Adenocarcinoma of the Lung Is Strongly Associated with Cigarette Smoking: Further Evidence from a Prospective Study of Women (original) (raw)
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The Lancet Oncology, 2008
Background-Whether women are more susceptible than men to lung cancer caused by cigarette smoking has been controversial. We aimed to determine the susceptibility of men and women to cigarette smoking by comparing lung carcinoma incidence rates by stratum of smoking use in the men and women of the National Institutes of Health-AARP cohort. Methods-The analysis included 279,214 men and 184,623 women from eight U.S. states aged 50 to 71 years at study baseline who were mailed a questionnaire between October 13, 1995 and May 6, 1996 and were followed until December 31, 2003. We present age-standardized incidence rates and multivariate adjusted hazard ratios (HR) adjusted for potential confounders, each with 95% confidence intervals (CI). Findings-During follow-up, lung carcinomas occurred in 4,097 men and 2,237 women. Incidence rates were 20.3 per 100,000 person-years (95% CI: 16.3-24.3) in never smoking men (99 carcinomas) and 25.3, 95% CI: 21.3-29.3 in never smoking women (152 carcinomas); for this group, the HR for lung carcinoma was 1.3 (95%CI: 1.0-1.8) for women relative to men. Smoking was associated with increased lung carcinoma risk in both men and women. The incidence rate of current smokers of >2 packs per day was 1,259.2 (95%CI: 1,035.0-1,483.3) in men and 1,308.9 (95%CI: 924.2-1,693.6) in women. Among current smokers, in a model adjusted for typical smoking dose, the HR was 0.9 (95%CI: 0.8-0.9) for women relative to men. For former smokers, in a model adjusted for years of cessation and typical smoking dose, the HR was 0.9 (95%CI: 0.9-1.0) for women relative to men.
Lung cancer and cigarette smoking in women: A multicenter case-control study in Europe
International Journal of Cancer, 2000
The association between cigarette smoking and lung cancer risk in women was investigated within the framework of a case-control study in 9 centres from 6 European countries. Cases were 1,556 women up to 75 years of age with histologically confirmed primary lung cancer; 2,450 controls with age distribution similar to cases were selected. The predominant cell type was adenocarcinoma (33.5%), with similar proportions for squamous-cell type (26.4%) and small-cell carcinoma (22.3%). Overall, smoking cigarettes at any time was associated with a 5-fold increase in lung cancer risk (odds ratio 5.21, 95% confidence interval 4.49 -6.04); corresponding figures for current smoking habits were 8.94, 7.54 -10.6. The association showed a dose-response relationship with duration of the habit and daily and cumulative lifetime smoking. A significant excess risk of 70% was associated with every 10 pack-years smoked. After 10 years of smoking cessation, the relative risk decreased to 20% compared to current smokers. The following characteristics were associated with a higher relative risk: inhalation of smoke, smoking non-filter cigarettes, smoking dark-type cigarettes and starting at young age. The association was observed for all major histological types, being the strongest for small-cell type carcinoma, followed by squamous-cell type and the lowest for adenocarcinoma. The proportion of lung-cancer cases in the population attributable to cigarette smoking ranged from 14% to 85%. We concluded that women share most features of the association between cigarette smoking and lung cancer observed in men. Int.
Lung cancer: Worldwide variation in occurrence and proportion attributable to tobacco use
Lung Cancer, 1993
Out of 660,500 new cases of lung cancer in the world in 1980,76% (84% of cases in men, and 46% in women) can be attributed to tobacco smoking. Thus, the frequency of lung cancer in different regions is directly related to the prevalence and duration of smoking in the population. Both the number of cases, and the proportion due to smoking will increase for several decades at least. The smaller percentage attributable to smoking in women is mainly due to their much lower exposure to tobacco. In non-smokers lung cancer (particularly squamous cell cancers) also seems to be less frequent in women than men, possibly because of an excess of other causative exposures (particularly occupational) in men. Chinese women have relatively high rates of lung cancer which cannot be explained by tobacco smoking alone.
Lung Cancer Rates in Men and Women With Comparable Histories of Smoking
JNCI Journal of the National Cancer Institute, 2004
Background: Recent case-control studies suggest that, given equal smoking exposure, women may have a higher relative risk of developing lung cancer than men. Despite prospective data that conflict with this hypothesis, mechanistic studies to find a biologic basis for a sex difference continue. Methods: We addressed the hypothesis directly by analyzing prospective data from former and current smokers in two large cohorts-the Nurses' Health Study of women and the Health Professionals Follow-up Study of men. We calculated incidence rates and hazard ratios of lung cancer in women compared with men, adjusting for age, number of cigarettes smoked per day, age at start of smoking, and time since quitting, using Cox proportional hazards models. We also reviewed published results from prospective analyses. Results: From 1986 through 2000, 955 and 311 primary lung cancers were identified among 60 296 women and 25 397 men, respectively, who ranged in age from 40 to 79 years. Incidence rates per 100 000 person-years for women and men were 253 and 232, respectively, among current smokers and 81 and 73, respectively, among former smokers. The hazard ratio in women ever smokers compared with men was 1.11 (95% confidence interval ؍ 0.95 to 1.31). Six published prospective cohort studies allowed assessment of comparative susceptibility to lung cancer by sex. None supported an excess risk of lung cancer for women. Conclusions: Women do not appear to have a greater susceptibility to lung cancer than men, given equal smoking exposure. Research should be focused on enhancing preventive interventions for all. [J Natl Cancer Inst 2004;96:826 -34] Affiliations of authors: School of Population Health, University of Queensland,
International Journal of Epidemiology, 1995
Kaisemnan M. Associations between cigarette smoking and each of 21 types of cancer. A multi-site case-control study. IntemationatJoumalotEpidemiology 1995; 24; 504-514. Background. Although the effects of cigarette smoking on cancer risk have been well documented, there remain several outstanding issues to be clarified, including the determination of which types of cancer are associated with smoking and estimation of the magnitude of the effect of smoking on different types of cancer. A further issue is whether the effects seen elsewhere can be demonstrated in Canada, where tobacco products differ somewhat from those in other countries. Methods. A case-control study was undertaken in Montreal to investigate the associations between a large number of environmental and occupational exposures on the one hand, and several types of cancer on the other. Between 1979 and 1985, interviews were canned out with incident male cases of 21 types of cancer, including 15 anatomical sites and six histological subtypes. The interview was designed to obtain detailed information on smoking histories, job histories, and other potential confounders. Altogether. 3730 cancer patients and 533 population controls were interviewed. For each type of cancer analysed, two control groups were used: population controls and cancer controls (selected from among other cancer patients). The purpose of the present analysis is to estimate the relative risk of each of 21 types of cancer in relation to smoking and to estimate the percentage of cancer cases attributable to cigarette smoking. Results. Separate analyses conducted with the two control groups produced similar results. Of the many sites of cancer examined, the following were not associated with cigarette smoking: colon, rectum, liver, prostate, kidney and skin (melanoma). Within the lymphoreticular system, there was no excess risk of Hodgkin's lymphoma, although the results for non-Hodgkin's lymphoma were weakly suggestive of an association with smoking. The following sites were clearly associated with smoking: lung (odds ratio {OR] =12.1), bladder (OR = 2.4). oesophagus (OR = 2.4), stomach (OR = 1.7), and pancreas {OR = 1.6). Population attributable risk percentages due to smoking were 90% for lung, 53% for bladder, 54% for oesophagus, 35% for stomach, and 33% for pancreas. Conclusions. Of the 21 types of cancer examined, the following were associated with smoking among men in Montreal: lung (including all major histotogicaJ subtypes), bladder (and its main histological subtypes), oesophagus, stomach and pancreas. Smoking likely accounts for a large proportion of cancers occurring at these sites.
Lung Cancer, 2005
In the time period 1988-2000, a case-case study on environmental factors and lung cancer risk was conducted in Montevideo, Uruguay. This study was designed in order the establish possible differences between squamous cell carcinomas (SCC) and small cell carcinomas (SCLC) of the lung in relation to tobacco smoking. Three hundred and ninety one (391) patients with small cell carcinoma were compared with 1187 patients with squamous cell carcinoma. Regarding sex, the study included a small number of women (26 with SCLC and 20 with SCC). SCLC was associated with higher risks for smoking status, smoking intensity and cumulative exposure to tobacco smoking when compared with SCC. These three tobacco variables were significantly different between both cell types in men. Smoking duration was significantly higher among SCLC compared with SCC only in women. With decreasing age at starting to smoke, the proportion of SCLC increases at the expense of SCC. Finally, Abbreviations: SCLC, Small cell carcinoma of the lung; SCC, Squamous cell carcinoma of the lung; OR, Odds ratios
Cigarette smoking and lung cancer risk according to histologic type in Japanese men and women
Cancer Science, 2013
Although cigarette smoking is a well-known risk factor for lung cancer, histology-specific risk has not been fully clarified in Japan. This case-control study evaluated the associations between smoking and lung cancer risk according to sex and histologic type. From among patients aged 30 years and over admitted to a single hospital in Japan between 1997 and 2009, 1670 lung cancer cases and 5855 controls were selected. History of smoking, quantity and duration of smoking, and passive smoking from spouses were assessed using a self-administered questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) for each exposure were estimated by unconditional logistic regression. Ever-smoking was significantly associated with a higher risk of squamous cell and small cell carcinoma. The OR for these two histologic types combined was larger in women (OR = 24.98, 95% CI: 13.50-46.23) than in men (OR = 9.43, 95% CI: 5.73-15.51). Analysis of the quantity and duration of smoking showed that the OR for each exposure level tended to be larger in women than in men. For adenocarcinoma, clear positive associations with quantity and duration-related factors were observed among men, and a significant positive association with passive smoking from spouses was found among non-smoking women (OR = 1.44, 95% CI: 1.06-1.95). These results suggest sex-and histologic type-differences in the association of smoking with lung cancer risk. Although smoking control should be continued to prevent lung cancers, further studies are required to better clarify differences in smoking-related lung cancer risk between the sexes and histologic types. (Cancer
Cancer research, 2003
The magnitude of the effect of smoking duration on lung cancer mortality relative to that of intensity (cigarettes/day) has practical implications for both tobacco control policy and research. This issue was addressed by R. Doll and R. Peto (J. Epidemiol. Commun. Health, 32: 303-313, 1978) in their historic analysis of one of the few large cohort studies in which intensity and duration were estimated separately. Their findings have been interpreted to mean that smoking duration is much more important than smoking intensity in causing lung cancer. The separate contributions of smoking duration and intensity to lung cancer risk have not been evaluated in other large prospective studies. We studied participants in the Cancer Prevention Study II, followed from 1982 through 1988. After restricting to people 40-79 years old who smoked < or =40 cigarettes per day at enrollment, we fit Poisson models for four age groups and evaluated lung cancer mortality (M) in relation to smoking durat...
Changes in patterns of cigarette smoking and lung cancer risk: Results of a case-control study
Lung Cancer, 1990
Data from a case-control study on lung cancer were used to evaluate how changes in cigarette habits, mainly smoking cessation, switch from non-filter to filter brands, from dark to light tobacco, or from handrolled to manufactured cigarettes, and reduction in daily consumption influence lung cancer risk. The results presented concern all males, exclusive cigarette smokers, involved in the study, i.e. 1,057 histologically confirmed lung cancer and 1,503 matched controls. The general decrease in lung cancer risk with the years since cessation was also found in each subgroup of cigarette exposure defined by duration of smoking, daily consumption and type of cigarettes smoked. Among smokers who had given up smoking from less than 10 years earlier, the lung cancer risks were twofold higher for those who had stopped smoking for coughing or health reasons than for those who had stopped smoking for reasons other than health problems. A decrease in lung cancer risk, although not significant, was found in people who switched from non-filter brands to filter brands and from dark to light tobacco and in smokers who reduced their daily consumption of cigarettes by more than 25% as compared to smokers who had not changed habits.