Passive smoking and the use of noncigarette tobacco products in association with risk for pancreatic cancer: a case-control study

BACKGROUND: The associations between passive smoking and the use of noncigarette tobacco products with pancreatic cancer are not clear. METHODS: In this case-control study, the authors collected information on passive smoking and the use of noncigarette tobacco products in 808 patients with pancreatic adenocarcinoma and 808 healthy controls by personal interview. Multivariable logistic regression was performed to estimate the adjusted odds ratio (AOR) and 95% confidence interval (95% CI). RESULTS: The results confirmed the previously reported association between active smoking and increased risk for pancreatic cancer. The AOR was 1.7 (95% CI, 1.4-2.2) for regular smokers, 1.8 (95% CI, 1.4-2.4) for long-term smokers, and 3.1 (95% CI, 2.2-4.3) for former smokers. Although passive smoking showed a nonsignificantly elevated risk for pancreatic cancer in the entire study population (AOR, 1.3; 95% CI, 0.9-1.7), the association was present among ever smokers (AOR, 1.7; 95% CI, 1.03-2.6) but was absent among never smokers (AOR, 1.1; 95% CI, 0.8-1.6). Neither intensity nor duration of passive smoking modified the risk of pancreatic cancer among never smokers. The use of chewing tobacco, snuff, and pipes showed no significant risk elevation for pancreatic cancer after controlling for the confounding effects of demographics and other known risk factors. The use of cigars in never smokers showed a borderline significant increase of risk for pancreatic cancer (AOR, 2.2; 95% CI, 1.0-4.7; P = .05). CONCLUSIONS: The current observations did not support a role for passive smoking or the use of noncigarette tobacco products in the etiology of pancreatic cancer. The association between cigar use and the risk of pancreatic cancer needs to be confirmed in other study populations.     

Analysis of Mortality of Stomach Cancer in China from 1990-1992

OBJECTIVE To assess the impact of stom‘ach cancer on the Chinese population by epidemiological analysis of its distributional mortality.METHODS Data from 1990-1992 on stomach cancer mortality collected by a sampling survey involved one tenth of the total Chinese population.RESULTS The crude mortality rate of stomach cancer in China was 25.2per 10^5 (32.8 per 10^5for males and 17.0 per 10^5 for females), which comprised23.2% of the total cancer deaths from 1990 to 1992, making stomach cancerthe leading cause of cancer death. The stomach cancer mortality rate ofmales was 1.9 times of that of females. The Chinese mortality rates ofstomach cancer adjusted by the world standard population were 40.8 per105 and 18.6 per 105 for males and females, which were 4.2-7.9 (for males)and 3.8-8.0 (for females) times of those in developed countries. Age-adjusted mortality rates of stomach cancer in China have distinctgeographical differences: form the lowest of 2.5 per 10^5 to the highest of153.0 per 10^5 in the 263 selected sites, and 15.3 per 10^5 in urban areas and24.4 per 10^5 in rural areas, a difference of 1.6 times.CONCW$10N The prevention and treatment of stomach cancer in L;n~na,especially in the countryside and the under-developed areas in thenorthwest, should be a long-term focus in preventing of cancers of thedigestive system. Urgent measures for prevention and early detection of stomach cancer should be taken.     

Cigarette smoking and leukemia: results from the Lutheran Brotherhood Cohort Study

In a 20-year follow-up (1966–86) of 17,633 White males who described tobacco use in a mailed questionnaire sent in 1966, there were 74 deaths from leukemia (including 30 myeloid, 30 lymphatic, and 14 other and unspecified leukemia). Among men who ever smoked cigarettes, increased risks were observed for lymphatic (relative risk [RR]=2.7), and other and unspecified leukemia (RR=1.5); risks rose with increasing number of cigarettes smoked, although the dose-response relationship was statistically significant only for total leukemia. Mortality from myeloid leukemia was not elevated, except among those smoking over a pack of cigarettes per day. Results from this cohort support a relationship between cigarette smoking and leukemia. Further studies are needed to elucidate subtype associations with cigarette smoking.Drs Linet, McLaughlin, Hsing, Wacholder, and Blot are with the Epidemiology and Biostatistics Program, National Cancer Institute. Dr Co-Chien is at Westat, Inc., Rockville, Maryland, USA, Dr Schuman is at the University of Minnesota, Minneapolis, Minnesota, USA. Dr Bjelke is with the Center for Epidemiologic Research, University of Bergen, Norway. Address correspondence to Dr Linet, Epidemiology and Biostatistics Program, National Cancer Institute, Executive Plaza North Room 415B, Bethesda, MD 20892, USA.     

Environmental tobacco smoke and lung cancer mortality in the American Cancer Society's Cancer Prevention Study II

Environmental tobacco smoke (ETS) has been classified as a human lung carcinogen by the United States Environmental Protection Agency (EPA), based both on the chemical similarity of sidestream and mainstream smoke and on slightly higher lung cancer risk in never-smokers whose spouses smoke compared with those married to nonsmokers. We evaluated the relation between ETS and lung cancer prospectively in the US, among 114,286 female and 19,549 male never-smokers, married to smokers, compared with about 77,000 female and 77,000 male never-smokers whose spouses did not smoke. Multivariate analyses, based on 247 lung cancer deaths, controlled for age, race, diet, and occupation. Dose-response analyses were restricted to 92,222 women whose husbands provided complete information on cigarette smoking and date of marriage. Lung cancer death rates, adjusted for other factors, were 20 percent higher among women whose husbands ever smoked during the current marriage than among those married to never-smokers (relative risk [RR]=1.2, 95 percent confidence interval [CI]=0.8-1.6). For never-smoking men whose wives smoked, the RR was 1.1 (CI=0.6-1.8). Risk among women was similar or higher when the husband continued to smoke (RR=1.2, CI=0.8-1.8), or smoked 40 or more cigarettes per day (RR=1.9, CI=1.0-3.6), but did not increase with years of marriage to a smoker. Most CIs included the null. Although generally not statistically significant, these results agree with the EPA summary estimate that spousal smoking increases lung cancer risk by about 20 percent in never-smoking women. Even large prospective studies have limited statistical power to measure precisely the risk from ETS.     

中国居民吸烟与男性膀胱癌死亡率关系的研究

目的:分析吸烟与我国城市男性居民膀胱癌死亡率的关系。方法:选取1986-01-01-1988-12-31全国人口死因与吸烟情况的调查资料,根据各市膀胱癌患者死亡数量,选择例数较多的22个城市35～69岁男性患者死者的资料进行吸烟与膀胱癌死亡率关系的分析。结果:22个城市35～69岁男性在1986-1988年的膀胱癌死亡率为1.85～8.89/10万。20岁前开始吸烟、累计吸烟年限≥40年与35～69岁膀胱癌的死亡率呈正相关,r值分别为0.55和0.59,P值分别为0.008和0.004;60～69岁者生前吸烟与该年龄组的膀胱癌死亡率呈正相关,r=0.46,P=0.03。结论:中国城市男性开始吸烟的年龄、累计吸烟年限和生前吸烟是膀胱癌的重要危险因素。     

Cigarette smoking,alcohol intake,and risk of glioma in the NIH-AARP Diet and Health Study

Background:

Although cigarette smoking and alcohol drinking increase the risk of several cancers and certain components of cigarette smoke and alcohol can penetrate the blood–brain barrier, it remains unclear whether these exposures influence the risk of glioma.

Methods:

We examined the associations between cigarette smoking, alcohol intake, and risk of glioma in the National Institutes of Health-AARP Diet and Health Study, a prospective study of 477 095 US men and women ages 50–71 years at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using models with age as the time metric and adjusted for sex, race/ethnicity, education, and marital status.

Results:

During a median 10.5 person-years of follow-up, 492 men and 212 women were diagnosed with first primary glioma. Among men, current, heavier smoking was associated with a reduced risk of glioma compared with never smoking, but this was based on only nine cases. No associations were observed between smoking behaviours and glioma risk in women. Greater alcohol consumption was associated with a decreased risk of glioma, particularly among men (>2 drinks per day vs <1 drink per week: HR=0.67, 95% CI=0.51–0.90).

Conclusion:

Smoking and alcohol drinking do not appear to increase the risk of glioma.     

Calcium,vitamin D,dairy products,and risk of colorectal cancer in the Cancer Prevention Study II Nutrition Cohort (United States)

Objective: Calcium, vitamin D, and dairy product intake may reduce the risk of colorectal cancer. We therefore examined the association between these factors and risk of colorectal cancer in a large prospective cohort of United States men and women. Methods: Participants in the Cancer Prevention Study II Nutrition Cohort completed a detailed questionnaire on diet, medical history, and lifestyle in 1992–93. After excluding participants with a history of cancer or incomplete dietary information, 60,866 men and 66,883 women remained for analysis. During follow-up through 31 August 1997 we documented 421 and 262 cases of incident colorectal cancers among men and women, respectively. Multivariate-adjusted rate ratios (RR) were calculated using Cox proportional hazards models. Results: Total calcium intake (from diet and supplements) was associated with marginally lower colorectal cancer risk in men and women (RR = 0.87, 95% CI 0.67–1.12, highest vs lowest quintiles, p trend = 0.02). The association was strongest for calcium from supplements (RR = 0.69, 95% CI 0.49–0.96 for 500 mg/day vs none). Total vitamin D intake (from diet and multivitamins) was also inversely associated with risk of colorectal cancer, particularly among men (RR = 0.71, 95% CI 0.51–0.98, p trend = 0.02). Dairy product intake was not related to overall risk. Conclusions: Our results support the hypothesis that calcium modestly reduces risk of colorectal cancer. Vitamin D was associated with reduced risk of colorectal cancer only in men.     

Female mortality trends in Spain due to tumors associated with tobacco smoking

Age- and period-specific mortality rates for esophageal, laryngeal, lung, and bladder cancers in Spanish women from 1952 to 1986 were analyzed using an age-period-cohort model for each location. The four sites exhibit a similar pattern, characterized by a decline in mortality (cohort effect) in post-1900 generations. In the case of cancers of the esophagus and larynx, the model and curvature analysis show a slight rise in mortality in post-1932 generations. In cancers of the esophagus and lung, the period effect parallels the trend traced by the cohort effect. Prevalence estimates of smoking among women in Spain would seem to suggest that the degree of exposure in cohorts studied has been very low. The study indicates that smoking in Spanish women is relatively frequent only in recent generations and that this exposure has not produced, as yet, relevant variations in time trends. Special attention should be paid to the well known synergistic effect of smoking and alcohol consumption, which might already have determined changes in esophageal and laryngeal mortality.Drs Lopez-Abente, Pollán, and Jiménez are with the Cancer Epidemiology Unit of the National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain. Dr Jiménez is presently with the Preventive Medicine Unit, Camino de Santiago Hospital, Ponferrada, Spain. Address correspondence to Dr López-Abente, Servicio de Epidemiología del Cáncer, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Sinesio Delgado, 6, 28029 Madrid, Spain.     

Cigarette smoking and prostate cancer-specific mortality following diagnosis in middle-aged men

Objective The aim of this study was to examine associations of smoking at the time of diagnosis with the risk of prostate cancer death in a population-based cohort of men with prostate cancer. Methods Data were from 752 prostate cancer patients aged 40–64 years, who were enrolled in a case–control study and under long-term follow-up for mortality. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between smoking and prostate cancer-specific and other cause mortality. Results Compared to never smoking, smoking at the time of diagnosis was associated with a significant increase in risk of prostate cancer-specific mortality. After controlling for demographic characteristics, Gleason grade, stage at diagnosis, and primary treatment, the HR was 2.66 (95% CI: 1.10–6.43). Conclusions Smoking at the time of diagnosis, independent of key clinical prognostic factors, is associated with an increased risk of prostate cancer death.     

Cigarette smoking and the risk of gastric cancer: a pooled analysis of two prospective studies in Japan

To examine the association between cigarette smoking and the risk of gastric cancer, we conducted a pooled analysis of 2 population-based prospective cohort studies in rural northern Japan. Cohort 1 included 9,980 men (>or=40 years old) and Cohort 2 included 19,412 men (40-64 years old). The subjects completed a self-administered questionnaire on cigarette smoking and other health habits. We identified 228 cases of gastric cancer among Cohort 1 subjects (9 years of follow-up with 74,073 person-years) and 223 among Cohort 2 subjects (7 years of follow-up with 141,675 person-years). From each cohort, we computed the relative risk (RR) and 95% confidence interval (CI) of gastric cancer associated with smoking using a Cox regression analysis and pooled these estimates to obtain summary measures. The pooled multivariate RRs (95% CIs) for current smokers and past smokers compared to subjects who had never smoked were 1.84 (1.39-2.43) and 1.77 (1.29-2.43), respectively. The higher number of cigarettes smoked per day among current smokers was associated with a linear increase in risk (trend p < 0.05). The significant increase in risk for past smokers remained for up to 14 years after cessation. An increased risk was noted for cancer of the antrum but not for cardia or body lesions. The risk was increased for both differentiated and nondifferentiated histologic subtypes. Our findings support the hypothesis that cigarette smoking is a risk factor for gastric cancer.     

吸烟与原发性肝癌关系的巢式病例对照研究

目的 分析吸烟与上海市区中老年男性原发性肝癌的关系.方法 应用巢式病例对照研究方法,对一个18 244名男性队列随访11年,以队列中213例新发肝癌患者作为病例组,按照患者年龄、采样日期、同居住区等配对条件,从队列中随机抽取1094名健康人作为对照组.使用配对Logistic回归分析,调整可能的混杂因素,估计吸烟对肝癌发生的危险度和95%可信区间(CI).结果 调整肝炎、肝硬化、胆石症或其他胆囊病史及乙型肝炎病毒感染等可能的混杂因素后,男性吸烟者患肝痛的危险性是不吸烟者的1.91倍(95%CI为1.28～2.86),日随着每天吸烟量、吸烟年限和吸烟包年数的增加而增加.每天吸烟≥20支者、吸烟≥40年者和吸烟37包年者患肝癌的相对危险度分别为2.16(95%CI为1.37～3.40)、2.14(95%CI为1.18～3.87)和2.12(95%CI为1.21～3.74).吸烟开始年龄越小,危险性越大,吸烟开始年龄<20岁者患肝癌的危险性为2.57(95%CI为1.50～4.40).结论 吸烟是上海市区男性原发性肝癌的危险因素.     

A longitudinal study of smokeless tobacco use and mortality in the United States

Few studies in the United States have examined longitudinally the mortality risks associated with use of smokeless tobacco (SLT). The sample of our study was composed of participants from the National Longitudinal Mortality Study who completed a single Tobacco Use Supplement to the Current Population Survey between the years 1985 and 2011. Using survival methods, SLT use at the baseline survey was examined as a predictor of all‐cause mortality and cause‐specific mortalities in models that excluded individuals who had ever smoked cigarettes, cigars or used pipes (final n = 349,282). The participants had median and maximum follow‐up times of 8.8 and 26.3 years, respectively. Regression analyses indicated that compared to the never tobacco users, the current SLT users did not have elevated mortality risks from all cancers combined, the digestive system cancers and cerebrovascular disease. However, current SLT users had a higher mortality risk for coronary heart disease (CHD) [hazard ratio (HR) (95% CI) = 1.24 (1.05, 1.46)] relative to never tobacco users. In a separate model, the elevated risk for CHD mortality corresponded to the use of moist snuff [HR (95% CI) = 1.30 (1.03, 1.63)]. The associations with CHD mortality could be attributed to long‐term nicotine exposure, other SLT constituents (e.g., metals) or the confounding effects of CHD risk factors not accounted for in our study. The study's findings contribute to the ongoing dialogue on tobacco harm reduction and the US FDA's evaluation of Modified Risk Tobacco Product applications submitted by American SLT manufacturers.     

Associations of cigarette smoking and alcohol drinking with stomach cancer survival: A prospective patient cohort study in Japan

Cigarette smoking and alcohol drinking may affect the prognosis of stomach cancer, but evidence has been inconsistent. We investigated the associations between pretreatment smoking and alcohol drinking and the risk of all‐cause and stomach cancer death among 1,576 patients with histologically confirmed stomach cancer diagnosed during 1997–2010 at a single hospital in Japan. Histories of smoking and alcohol drinking were assessed using a self‐administered questionnaire. The patients were followed until December 31, 2013. The Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 9,625.1 person‐years, 670 all‐cause and 419 stomach cancer deaths were documented. Among the patients overall, ever‐drinking was significantly associated with an increased risk of all‐cause death (HR: 1.25; 95% CI: 1.03–1.51), but not stomach cancer death. Positive linear associations with the frequency of drinking (p_trend = 0.02) and the amount of alcohol consumed per day (p_trend = 0.03) were observed for the risk of all‐cause death. Ever‐smoking was not related to either the risk of all‐cause or stomach cancer death. Conversely, among the patients who underwent curative resection, a significant positive association was found between ever‐smoking and the risk of stomach cancer death (HR: 2.44; 95% CI: 1.17–5.08). A positive association was also found for earlier age at start of smoking (p_trend = 0.0046). Pretreatment smoking and alcohol drinking have significant effects on stomach cancer survival. Lifestyle adjustments throughout life may improve survival.     

A prospective study on active and environmental tobacco smoking and bladder cancer risk (The Netherlands)

Objective: In a prospective cohort study among 120,852 adult subjects the authors investigated the associations between cigarette, cigar, pipe, environmental tobacco smoking (ETS), and bladder cancer. Methods: In 1986 all subjects completed a questionnaire on cancer risk factors. Follow-up for incident bladder cancer was established by linkage to cancer registries until 1992. The case–cohort analysis was based on 619 cases and 3346 subcohort members. Results: Compared with lifelong non-smokers the age- and sex-adjusted incidence rate ratios (RR) for ex- and current cigarette smokers were 2.1 (95% CI 1.5–3.0) and 3.3 (95% CI 2.4–4.6), respectively. The RR for smoking duration was 1.03 (95% CI: 1.02–1.04) per 1-year increment. The RR per 10 cigarettes/day was 1.3 (95% CI 1.2–1.4). Tar and nicotine exposure increased bladder cancer risk only weakly. It appeared that associations of cigarette smoking characteristics with bladder cancer risk were largely attributable to cigarette smoking duration only. Smoking cessation, age at first exposure, filter-tip usage, cigar and pipe smoking, and ETS were no longer associated with bladder cancer risk after adjustment for frequency and duration of smoking. Conclusions: The authors conclude that current cigarette smokers have a three-fold higher bladder cancer risk than non-smokers. Ex-smokers experience a two-fold increased risk. About half of male bladder cancer and one-fifth of female bladder cancer was attributable to cigarette smoking. Other smoking types (cigar, pipe, or ETS) were not associated with increased risks.     

Effects of tobacco smoking on cancer and cardiovascular disease in urban black South Africans

Demographic and lifestyle information from 9690 black patients diagnosed with cancer or cardiovascular disease was collected in an ongoing case-control study in Johannesburg, South Africa. Compared to never smokers, the odds ratio (OR) for lung cancer among current smokers was 16.3 (95% confidence interval (CI), 9.6-27.6) for men and 6.4 (95% CI, 4.0-10.4) for women. The corresponding OR for other smoking-related cancers was 4.6 (95% CI, 3.7-5.7) among men and 1.9 (95% CI, 1.6-2.2) among women, and for cardiovascular disease, 3.4 (95% CI, 2.1-5.4) among men and 1.5 (95% CI, 1.1-2.1) among women. Risks were higher among smokers than former smokers, and all risk estimates increased with increasing levels of smoking duration and intensity. Non-electric domestic fuel was associated with approximately 60% increase in the risk of smoking-related cancer, but not cardiovascular disease. Risks for cancers of cervix, oesophagus, oral cavity/pharynx, stomach, larynx, pancreas and anogenital region, as well as squamous cell carcinoma of skin were all significantly higher among current than never-smokers, with ORs ranging from 1.5 for cervix (95% CI, 1.2-1.8) to 14.7 for larynx (95% CI, 7.2-30). The risks of tobacco-related disease reported here are similar to that currently observed in Western countries, even though cigarette consumption is relatively low in this population.     

Cigarette Smoking and Prostate Cancer Risk: Negative Results of the Seoul Male Cancer Cohort Study

We evaluated cigarette smoking as a risk factor for prostate cancer in a prospective, population-based cohortstudy. The subjects were 14,450 males among the participants in the Seoul Male Cancer Cohort Study who hadat least 1-year follow-up. They were followed up between 1993 and 2008. During the 16-year follow-up period,87 cases of prostate cancer occurred over the 207,326 person-years of the study. The age-adjusted relative risksof past and current smokers at entry were 0.60 (95%CI: 0.34-1.06) and 0.70 (95%CI: 0.43-1.13), respectively,suggesting that cigarette smoking may not be a risk factor for prostate cancer. The relationship between prostatecancer and other modifiable factors, such as Westernized diet, should be studied with the goal of establishingprevention programs for prostate cancer.     

Waterpipe Tobacco Smoking and Risk of Stomach Cancer: A Case-Control Study in Vietnamese Men

Objective: This study investigated the impacts of waterpipe tobacco (WTP) and cigarette smoking on stomach cancer development in Vietnamese men. Methods: A total of 80 stomach cancer cases and 146 controls were recruited in a hospital-based case-control study. Data on sociodemographic, anthropometric characteristics, tobacco smoking, and the dietary pattern was obtained based on a semi-quantitative food frequency and demographic lifestyle questionnaire; and venous anti-Helicobacter pylori IgG antibodies were tested by ELISA. Unconditional logistic regression analysis with adjustments for potential confounding was performed to estimate the association between target exposures and stomach cancer. Results: Compared to the never tobacco smokers, the risk of stomach cancer significantly increased among tobacco smokers (OR 2.95, 95%CI 1.26-6.90, p=0.013). Those who early started tobacco smoking before 26 years old had a high risk of SC (OR 3.04, 95%CI 1.29-7.20, p for trend=0.011). For types of tobacco, It was increased risk in exclusively cigarette smokers (OR 2.85, 95%CI 1.19-6.85, p=0.019) and in WPT smokers (OR 3.09, 95%CI 1.24-7.68, p=0.015). The daily frequency and longer duration of exclusively WPT or cigarette smoking tended to be significantly higher SC risk. Conclusions: The findings suggest that tobacco smoking, particularly water pipe tobacco smoking, dramatically and independently increased the risk of stomach cancer.     

中国胃癌流行病学现状

  目的  通过对中国人群肿瘤登记数据中胃癌资料进行分析,了解全国胃癌流行现状。  方法  根据全国肿瘤登记中心的数据,评估全国胃癌流行情况及胃癌长期变化趋势。  结果  2012 年中国胃癌新发病例约 42.4 万例,死亡病例约 29.8 万例。2000 年至 2012 年我国城市地区男性与女性胃癌发病率、死亡率保持平稳,农村地区男性呈上升趋势,农村地区女性变化不大,调整年龄后发病率和死亡率均呈下降趋势。2003 年至 2005 年胃癌 5 年相对生存率为 27.4%(95%CI:26.7%～28.1%) 。  结论  胃癌是中国常见的恶性肿瘤,疾病负担严重,农村地区尤为明显,是国家癌症防治的重点。       

Prospective study of screening for stomach cancer in Japan

Although screening for stomach cancer is a widespread community service in Japan, the benefits of the screening program remain unclear. Our study investigated prospectively the relation between participation in stomach-cancer screening during the past 12 months and subsequent deaths. Data was derived from the Japan Collaborative Cohort Study, in which 480 stomach-cancer deaths were identified during an 8-year follow-up period. Cox proportional hazard regression was used to estimate the relative risk of death from stomach cancer and that from other causes while adjusting for potential confounding factors. In men, screening participation was associated significantly with a reduced risk of death from stomach cancer (relative risk [RR] = 0.54; 95% confidence interval [CI] = 0.41-0.70). The extent of the risk reduction was greater than potential health selection (for deaths other than stomach, RR = 0.71). The adjustment for potential confounding variables, however, attenuated the difference in risk of death (stomach cancer, RR = 0.65; other causes, RR = 0.71). In women, the magnitude of the association between screening participation and death from stomach cancer (RR = 0.74; 95% CI = 0.52-1.07) was equal to that for deaths from non-stomach cancers (RR = 0.74). Subgroup analysis showed that women with a parental history of stomach cancer had a reduced risk of death from stomach cancer associated with screening (RR = 0.32; 95% CI = 0.12-0.87). The present results underline the potential for selection bias in observational studies, and thus it remains an open question whether screening for stomach cancer is effective.