magnitude of the devastating health effects of tobacco use in all its forms and will continue to fail unless we attack the leading public health problem of our time in its entirety. By dividing it up, we will be defeated. We have failed to convince smokers that exposing others (and themselves) to smoke in enclosed air spaces can cause injuries to their > health no less severe, albeit delayed and of different kind, than can be caused by driving under the influence of alcohol or illicit substances. I am confident that the majority of smokers, once they have internalized this message, will no longer insist to smoke in the presence of nonsmokers as no one today claims the right to drive while intoxicated; business concerns will then also be laid to rest. All this has to be impressed upon Congress, so that the need of protecting Americans from exposure to a major environmental poison and its psychosocial implications is fully recognized as an urgent goal of federal legislation.

April 14, 1998

Dear Senator,

I am writing to request that you enter the enclosed written testimony into the record for the April 1 Senate Hearing on Environmental Tobacco Smoke. I am also faxing the testimony today to the Senate Committee on Environment and Public Works.

As Congress is considering comprehensive tobacco legislation, it is imperative that the pervasive problem of ETS exposure is given full attention. Action by the federal government to protect American workers and families from the physical and psychosocial consequences of ETS exposure has been long overdue. The present moment offers a unique opportunity to make good on past omissions and stop the unconscionable injury inflicted by ETS exposure on the nonsmoking majority of the people of this nation. Your dedication to this cause will be greatly appreciated.

Sincerely,

K.H. Ginzel, MD
Professor of Pharmacology and Toxicology Emeritus
University of Arkansas for Medical Sciences
5015 Alamo Mine Trail Las Cruces, NM 88011
Ph. and Fax 505-522-0180

jdunaway@nmsu.edu

A position statement from the World Health Organization (WHO) can be found at their Web Site National Jewish Medical and Research Center in Denver CO visit here.

Graham Kelder has written a comprehensive review on the topic of ETS.

The URL for the California EPA report on secondhand smoke is now: CalEPA. This is a very comprehensive report on all aspects of ETS.

An entire textbook of information on this subject can be found at ETS

An extensive bibliography on ETS can be found here courtesy of ASH: Action on Smoking and Health

If you are interested in finding out the status of your state with regard to laws protecting citizens right to smoke-free air, visit this excellent interactive web page provided by Americans for Non-smokers Rights

• 1. Fetal Growth Low birthweight or small for gestational age Sudden Infant Death Syndrome (SIDS)
• 2. Respiratory Effects Acute lower respiratory tract infections in children ( e.g., bronchitis and pneumonia) Asthma induction and exacerbation in children Chronic respiratory symptoms in children Eye and nasal irritation in adults Middle ear infections in children
• 3. Carcinogenic Effects Lung Cancer Nasal Sinus Cancer
• 4. Cardiovascular Effects Heart disease mortality Acute and chronic coronary heart disease morbidity

• 1. Respiratory Effects Exacerbation of cystic fibrosis Decreased pulmonary function
• 2. Carcinogenic Effects Cervical cancer
• 3. Miscellaneous Effects Spontaneous abortion Adverse impact on cognition and behavior

  ==================================================== Table ES.2: Estimated Annual Morbidity and Mortality in Nonsmokers Associated with ETS Exposure

  Number of People Condition or Cases in the U.S. Developmental Effects:

• Low birthweight 9,700 - 18,600 cases Sudden Infant Death Syndrome (SIDS) 1,900 - 2,700 deaths
• Respiratory Effects in Children:
• Middle ear infection 700,000 - 1,600,000 physician office visits
• Asthma induction 8,000 - 26,000 new cases
• Asthma exacerbation 400,000 - 1,000,000 children
• Bronchitis or pneumonia 150,000 - 300,000 cases, in infants and toddlers 7,500 - 15,000 hospitalizations, (18 months and under) 136 - 212 deaths
• Cancer:
• Lung 3,000 deaths
• Nasal sinus Not available
• Cardiovascular Effects:
• Ischemic heart disease 35,000 - 62,000 deaths

Note: The numbers in this table are based upon estimates of the risk. There are uncertainties in these estimates so actual impacts could be higher or lower than indicated above.

I have found an even better place to find out "what's in cigarette smoke?". This truly awesome web site was put together by Canadian MDs . They also have great pages on why second hand smoke is bad for kids and offer some great advice to parents on "taking their butts outside".