Passive Smoking and Lung Cancer: A Reanalysis of Hirayama’s Data

  • K. Überla
  • W. Ahlborn
Part of the International Archives of Occupational and Environmental Health Supplement book series (OCCUPATIONAL)


The statistical association between environmental tobacco smoke and lung cancer is controversial. The Hirayama Study seems to provide sound epidemiological evidence supporting this hypothesis. In a recent paper [6] I have analyzed the published studies. Regarding the Hirayama study the following facts have to be kept in mind:
  • The study was not designed to test the hypothesis, whether passive smoking is associated with lung cancer or not. It can therefore only generate this hypothesis, not prove it.

  • The cohort was not representative for the population of Japan. A selection bias is possible.

  • The exposure indicator — the fact of being married to a man who smokes — is not reliable, not valid and not specific.

  • The event indicator — dying on lung cancer as noted on death certificates — is neither reliable nor valid.

  • Various confounding factors — for instance exposure at the working place, indoor air pollution, overall air pollution, type of medical care — were not accounted for.

  • Bias in registering the fact, that a woman is a nonsmoker, was not controlled. Resulting differential misclassifications of the cases, who were smokers and had to be excluded, have not been considered.

  • Almost nothing is known about the 200 cases. No case reports are available, autopsy and histology arc available in only 11.5%.


Lung Cancer Risk Ratio Rate Ratio Smoking Habit Environmental Tobacco Smoke 
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© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • K. Überla
  • W. Ahlborn

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