Forensic Analysis of Lung Cancer from Secondhand Smoke Exposure of a Motel Worker

Abstract

Background: In July 2018, Ms. PJM, a 50-year-old lifelong nonsmoker, was diagnosed with primary Stage IV lung adenocarcinoma with secondary metastasis to the brain, after being hospitalized for a fall in the motel where she worked, in Los Angeles, California. She had been employed as a maid cleaning rooms in this motel for 20 years, where she was exposed to secondhand and thirdhand tobacco smoke daily. Her death certificate, dated June 2021, declared metastatic lung cancer to be the cause of her death at age 53. Occupational disability and death claims filed by her attorney were contested by her employer. Aims: To conduct a forensic analysis using mathematical modeling to quantify Ms. PJM’s toxic secondhand and thirdhand smoke exposures, in order to estimate her risk of lung cancer from exposure to tobacco combustion products and other potential carcinogenic agents to which she might have been exposed. Methods: A quantitative analysis employing assessment of Hazard, Exposure, Dose, Dose-Response, and Risk plus a Discussion of Uncertainty. It is routinely used by U.S. federal regulatory agencies, including the Occupational Safety and Health Administration (OSHA), and the Environmental Protection Agency (EPA). Results: Ms. PJM’s modeled exposure to fine particulate matter from secondhand smoke ranged from the Hazardous to Significant Harm Levels of the EPA Air Quality Index for fine particles (PM2.5). Her modeled dose of serum cotinine ranged from the 90th to beyond the 95th percentile of nonsmokers’ dose, measured in a statistical sample of the U.S. nonsmoking population. Her estimated risk exceeds OSHA’s Significant Risk of Material Impairment of Health Level by a factor of three. She is estimated to have been exposed to the thirdhand smoke of at least 1.4 million cigarettes outgassing from room surfaces during her 20 years of labor. As for potential confounders, there were no known carcinogens in any of the cleaning agents she used; there is no evidence that she was exposed to asbestos, and she resided in a low-radon area of Los Angeles. Conclusions: As a result of her occupational exposure to secondhand and thirdhand smoke, Ms. PJM lost an estimated 33 years of life expectancy. The State of California has been remiss in failing to extend its workplace smoking ban to hotels and motels, leaving their workstaff at grave risk of the manifold diseases of passive smoking.