Family History and Lung Cancer

Anna Wu, Elizabeth T.H. Fontham, Peggy Reynolds, Raymond S. Greenberg, Patricia Buffler, Jonathan Liff, Peggy Boyd, and Pelayo Correa Am J Epidemiol 1996; 143:535-42

For those who follow weak association epidemiology, Elizabeth Fontham and crew are infamous for reporting a link between environmental tobacco smoke (ETS) and lung cancer. Their study played a key role in EPA's ETS "risk assessment" (at least that's what EPA calls it) and OSHA's proposal to ban workplace smoking.

Fontham and crew have now published a study reporting that nonsmokers with a family history of lung cancer have a 30 percent increase in lung cancer risk. Although the reported study outcome is not statistically significant (95% C.I. 0.9-1.9), the study is notable in that when Fontham and crew adjusted their data for ETS exposure, the reported risk of lung cancer did not change. Fontham's spin on this is that her reported association is strengthened by the fact that ETS-adjustment did not change the reported result.

Could it be that Fontham and crew may have overlooked the more interesting implication of the ETS adjustment? Do the reported results show that ETS was not a risk factor for lung cancer?

Heavens to Betsy! How could this be? In her study on ETS ( JAMA 1994;271:1752-9), Fontham was sure that ETS was associated with lung cancer risk! Did Fontham really mean to report results to the contrary? Did these results slip by the authors, peer reviewers, and editors?

Given that this new study has more cases than her ETS study, should Fontham revisit, reconsider and maybe even (gulp!) update her ETS study? Or, are Fontham and crew so brazen that they think they don't have to reconcile new results with old results?

Will EPA and OSHA staffs have meltdowns? Did EPA adequately assess the risk of relying on Fontham's ETS study? Will OSHA propose to ban Fontham from further study of lung cancer? What about the tobacco plaintiff lawyers? What will they say? Will they sue Fontham and crew for violating their civil (suit) rights?

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