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Fine particles and lung cancer
  1. F Forastiere
  1. Correspondence to:
 Dr F Forastiere
 Department of Epidemiology, Rome E Health Authority, Via Santa Costanza, 53, 00198 Rome, Italy;

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Which constituent of particulate matter is causing lung cancer?

Almost five decades have elapsed since the effect of the so-called “urban factor” on lung cancer has been suggested.1–3 Air pollution has always been an attractive explanation for the 10–40% increase in lung cancer mortality observed in urban versus rural areas, but confounding from smoking and other factors has been a great limitation in interpreting geographical comparisons. Several attempts have been made to specifically evaluate the role of air pollution on lung cancer aetiology during the 1960s and 1970s.4 In 1976, in a review for the International Agency for Research on Cancer (IARC), Higgins5 concluded that the studies available:

“provide support for the view that air pollution is a factor in this disease. But the effect of pollution cannot be large. It is likely to be a small fraction (possibly a tenth) of the effect of cigarette smoking.”

When the results of the two large American cohort studies on air pollution, the Six Cities Study6 and the American Cancer Society (ACS),7 were published, a strong association between particulate matter (PM) concentrations and cardiorespiratory mortality was reported, and …

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