亚太若干地区恶性肿瘤流行趋势分析

目的研究亚洲太平洋若干地区恶性肿瘤造成的疾病负担及其流行趋势.方法采用世界标化人口计算恶性肿瘤年发病率和死亡率,提出重点防治的癌症.在估计人口增长和人口老化的基础上,预测今后50年恶性肿瘤流行趋势.结果亚太若干地区2000年恶性肿瘤新发病例300多万,死亡200多万,现患病例540万.最常发生的是胃癌(占16.4%),肺癌(占15.8%)和肝癌(占13.6%).预计2050年恶性肿瘤发病和死亡例数将是2000年的2倍以上,新发病例和死亡病例将分别达到780万和570万.结论随着人口增长和平均期望寿命增加,恶性肿瘤造成的疾病负担将明显加重.     

2015年上海市恶性肿瘤流行特征分析

背景与目的：恶性肿瘤严重威胁着居民健康，已成为重大的公共卫生问题。本研究旨在描述和分析2015年上海市恶性肿瘤流行特征。方法：根据上海市恶性肿瘤病例报告登记系统收集的恶性肿瘤发病和死亡资料，按地区、性别分层，分别计算恶性肿瘤发病与死亡粗率、标化率、前10位恶性肿瘤发病与死亡顺位和构成等，并应用Joinpoint统计软件分析2002—2015年上海市肺癌发病和死亡趋势，估算总体和分阶段的年度变化百分比（annual percent change，APC）。采用Segi’s世界标准人口年龄构成计算标化率。结果：2015年上海市共报告恶性肿瘤新发病例71 610例，死亡病例38 445例。病理学诊断比例（percentage of morphologically verified cases，MV%）为78.42%，只有死亡医学证明书比例（percentage of death certifications only，DCO%）为0.21%，死亡发病比（mortality to incidence ratio，M/I）为0.55。上海市恶性肿瘤粗发病率为497.33/10万，标化发病率为228.82/10万，男性标化发病率低于女性，市区低于郊区。恶性肿瘤发病在40岁以后快速上升，在80~84岁年龄组达到高峰。全市发病前10位恶性肿瘤依次为肺癌、结直肠癌、甲状腺癌、胃癌、乳腺癌、肝癌、前列腺癌、胰腺癌、脑和中枢神经系统肿瘤以及膀胱癌，前10位恶性肿瘤占全部恶性肿瘤发病的76.59%。全市恶性肿瘤粗死亡率为267.00/10万，标化死亡率为95.99/10万，男性标化死亡率高于女性，市区和郊区基本持平。死亡率在45岁以后快速上升，在≥85岁年龄组达到高峰。死亡前10位恶性肿瘤依次为肺癌、结直肠癌、胃癌、肝癌、胰腺癌、乳腺癌、食管癌、胆囊癌、前列腺癌以及脑和中枢神经系统肿瘤，前10位恶性肿瘤占全部恶性肿瘤死亡的78.07%。截至2016年12月31日，上海市共有399 027例现患肿瘤病例，现患率为2.77%。市区现患率为3.07%，郊区为2.55%。乳腺癌是现患病例中最常见的恶性肿瘤，占15.33%。现患病例生存达5年的占50.90%。肺癌是上海市发病和死亡均位居第1位的恶性肿瘤。Joinpoint趋势分析显示，2011年男性和女性肺癌发病率均出现拐点。男性肺癌发病率在2002—2011年期间显著下降，APC为-1.34%（P<0.001），自2011年起显著上升，APC为3.30%（P<0.001）；女性肺癌发病率在2002—2011年期间无明显变化趋势，较为平稳，2011—2015年期间呈快速上升趋势，APC达15.25%（P<0.001）。与发病率变化不同，2002—2015年间上海市男性肺癌死亡率呈缓慢持续下降趋势，APC为-0.72%（P=0.03），女性无明显变化趋势。与2002年相比，2015年男性和女性肺癌诊断时期别为Ⅰ期的病例比例和腺癌比例均明显上升。男性肺癌诊断时期别Ⅰ期比例由2002年的3.96%上升到2015年的11.08%，女性由3.72%上升至23.57%。男性腺癌比例由2002年的15.81%上升到2015年的34.46%，女性由28.76%上升至66.08%。结论：肺癌、消化系统恶性肿瘤、甲状腺癌和女性乳腺癌仍是威胁上海市居民健康的主要癌种。乳腺癌是现患病例中最常见的恶性肿瘤。自2011年开始，男性和女性肺癌发病率显著上升，提示与低剂量螺旋CT广泛应用有一定关系，但需更多数据和研究支持。     

气管隆凸、支气管成形术治疗肺癌45例

我科从 1991年 11月至 1999年 3月用半隆凸切除、支气管袖状肺叶切除术治疗累及气管下端隆凸边缘、主支气管及叶支气管开口的肺癌患者 4 5例 ,现将其临床资料分析报告如下。1　临床资料1.1　一般资料　本组病例男 4 0例 ,女 5例 ;年龄 31～73岁。主要症状表现为咳嗽 (4 2例 ,占 93.3% )和间歇性血痰 (31例 ,占 6 8.9% ) ,其次为胸闷胸痛 (18例 ,占4 0 % ) ,发热 (8例 ,占 17.8% ) ,气促 (1例 ,占 2 .2 % ) ;查体有 2 2例患者患侧肺呼吸音减低 ,3例闻及干性罗音 ,1例患侧胸壁浅静脉怒张 ,1例四肢关节肿胀 ,余无其他特殊异常。1.2　实验室检查…     

肿瘤生物信息数据库(1)

前言 恶性肿瘤是以细胞异常增殖及转移为特点的一大类疾病,其发病与有害环境因素、不良生活方式及遗传易感性密切相关.2000年全球新发恶性肿瘤病例约1000万,死亡620万,现患病例2200万.预计2020年恶性肿瘤新发病例将达到1500万,死亡1000万,现患病例3000万.恶性肿瘤正在成为新世纪人类的第一杀手.     

肿瘤患者医院感染现患率调查及分析

目的:了解我院住院肿瘤患者医院感染的现患率情况,为预防和控制医院感染提供可靠依据.方法:采用床旁和病历相结合调查方式,填写个案调查表,对我院2007年8月6日所有住院患者前1天零时至当日零时的医院感染情况进行调查及分析.结果:被调查的1 602例中,发生医院感染76例,现患率为4.74%.医院感染部位构成中呼吸道感染居首位,其次为手术切口感染.结论:医院感染现患率调查可以及时发现医院感染管理中存在的问题,有利于控制和预防医院感染.     

深圳市原住居民女性生殖道HPV感染

[目的]了解深圳市原住居民女性人群的生殖道高危型人乳头瘤病毒（HPV）感染现状、宫颈上皮内瘤样病变（CIN）和宫颈癌的现患率。[方法]2009年6月至2009年10月在深圳市龙岗区坑梓街道办事处辖区25~59岁、3年内未做过宫颈癌筛查的原住居民女性进行整群抽样,并以同一辖区外来移民女性为对照。所有接受筛查女性均行宫颈液基细胞学检查及第二代杂交捕获技术（hybrid captureⅡ,HC-Ⅱ）高危型HPV检测。HPV阳性和/或细胞学≥ASCUS的女性行阴道镜检查和活检。[结果]共有942名原住居民妇女和1183名外来移民女性参加了本次调查。原住居民与外来移民妇女HPV阳性率分别为16.9%和11.8%（P〈0.05）。原住居民妇女CIN现患率为9.7%,其中CINⅡ及以上病变现患率为6.3%,外来移民CIN现患率5.1%,其中CINⅡ及以上病变现患率为2.6%。原住居民妇女CIN和CINⅡ及以上病变现患率均明显高于外来移民（P〈0.001）,尤以30~39岁年龄组最为明显。[结论]30~39岁年龄组妇女HPV感染和CIN现患率均较高,应作为宫颈癌防治的重点监测对象。     

中国癌症预防与控制规划纲要(2004-2010)

一、背景 (一)癌症正在成为人类第一杀手 癌症是以细胞异常增殖及转移为特点的一大类疾病,其发病与有害环境因素、不良生活方式及遗传易感性密切相关.2000年全球新发癌症病例约1000万,死亡620万,现患病例2200万.预计2020年癌症新发病例将达到1500万,死亡1000万,现患病例3000万.癌症正在成为新世纪人类的第一杀手.     

山东省临朐县2005年肿瘤发病情况分析

[目的]探讨山东省临朐县恶性肿瘤发病情况及流行特征.[方法]对2005年恶性肿瘤新发病例登记报告资料进行分析,计算发病率、标化发病率、标化截缩率、发病构成、累积率等指标.[结果]临朐县2005年恶性肿瘤发病率177.64/10万.中国标化发病率102.62/10万.世界标化率为136.37/10万,35～64岁标化截缩率为182.23/10万;0～74岁累积率为16.58%.肺癌、胃癌、肝癌三大肿瘤占全部肿瘤的67.02%;其中男性占73.45%.女性占55.73%:肺癌发病率上升到第一位.[结论]恶性肿瘤防治工作的重点应放在肺癌、胃癌、肝癌上,重点人群为25～50岁的中青年.     

分化型甲状腺癌不同术式术后主要并发症的分析

目的 对比分析分化型甲状腺癌不同手术方式术后主要并发症的情况.方法 回顾性分析河北医科大学第二医院2004年1月至2012年1月经手术治疗的264例分化型甲状腺癌资料.结果 患侧腺叶及峡部切除术77例,术后喉返神经损伤1例(占1.3%),低钙血症1例(占1.3%);患侧腺叶及峡部+对侧大部切除术137例,术后喉返神经损伤4例(占2.9%),低钙血症9例(占6.6%);甲状腺全切术50例,术后喉返神经损伤2例(占4.0%),低钙血症11例(占22.0%).结论 甲状腺全切术、患侧腺叶及峡部切除术与患侧腺叶及峡部+对侧大部切除术术后喉返神经损伤率无统计学差异;甲状腺全切术术后低钙血症发生率明显高于患侧腺叶及峡部切除术与患侧腺叶及峡部+对侧大部切除术.     

数字警示

12%癌症是全球第三大死因。据世界卫生组织2002年统计资料表明,全球新发癌症病例为1090万,死亡人数为670万,现患人数为2460万。2005年统计癌症死亡人数已上升到760万。全球因癌症死亡的人数已占总死亡人数的12%,20年后全球每年死于癌症的人数将达1000万,每年新增癌症发病人数达到1500万发展中国家每年癌症患者达550万,而发     

Surviving colorectal cancer : patient-reported symptoms 4 years after diagnosis

BACKGROUND: The number of long-term survivors after a cancer diagnosis is increasing, yet relatively few studies have addressed survivors' reported symptoms beyond the initial year after diagnosis. METHODS: The symptom reports of 474 survivors of colon and rectal cancer from 5 US metropolitan areas were collected during 2002-2003 as part a larger study of the quality of care for patients with cancer diagnosed in 1998. The relation between the prevalence of reported symptoms and prior treatments received was analyzed, adjusting statistically for other patient characteristics. RESULTS: Sixty-nine percent of the survivors had colon cancer and 31% had rectal cancer. The most commonly reported symptoms were "fatigue" (23%), "negative feelings about body appearance" (14%), "diarrhea" (13%), and "constipation" (7%). Higher percentages of respondents attributed health effects to cancer or its treatment including "worry about health" (24%), "physical discomfort" (19%), and "activity limitations" (15%). In general, prior treatment was not associated with symptom prevalence. However, radiation therapy recipients and patients that received a diverting ostomy were more likely than others to report some of the symptoms we studied. Attribution of health effects to disease or treatment did not vary by prior treatment except that recipients of radiation therapy were more likely than others to report limitations in their activities (30% vs 10%; P = .003). CONCLUSIONS: Among colorectal cancer survivors the prevalence of symptoms at 4 years was low and relatively comparable to published estimates for the general population, but some survivors continue to attribute health effects to cancer or its treatment.     

Estimation of the number of cancer survivors according to site in Japan

Based on incidence and survival data from the Osaka Cancer Registry, the numbers of cancer survivors were estimated by site in this study. The method used for estimation of survivors from all sites of cancer in the previous study was simplified further by not subdividing the data according to age-group. The observation period was the 25 years from 1960 to 1984. The number of incident cancers at all sites that occurred during the 25 years was estimated as 4,776,100. The leading sites of incidence during this 25-year period were the stomach (1,612,000), lung (427,100), and liver (329,100) for both sexes. The number of total cancer survivors on January 1, 1985 was estimated as 1,009,100. Among males, stomach cancer survivors accounted for 45% (180,100) of all survivors. The next most common sites were the rectum (7%, 27,000) and colon (6%, 25,600). Among females, the leading sites were the uterus (26%, 157,600), breast (22%, 132,100) and stomach (18%, 106,800). Most of the cancer survivors living at not more than 5 years after diagnosis were assumed to be receiving some kind of cancer medical care and were therefore regarded as an approximation of what is generally called "cancer prevalence." The number in this category for all sites was estimated as 417,900. The sites showing the largest numbers of these short-term survivors were again the stomach, followed by the rectum and colon among males, and the breast, uterus, and stomach among females. The reliability and utility of the results are discussed. The results are compared with other recently reported registry data from other countries and with other estimated data in Japan.     

Estimation of the number of cancer survivors in Japan

Cancer prevalence statistics are necessary for cancer control programs. Although a long-term cancer registry keeps files which cover incidence, prevalence and cured cases, the latter two categories are difficult to distinguish from each other. The Connecticut and the Finnish Cancer Registries therefore defined the sum of these two groups as "prevalence." The authors estimated the numbers and rates of survivors from cancer ("prevalence") in Japan as of January 1, 1985, based on the number of cancer patients for all sites diagnosed since 1960. The number of cancer patients in Japan diagnosed during the period from 1960 to 1984 was estimated to be 4,686,352 (both sexes). Of these, the number of cancer survivors as of January 1, 1985 was estimated to be 952,870 (both sexes). Among the survivors, 430,940 were diagnosed in the final five years from 1980-84. The results were compared with those reported from the USA and Finland.     

Short Sleep Duration and Its Correlates among Cancer Survivors in Korea: the Korea National Health and Nutrition Examination Surveys

Background: Though a large proportion of cancer survivors are assumed to be commonly affected by sleepdisturbance, few studies have focused on short sleep problems and its correlates among Korean cancer survivors.The purpose of this study was to evaluate the prevalence of short sleep in adult cancer survivors from a nationwidepopulation-based sample and to identify risk factors for short sleep duration. Materials and Methods: Based onthe fourth and fifth Korea National Health and Nutrition Examination Surveys (2007-2012), 1,045 cancer survivorsand 33,929 non-cancer controls were analyzed. The prevalence of short sleep was compared between these twogroups. Associations between short sleep and its correlates were evaluated using multiple logistic regression amongcancer survivors: odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated after adjusting forsociodemographic factors, lifestyle factors, psychological conditions, and cancer-related factors. Results: About8.1% of cancer survivors slept for less than 5 hours per day (6.2% men and 9.3% women), whereas this was thecase for only 3.7% of non-cancer controls. Cancer survivors who had the lowest household income level showeda significantly higher likelihood for short sleep (adjusted OR 2.82, 95%CI 1.06-7.54). Self-reported poor healthand depressive symptoms were found to be associated with significantly increased likelihood for short sleep incancer survivors (adjusted OR 3.60, 95%CI 1.40-9.26 and adjusted OR 2.00, 95%CI 1.17-3.42). Gastric cancersurvivors had a 3.97-fold increased risk for short sleep (95%CI 1.60-9.90). Conclusions: The prevalence of shortsleep occurs at a high rate among the Korean cancer survivors, which may indicate a poorer quality of life anda higher risk of future complications in survivorship. Targeted interventions that can assist cancer survivorsto cope with sleep disturbances as well as ensuring psychological stability are warranted to reduce the latentdisease burden.     

Analysis of nonresponse in the assessment of health-related quality of life of childhood cancer survivors.

The aim of this study was to compare the characteristics of respondents and nonrespondents in a survey of childhood cancer survivors recorded in the Childhood Cancer Registry of Piedmont and their current primary care general practitioners. Eligible subjects were identified from the Childhood Cancer Registry of Piedmont and the referring general practitioners were traced through the National Health Service. A postal questionnaire was sent both to childhood cancer survivors and to their general practitioners. Prevalence odds ratios were estimated for demographic and clinical characteristics in survivors and for demographic characteristics in general practitioners. A total of 1005 childhood cancer survivors and 857 general practitioners (132 of them had two or more cancer survivors in care) were included in the study. Completed questionnaires were obtained from 691 survivors (69%) and 615 general practitioners (72%). For survivors, the only associations with nonresponse were for age 35-44 years [prevalence odds ratio: 0.53 (95% confidence interval: 0.33-0.85)], being married [prevalence odds ratio: 1.45 (95% confidence interval: 0.96-2.18)] and diagnosis after 1977 [prevalence odds ratio: 0.66 (95% confidence interval: 0.42-1.03)]. For general practitioners, the only associations were for male sex [prevalence odds ratio: 1.62 (95% confidence interval: 1.13-2.32)] and place of work outside of the city of Turin [prevalence odds ratio: 1.93 (95% confidence interval: 1.07-3.47)]; furthermore associations were relatively weak. An association was also found between nonresponse in survivors and nonresponse in their general practitioners [prevalence odds ratio: 3.40 (95% confidence interval: 2.54-4.56)]. In conclusion, apart from age, marital status and period of diagnosis, there were little differences between respondent and nonrespondents, for the considered clinical and demographical characteristics. Participation of survivors and their general practitioners correlated, suggesting that involvement of the general practitioners in the study may be a method to increase participation of survivors of childhood cancers.     

Parenthood in survivors after adulthood cancer and perinatal health in their offspring: a preliminary report

Cancer survivors may fear infertility, obstetric problems, and genetic alterations in their offspring. After linkage of three registries the probability of post-treatment parenthood and the risk of obstetric and perinatal problems were estimated in cancer survivors compared to individuals without a cancer diagnosis. A total of 1531 of 13,817 patients had 2307 children after one parent's cancer diagnosis: 972 males had 1479 children and 559 females had 828. A total of 1217 patients (784 males and 433 females) became parents > or =9 months after the diagnosis (1899 births: 1221 to male cancer patients and 678 to female patients). The post-diagnosis parenthood probability was 8% at 5 years, and 14% at 10 years without further increase. Female cancer survivors gave birth to post-diagnosis infants with on average 130 grams lower birth weight and 6 days shorter gestations compared with infants in the non-cancer population. Infants fathered by male cancer survivors did not differ from control infants with respect to birth weight or gestational age. There was no increase in the prevalence of major congenital malformations in the offspring of cancer survivors as compared with the offspring of the non-cancer population. Multiple births and deliveries by cesarean sections were increased. Parenthood after cancer is possible in a significant number of patients, more so for males than females. The risk of major congenital malformations was not increased relative to the non-cancer population, nor was perinatal mortality increased. However, female cancer survivors delivered more preterm births and low-birth-weight infants than what was found in the non-cancer population.     

Health behaviors of cancer survivors: examining opportunities for cancer control intervention.

PURPOSE: A population-based investigation was conducted to examine the prevalence of health behaviors (smoking, alcohol use, physical activity, and cancer screening) of cancer survivors by age, time since diagnosis, and cancer site. Understanding health behaviors of survivors is imperative, as many survivors are living longer and are at risk for cancer recurrence, second cancers, and complications from treatment. METHODS: Using the National Health Interview Survey, this study examined the prevalence of smoking and alcohol use as well as whether cancer survivors (n = 7,384) are meeting current recommendations for physical activity and cancer screening compared with noncancer controls (n = 121,347). RESULTS: Cancer survivors are similar to controls with respect to smoking status and alcohol consumption after adjusting for group differences. However, younger survivors (18 to 40 years) are at greater risk for continued smoking than controls. Survivors are 9% more likely to meet physical activity recommendations compared with controls. chi2 tests indicate no significant differences in smoking, alcohol consumption, and physical activity by time since diagnosis, but differences by cancer site exist. Female cancer survivors are 34% and 36% more likely to meet mammogram and Papanicolaou smear screening recommendations, respectively, compared with controls. Similar screening patterns were found for prostate-specific antigen screening in men. CONCLUSION: This study provides benchmark approximations of the prevalence of risky health behaviors of survivors by time since diagnosis and cancer site. As part of the collective effort to reduce late effects of cancer treatment, oncologists may be in the best position to offer initial guidance for promoting healthy lifestyle behaviors among cancer survivors.     

Incidental findings on brain Magnetic Resonance Imaging in long-term survivors of breast cancer treated with adjuvant chemotherapy

Purpose

Incidental brain findings defined as previously undetected abnormalities of potential clinical relevance that are unexpectedly discovered at brain imaging and are unrelated to the purpose of the examination are common in the general population. Because it is unclear whether the prevalence of incidental findings in breast cancer patients treated with chemotherapy is different to that in the general population, we compared the prevalence in breast cancer survivors treated with chemotherapy to that in a population-based sample of women without a history of any cancer.

Patients and methods

Structural brain MRI (1.5T) was performed in 191 female CMF (Cyclophosphamide, Methotrexate, 5-Fluorouracil) chemotherapy-exposed breast cancer survivors. A reference group of 1590 women without a history of cancer was sampled from a population-based cohort study. All participants were aged 50 to 80 years. Five trained reviewers recorded the brain abnormalities. Two experienced neuro-radiologists reviewed the incidental findings.

Results

The cancer survivors had completed chemotherapy on average 21 years before. Of the 191 subjects, 2.6% had an aneurysm and 3.7% had a meningioma. The prevalence of meningiomas and aneurysms was not different between the groups. The prevalence of pituitary macro adenomas in the breast cancer survivors (1.6%) was higher than that in the reference group (0.1%) (OR = 23.7; 95% CI 2.3-245.8).

Conclusion

Contrary to commonly held opinions, we did not observe an increased prevalence of meningiomas in cancer survivors. Breast cancer survivors previously treated with chemotherapy are more likely to develop pituitary adenomas than persons without a history of cancer and chemotherapy treatment.     

Fractures among long‐term survivors of childhood cancer

BACKGROUND:

Although reductions in bone mineral density are well documented among children during treatment for cancer and among childhood cancer survivors, little is known about the long‐term risk of fracture. The objective of this study was to ascertain the prevalence of and risk factors for fractures among individuals participating in the Childhood Cancer Survivor Study (CCSS).

METHODS:

Analyses included 7414 ≥5‐year survivors of childhood cancer diagnosed between 1970 and 1986 who completed the 2007 CCSS follow‐up questionnaire and a comparison group of 2374 siblings. Generalized linear models stratified by sex were used to compare the prevalence of reported fractures between survivors and siblings.

RESULTS:

The median ages at follow‐up among survivors and siblings were 36.2 years (range, 21.2‐58.8 years) and 38.1 years (range, 18.4‐62.6 years), respectively, with a median 22.7 years of follow‐up after cancer diagnosis for survivors. Approximately 35% of survivors and 39% of siblings reported ≥1 fracture during their lifetime. The prevalence of fractures was lower among survivors than among siblings, both in males (prevalence ratio, 0.87; 95% confidence interval, 0.81‐0.94; P < .001) and females (prevalence ratio, 0.94; 95% confidence interval, 0.86‐1.04; P = .22). In multivariable analyses, increasing age at follow‐up, white race, methotrexate treatment, and balance difficulties were associated with increased prevalence of fractures among female survivors (P = .015). Among males, only smoking history and white race were associated with an increased prevalence of fracture (P < .001).

CONCLUSIONS:

Findings from this study indicated that the prevalence of fractures among adult survivors did not increase compared with that of siblings. Additional studies of bone health among aging female cancer survivors may be warranted. Cancer 2012. © 2012 American Cancer Society.     

Tobacco use in adult long-term survivors of retinoblastoma.

A significant risk of lung cancer was identified among hereditary, but not nonhereditary, retinoblastoma (Rb) patients. Tobacco use was investigated to determine whether differences in smoking prevalence might explain the lung cancer excess and to characterize smoking patterns in adult survivors of Rb. Subjects were 441 hereditary and 395 nonhereditary 1-year survivors of Rb, age >or=18 years, who responded to a telephone survey about current health behavior, including tobacco use. Response rates were 76% for hereditary and 73% for nonhereditary survivors. We compared patterns and predictors of current tobacco use among hereditary and nonhereditary survivors with other childhood cancer survivor studies and the U.S. population. Hereditary Rb survivors currently smoke cigarettes significantly less frequently than nonhereditary survivors (16. 8% versus 24.3%), although among current smokers, age at smoking initiation (17 years old) and average cigarettes (1.5 packs) smoked daily are similar. Predictors of current and ever cigarette smoking include nonhereditary Rb, older age, being female, less education, and use of other tobacco products. Rb survivors smoke cigarettes significantly less than the U.S. population (rate ratio, 0.63; 95% confidence interval, 0.5-0.8 for males; rate ratio, 0.75; 95% confidence interval, 0.6-0.9 for females), but Rb survivors have comparable smoking rates with other childhood cancer survivors. Smoking did not account for the increased risk of lung cancer among hereditary Rb patients, and this may point to an enhanced sensitivity to the carcinogenic effects of tobacco. Adult survivors of Rb should be encouraged to stop smoking.