How important is personal exposure assessment in the epidemiology of air pollutants?

Musicians playing wind instruments and risk of lung cancer: is there an association? Lung cancer is an important public health problem. Tobacco is its main risk factor. Occupation is also an important risk factor. Some jobs have shown higher risks than others, but few investigations have asked about activities or hobbies in leisure time in relation to the risk of lung cancer. A case-control study was performed between 1999 and 2000 in the Santiago de Compostela Health District (Galicia, northwest Spain). A total of 132 cases with confirmed diagnosis of lung cancer and 187 controls were enrolled. Controls underwent trivial surgery at the same hospital as did the cases. A personal interview about lifestyle and activities (past and present) was conducted by a trained researcher. We found that, besides tobacco and occupational exposure to carcinogens, some leisure time activities were risk factors for lung cancer. Among the cases there were two musicians who played wind instruments, whereas there were no wind instrument players among the controls. The two cases had been playing the clarinet and trombone for 35 and 30 years respectively. Both were exsmokers (moderate smokers) and played music as a hobby. They had epidermoid lung cancer and were diagnosed at 57 and 76 years of age. Since in our population the prevalence of persons playing musical instruments and specifically wind instruments is extremely low, we think that this activity might be a risk factor in development of lung cancer. The very low number of persons playing this type of musical instrument is probably a reason for the lack of studies focused on this activity, as many occupational studies of lung cancer and occupation are based on registries of workers. One study found an increased mortality rate of lung cancer for a category that included painters, potters, musicians, and actors—an inhomogeneous category that did not allow us to extrapolate results. The results were not adjusted according to smoking history. This hobby requires inspiration and breathing of large volumes of air, making the lung alveoli expand more than in other people. This fact could facilitate the penetrance of carcinogens in the cells of the lung epithelium, and this could be more harmful in smokers. We have found no other studies that have reported this possible association. It would therefore be necessary to explore this association in greater samples of professionally exposed persons in order to ascertain whether this finding is consistent or due to chance.