Abstract
A review of published epidemiological studies on lung cancer consistently shows Chinese females in China, Hawaii, Hong Kong, Singapore, and Taiwan having low relative (2-4) and attributable risks (-1/3) from smoking. However, female lung cancer incidence/mortality rates within China are variable, with some comparable to the lowest rates in other parts of the world. This variablity suggests the role of environmental etiological factors. Research on risks from inhaled air pollutants indicate that smoky coal used for cooking and heating in the colder parts of NE and SW China increased risk for lung cancer. However, risks from other air pollutants like environmental tobacco smoke, cooking fumes, and cooking oils were equivocal, and that for mosquito coil, incense, and other cooking fuels showed no risk. Risk from the effects of diet are inconsistent, with some studies from China showing increased fruit and vegetable intakes associated with increased risk. However, dietary results from Chinese communities outside China (Hong Kong, Singapore, Taiwan) are more similar to risks found among Western societies. There was some indication that previous respiratory diseases like chronic bronchitis and tuberculosis may be associated with lung cancer risk, but these results may be due to prodromal symptoms and recall bias, respectively. The role of reproductive health factors like parity, age at menopause, menstrual cycle length, etc. is unclear. Hence, aside from smoky coal exposure in cold and less developed parts of China, the etiological factors causing high lung cancer rates among Chinese women living in affluent urban warm climates like Shanghai, Hong Kong, Singapore, and USA remain unclear. J Epidemiol, 1996 ; 6 : S231 -S236.
