Passive smoking and lung cancer: a cumulative meta-analysis

Aust N Z J Public Health. 2001 Jun;25(3):203-11. doi: 10.1111/j.1467-842x.2001.tb00564.x.


Objective: To review the epidemiological evidence for the association between passive smoking and lung cancer.

Method: Primary studies and meta-analyses examining the relationship between passive smoking and lung cancer were identified through a computerised literature search of Medline and Embase, secondary references, and experts in the field of passive smoking. Primary studies meeting the inclusion criteria were meta-analysed.

Results: From 1981 to the end of 1999 there have been 76 primary epidemiological studies of passive smoking and lung cancer, and 20 meta-analyses. There were 43 primary studies that met the inclusion criteria for this meta-analysis; more studies than previous assessments. The pooled relative risk (RR) for never-smoking women exposed to environmental tobacco smoke (ETS) from spouses, compared with unexposed never-smoking women was 1.29 (95% CI 1.17-1.43). Sequential cumulative meta-analysed results for each year from 1981 were calculated: since 1992 the RR has been greater than 1.25. For Western industrialised countries the RR for never-smoking women exposed to ETS compared with unexposed never-smoking women, was 1.21 (95% CI 1.10-1.33). Previously published international spousal meta-analyses have all produced statistically significant RRs greater than 1.17.

Conclusions: The abundance of evidence in this paper, and the consistency of findings across domestic and workplace primary studies, dosimetric extrapolations and meta-analyses, clearly indicates that non-smokers exposed to ETS are at increased risk of lung cancer.

Implications: The recommended public health policy is for a total ban on smoking in enclosed public places and work sites.

Publication types

  • Meta-Analysis

MeSH terms

  • Developed Countries / statistics & numerical data
  • Epidemiologic Studies
  • Evidence-Based Medicine
  • Female
  • Humans
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / etiology*
  • Male
  • Risk Factors
  • Spouses
  • Tobacco Smoke Pollution / adverse effects*
  • Tobacco Smoke Pollution / statistics & numerical data


  • Tobacco Smoke Pollution