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Leslie Stayner, PhD, James Bena, MS, Annie J. Sasco, MD, DrPH, Randall Smith, MA, Kyle Steenland, PhD, Michaela Kreuzer, PhD and Kurt Straif, MD, PhD

Leslie Stayner is with the School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois, Chicago. James Bena is with the Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio. Annie J. Sasco is with the Victor Ségalen Bordeaux 2 University, Cancer Group, Bordeaux, France. Randall Smith is with the National Institute for Occupational Safety and Health, Cincinnati, Ohio. Kyle Steenland is with the Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, Ga. Michaela Kreuzer is with Gesellschaft für Strahlenforschung–National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany. Kurt Straif is with The International Agency for Research on Cancer, Lyons, France.

Correspondence: Requests for reprints should be sent to Leslie Stayner, PhD, Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health (M/C 923), 1603 West Taylor St, Room 971, Chicago, IL 60612 (e-mail: lstayner{at}uic.edu).

Objectives. We sought to quantitatively evaluate the association between work-place environmental tobacco smoke exposure and lung cancer.

Methods. We performed a meta-analysis in 2003 of data from 22 studies from multiple locations worldwide of workplace environmental tobacco smoke exposure and lung cancer risk. Estimates of relative risk from these studies were analyzed by fitting the data to fixed and mixed effects models. Analyses of highly exposed workers and of the relationship between duration of exposure and lung cancer were also performed.

Results. The meta-analysis indicated a 24% increase in lung cancer risk (relative risk [RR]=1.24; 95% confidence interval [CI]=1.18, 1.29) among workers exposed to environmental tobacco smoke. A 2-fold increased risk (RR=2.01; 95% CI=1.33, 2.60) was observed for workers classified as being highly exposed to environmental tobacco smoke. A strong relationship was observed between lung cancer and duration of exposure to environmental tobacco smoke.

Conclusions. The findings from this investigation provide the strongest evidence to date that exposure to environmental tobacco smoke in the workplace is associated with an increased risk of lung cancer.

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