"No - there are other exposures that can also cause the same diseases. For heart disease, there is also hypertension, diabetes, obesity, high cholesterol. For lung cancer, there is also arsenic and radon. For chronic lung disease, there are also some occupational exposures."
Unfortunately there's quite a bit more than that as confounders ...as examples:
Occupational::
Australian meat workers found with an SIR 164, 95% CI 97 to 259 (which is referred to as non-significant) for lung cancer
New Zealand pulp and paper workers at SMR = 1.33, 95% CI 0.94-1.83, 37 deaths for lung cancer (again "not significantly significant")
Female agricultural workershad an OR 1.7, 95% CI 0.7-4.4 for lung cancer (again stated as statistically insignificant)....apparently this occupation is protective for breast cancer in post-menopausal women, though.
Also at increased risk....miners (all forms), anybody dealing with diesel exhaust on the job, sandblasters, quarry and foundry workers, grinders, stonecutters, and a truckload of others.
Diet:
In women lung cancer risk increased for total meat consumption (OR=1.6, C.I. 1.1-2.4), red meat (OR=1.8, C.I., 1.2-2.7), well-done red meat (OR=1.5, C.I.s, 1.1-2.1) and fried red meat (OR=1.5, C.I., 1.1-2.0), (interesting, these guys consider these numbers significant at overall 1.04 to 1.09)
This study found lung cancer risk increased from NDMA intake in foods (fish, poultry, cured and salted meats) as well as beer and hard alcohol i intake. (although all of the number ranges crossed 0, so I'm a little unsure how it was considered significant)
The mediterranean diet apparently has a protective effect (and, by extension, the North American diet not so much) for lung cancer.......we found a protective effect for high consumption of carrots (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.42-1.05), tomatoes (OR = 0.59, 95% CI = 0.34-1.03), white meat (OR = 0.66, 95% CI = 0.42-1.02), exclusive use of olive oil (OR = 0.67, 95% CI = 0.45-0.99),and regular consumption of sage(OR=0.43,95% CI=0.29-0.65)
Increased levels of dietary zinc, copper and selenium as well as folate intake , phytoestrogens , beta carotene, raw fruits and vegetables, and vitamin E supplements have all shown a protective effect for lung cancer.
*takes a deep breath*
And, There was a positive dose-response relation between the consumption of processed meats (luncheon meats, bacon, sausage), dairy foods (whole milk, regular ice cream), eggs, and particular desserts (fruit pies, custard/cream pies) and the risk of lung cancer in men.
Environmental:
Wood stoves. After extensive adjustment for all the empirical confounders the odds ratio (OR) for all upper aero-digestive tract cancers was 2.68 (95% confidence interval [CI] : 2.2–3.3)
My guess is that this would be the same for fireplaces, campfires, etc.
Living near heavy industry apparently doubles your risk.
Cooking oil contains acrolein -- found in tobacco and also some cooking oils -- which appears to be a prime cause of smoking-related lung cancer and some nonsmoking-related lung cancers as well, according to studies conducted with lung cancer cells.
Air pollution is listed here as being responsible for 10.7% of lung cancer, radon as 4.5%, and (whoops, someone missed the "tobacco smoke is the worst" message) SHS as 1.6%.
Exposure to human papillomavirus appears to have some bearing on lung cancer incidence.
The ACS also lists arsenic (in drinking water), beryllium. vinyl chloride, nickel chromates, coal products, mustard gas, chloromethyl ethers, and of course genetics as major factors.
Lest we forget, ethnic background and age also must be factored in, it seems.
And, even worse, apparently the type of cigarette (filter or non, hand-rolled or premade, blond or black tobacco, and, yes, tar levels) makes a drastic difference in lung cancer risk for smokers.
Finally, somehow in my haste when posting this I completely forgot to include exercise levels as a major factor in reduction of lung cancer risk. From what I can tell, most of the studies seem to agree that this follows for smokers and non-smokers alike.
My apologies for not posting more of them (do a search for "environmental lung cancer increased risk"....sorry, PubMed won't let me link the search results), but I can only dig through PubMed for so long before my eyes start to cross.
As well, please note.....these are only the lung cancer confounders. The list for CHD and CLD are just as bad.
As usual, most of the studies I checked suggested that 1.2, 1.4, 1.8, etc were statistically insignificant unless we they were talking about tobacco....then those numbers became "significant risk", "moderate high risk", etc.
And only in one case did anybody even think to suggest that not accounting for diet issues as a confounder might be a reason to suspect skewed results on previous studies on smokers, even though most of the studies seem to agree (when they mention it at all) that smokers tend to have a less-healthy diet, get less exercise, and be in the lower income brackets (which often means higher risk jobs like mechanic, truck driver, etc).
While most of the studies seem to factor in a few confounders (usually education and/or income levels), I've yet to see one that accounts for diet, exercise, and occupation.
No comments:
Post a Comment