Dietary Habits and Risk of Lung Cancer Death in a Large-scale Cohort Study (JACC Study) in Japan by Sex and Smoking Habit

Lung cancer has increased and is the leading cause of cancer death among Japanese males. The associations of dietary habits with the risk of lung cancer death were evaluated by sex and smoking habits in this study. In the Japan Collaborative Cohort (JACC) Study, a cohort established in 1988–90 and consisting of 42 940 males and 55 308 females was observed for lung cancer deaths up to the end of 1997. During the observation period, 446 males and 126 females died of lung cancer. A self-administered food frequency questionnaire was used as the baseline survey. Hazard ratios for dietary factors were calculated by Cox's proportional hazards model. Among males, a high intake of ham and sausages, cheese, green-leafy vegetables, oranges, and other fruits significantly and dose-dependently decreased the risk of lung cancer death. Among females, a high intake of miso-soup, ham and sausages, and liver significantly and almost dose-dependently increased the risk. Vegetables and fruits rich in antioxidative and carcinogenic agents reduced the risk of lung cancer deaths among male smokers more than among female nonsmokers. The results among female nonsmokers were partially consistent with the hypothesis that high fat consumption increases the risk of lung cancer, especially that of adenocarcinoma.     

Second Primary Cancer Following Laryngeal Cancer with Special Reference to Smoking Habits

The risk of developing a second primary cancer following laryngeal cancer was estimated by following-up 472 male laryngeal cancer patients for an average of 8.6 years by means of record linkage to the Osaka Cancer Registry. Of these patients, 115 developed a second cancer other than laryngeal cancer, whereas the expected number derived from the incidence rates among Osaka residents was 51.4 (relative risk (RR) = 2.2, 95% confidence interval = 1.85 2.69). Cumulative risk of developing a second primary cancer was estimated to be 31.1% at 15 years after laryngeal cancer. By site, the risks were significantly increased for tobacco-related cancers, RR = 24.5, 6.1 and 2.3 for cancers of the oral cavity & pharynx, esophagus and lung, respectively. Also, the risks were higher among heavy smokers for cancer of the oral cavity & pharynx and esophagus than among light smokers. No adverse effects of radiotherapy for laryngeal cancer on the development of thyroid cancer, lymphoma and leukemia were observed. The present study suggests the necessity of following-up laryngeal cancer patients over a long period in order to enable the early detection of tobacco-related cancer.     

Epidemiologic Survey on Lung Cancer with Respect to Cigarette Smoking and Plant Diet1

This case-control study of lung cancer was based on a cross-sectional questionnaire survey of inpatients at 5 general hospitals in Okinawa, Japan, from 1982 to 1987. The purpose of the study was to clarify the relations of lung cancer to cigarette smoking and plant diet. Ingestion frequencies of 17 major dietary plants and/or herbs were obtained by means of a questionnaire interview. As eligible subjects for a case-control analysis, there were 673 respondents aged over 30 years with clear smoking history, age, sex and diagnosis. Psychiatric patients were excluded. Odds ratios of newly diagnosed lung cancer were calculated by the Mantel-Haenszel procedure. A pair consisted of a case and two controls which were selected randomly by using multivariate caliper matching. Sixty-four pairs matched for age (±5) and sex showed a significantly high odds ratio of 2.9 (P< 0.0005). However, three male groups who were categorized by the number of cigarettes smoked did not exhibit dose-dependency of lung cancer on smoking. Lung cancer was more prevalent in ex-smokers than in current smokers. Case-control analyses by male generations revealed that lung cancer incidence was age-dependent, and there was a clear dose-response relationship between smoking and lung cancer in males in their sixties. A case-control analysis of each of 17 edible plants based on 44 pairs who were matched for age (±5), sex and smoking history demonstrated that the odds ratio of aloe (Aloe arborescens Mill var. natalensis Berger ) was 0.5 (P<0.1), suggesting that the aloe may prevent human carcinogenesis at various sites.     

A Case-control Study of Risk Factors for Lung Cancer in Mumbai,India

In the year 2010, it is estimated that nearly 1.35 million new cases and 1.18 million deaths with lung canceroccurred. In India, among males, lung cancer rates vary across the country which has encouraged us to conduct acase-control study to study the risk factors. The present unmatched hospital-based case-control study conductedat Tata Memorial Hospital included subjects registered between the years 1997-99. There were 408 lung ‘cancercases’ and 1383 ‘normal controls. Data on age, tobacco habits, occupational history, dietary factors, tea, coffeewere collected by the social investigators. Univariate and regression analysis were applied for obtaining theodds ratio for risk factors. In the study, cigarette smoking (OR=5.2) and bidi smoking (OR=8.3), as well asalcohol consumption (OR=1.8), demonstrated dose-response relationships with lung cancer risk. Among thedietary items, only red-meat consumption showed 2.2-fold significant excess risk. Consumption of milk showeda 60% reduction in risk; while coffee showed a 2-fold excess risk for lung cancer. In addition, exposure to useof pesticides showed a 2.5-fold significant excess risk for lung cancer.     

Relationship between Cigarette Smoking and Histologic Type of Lung Cancer, with Special Reference to Sex Difference

In order to clarify sex differences associated with the relationshipbetween smoking and each histologic type of lung cancer, thesmoking histories of 2,083 lung cancer patients (1,660 men and423 women) diagnosed at the Center for Adult Diseases, Osaka,from 1965 to 1983 were analyzed. The rates expected of smokersamong these cases were calculated from the sex and age specificrates of smokers in the general population, reported annuallyby the Japan Tobacco and Salt Public Corporation. The odds ratiosfor smoking were estimated to be 5.2, 3.1, 6.9 and 4.1 in menfor squamous cell carcinoma, adenocarcinoma, small cell carcinomaand large cell carcinoma, and 7.2, 1.8, 14.4 and 3.8 in womenrespectively. Significant differences in the odds ratios foreach histologic type between men and women were observed onlyfor adenocarcinoma. In squamous cell carcinomas, the odds ratioswere estimated by dividing them into two groups according tolocation. No difference was found between men and women in thisrespect.     

A Case-Control Study of Gastric Cancer and Diet in Northern Kyushu, Japan

A case-control study of gastric cancer was done in a rural area of northern Kyushu, Japan, in relation to dietary habits especially focusing on the relationship with the consumption of broiled fish. The study was based upon 139 cases of newly diagnosed gastric cancer at a single institution, 2,574- hospital controls and 278 controls sampled randomly from the residents of the study area (with sex and year of birth matched). No association was observed between the consumption of broiled fish and gastric cancer risk whether three types of broiled fish (raw fish, dried fish and salted fish) were analyzed separately or as a single category. However, consistently in the comparisons with both sets of controls, the risk of gastric cancer was inversely related with the consumption of fruits and positively associated with cigarette smoking. A decreased risk of gastric cancer was also noted among those with high consumption of green tea (10 or more cups per day).     

吸烟和环境烟草烟雾暴露与女性肺癌的关系的病例──对照研究

在上海市区进行了女性肺癌病例—对照研究中共调查新病例649例，对照675例。资料分析表明各种组织学类型肺癌都与吸烟有联系．其中鳞癌和小细胞癌与吸烟关系非常密切．OR分别为5.6和9．9，吸烟使腺癌危险性略有增加，OR=1.195％可信阳=0.7～1.7,吸烟对肺癌总的相对危险度为2.4（95％可信限=1.8～3.3）。各类肺癌的危险性均随每日吸烟量的增加、吸烟年限的延长和开始吸烟年龄的提前而增加。鳞癌和小细胞癌危险性上升速度最快，腺癌危险性增加缓慢，且趋势不显著。本研究还发现工作环境中的环境烟草烟雾暴露使女性非吸烟者肺癌危险性增加到1.5倍，95％可信限=1．1～2.0。未发现儿童期父母吸烟和成年期丈夫吸烟增加女性非吸烟者肺癌危险性。     

A Case-Control Study on Occupational Lung Cancer Risks in an Industrialized City of Japan

A hospital-based case-control study was conducted to evaluate occupational risks of lung cancer in an industrialized city of Japan. The lung cancer cases were obtained from 3 major hospitals in the city. The control group consisted of patients with a variety of diseases hospitalized in the same wards of the same hospitals as the cases. After matching on sex, 5–year age category and hospital, 144 cases and 676 controls comprised the study group. A self-administered questionnaire was used to obtain lifetime job histories and smoking status. The conditional logistic regression model was used to estimate relative risks after controlling for smoking and employment in other jobs. The workers in shipbuilding, ironworks and other plants (mostly chemical plants) showed statistically significant increases in lung cancer risk with relative risks of 6.18, 2.02, and 2.66, respectively. An increase in risk with the duration of employment was also observed in the "other plants" category. Building and road construction workers also showed increased relative risks, 1.95 and 1.79, but they were not significant. When the risk was evaluated on the exposure chemicals, the workers exposed to inorganic acids and bases had significantly increased risk. The workers exposed to asbestos, dust or organic chemicals also showed increased risk but the effects were not significant. The combined effect of smoking and employment in ironworks showed a good fit to an additive model, while that in the "other plants" category was closer to a multiplicative model.     

Tea Consumption and Lung Cancer Risk: A Case-Control Study in Okinawa, Japan

To disclose the relationship between tea consumption and lung cancer risk, we analyzed the data from a case-control study conducted in Okinawa, Japan from 1988 to 1991. The analysis, based on 333 cases and 666 age-, sex- and residence-matched controls, provided the following major findings, (a) The greater the intake of Okinawan tea (a partially fermented tea), the smaller the risk, particularly in women. For females, the odds ratios (and 95% confidence intervals) for those who consumed 1-4, 5-9, and 10 cups or more of Okinawan tea every day, relative to non-daily tea drinkers, were 0.77 (0.28-2.13), 0.77 (0.26-2.25) and 0.38 (0.12-1.18), respectively (trend: P =0.032). The corresponding odds ratios for males were 0.85 (0.46-1.55), 0.85 (0.46-1.56) and 0.57 (0.31-1.06) (trend: P =0.053). (b) The risk reduction by Okinawan tea consumption was detected mainly in squamous cell carcinoma. Daily tea consumption significantly decreased the risk of squamous cell carcinoma in males and females, the odds ratios being 0.50 (95% confidence interval 0.27-0.93) and 0.08 (0.01-0.68), respectively. These findings suggest a protective effect of tea consumption against lung cancer in humans.     

Prognostic Factors for Surgically Treated Lung Adenocarcinoma Patients, with Special Reference to Smoking Habit

Prognostic factors for lung adenocarcinoma patients who had been treated surgically at the Center for Adult Diseases, Osaka, in 1978–87 (N = 267) were analyzed In terms of year of operation, sex, age at operation, postsurgical stage, grade of differentiation, and smoking habit. Survival was improved for later year of operation (1983–87), younger age at operation, stage I or II, well or moderately differentiated adenocarcinoma, and nonsmoking status in univariate analysis. A proportional hazards model including the above variables showed that stage III and stage IV patients had 4.06 and 8.81 times higher risk of death compared to stage I and II patients. Poorly differentiated adenocarcinoma showed 2.01 times higher risk of death than well or moderately differentiated adenocarcinoma. Earlier year of operation and female status showed 1.70 and 1.82 times higher risk of death, respectively, as compared to each reference group. All these hazard ratios showed statistical significance. Current smokers who smoked 1,000 or more on the cigarette index showed 2.38 times higher risk of death than nonsmokers with statistical significance. This indicates that smoking is another independent prognostic factor for patients who undergo operations for adenocarcinoma of the lung.     

非吸烟人群肺癌危险因素的病例对照研究

目的探讨中国非吸烟人群肺癌的危险因素,为防癌措施提供依据。方法采用病例对照研究的方法,按频数匹配收集非吸烟肺癌新发病例306例及非吸烟对照306例,利用统一编制的调查表对调查对象进行面访,收集病例和对照危险因素的暴露史等。结果单因素分析发现25个因素与非吸烟人群肺癌的发病有关联;多因素分析后发现：非吸烟人群肺癌发病的危险因素是体重指数(body mass index,BMI)＜18.5,居住地周围有污染企业、装修刺激性气味、家庭被动吸烟、工作场所被动吸烟、使用农药、性格内向、食用油炸食品、肺部手术史、癌症家族史,而保护因素是BMI≥24、常吃蛋类、常吃水果、饮茶、常以散步作为锻炼(2年前),经广义多因子降维法（GWDR）拟合的最优的交互作用模型是居住地企业+装修刺激性气味+家庭被动吸烟+工作场所被动吸烟+农药接触史+癌症家族史。结论非吸烟者发生肺癌的影响因素较多,仍需进一步识别。     

肺癌死亡和存活组病例对照研究分析

目的 比较肺癌死亡病例组和存活病例组危险因素研究结果的差异。方法 利用京津沪渝四市肺癌病例对照资料,采用单因素和多因素Ｌｏｇｉｓｔｉｃ回归分析。结果 死亡和存活病列组间吸烟、家族恶性肿瘤史、既往呼吸系疾病史、体质指数、心理等因素的ＯＲ值接近,死亡病例组中因素的作用略大;而食物、环境烟雾因素等则差别较大。结论 用代理人资料来研究暴露明确且联系程度较大的肺癌危险因素是可行的。     

Case-Control Study for Lung Cancer and Cigarette Smoking in Osaka, Japan: Comparison with the Results from Western Europe

In order to clarify the relation between cigarette smoking and lung cancer, a case-control study was conducted. The case series consisted of 1,376 lung cancer patients (1,082 males and 294 females) who were newly diagnosed and admitted to eight hospitals in Osaka during 1986–88. Smoking histories were compared with those of 2,230 controls (1,141 males and 1,089 females) admitted to the same hospitals during the same period without established smoking-related diseases. Odds ratios of current smoker versus nonsmoker were 18.1, 1.9, 21.4, and 3.8 for squamous, adeno, small, and large cell carcinoma, respectively, for males, and 9.7, 1.3, 12.1, 3.7, respectively, for females. Compared to the results from previous studies in Japan, the magnitude of the odds ratios for squamous and small cell carcinoma is approaching the level of Western Europe in the late 1970s. Population attributable risk of exsmokers has also been increasing to the level of Western Europe. Among male current smokers, smoking intensity, such as number of cigarettes per day or fraction smoked per cigarette, seemed to have a slightly greater influence on squamous cell carcinoma than adenocarcinoma, while factors associated with the spread of cigarette smoke, such as inhalation, seemed to have greater influence on adenocarcinoma. The difference in the distribution of these smoking characteristics between Japan and Western Europe could not fully explain the difference in lung cancer incidence and distribution of histologic types between the two areas.     

An Autopsy Study of Lung Cancer with Special Reference to the Relationship between Cigarette Smoking and Histological Differentiation of Adenocarcinoma and Squamous Cell Carcinoma

To clarify the relationship between cigarette smoking and thedegree of differentiation of adenocarcinoma and squamous cellcarcinoma of the lung, 207 male and 103 female cases of adenocarcinomaand 125 male and 26 female cases of squamous cell carcinoma,autopsied between 1958 and 1985, were reviewed. In males, adenocarcinomacases increased as the degree of differentiation decreased.In females, poorly differentiated cases of adenocarcinoma and,in males, those of squamous cell carcinoma, were minimal, andthe number of poorly-differentiated adenocarcinoma cases significantlyless (p<0.005) in females than in males. The number of malesmokers with adenocarcinoma increased, and that of female non-smokersdecreased, as the degree of differentiation decreased. On theother hand, the number of male smokers with squamous cell carcinomadecreased and that of female non-smokers increased as the degreeof differentiation decreased. The incidences of well-differentiatedadenocarcinoma in female non-smokers, well-differentiated squamouscell carcinoma in male heavy smokers and poorly-differentiatedsqumous cell carcinoma in female non-smokers were prominentA histopathological diagnoses of differentiated subtypes ofadenocarcinoma and squamous cell carcinoma of the lung is usefuland important in understanding the biological characteristicsof lung cancer and also the effects of cigarette smoking.     

Decrease in Risk of Lung Cancer Death in Males after Smoking Cessation by Age at Quitting: Findings from the JACC Study

To evaluate the impact of smoking cessation in individuals and populations, we examined the decrease in risk of lung cancer death in male ex-smokers by age at quitting in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk Sponsored by Monbusho (JACC Study), which was initiated from 1988 to 1990 in Japan. For simplicity, subjects were limited to male non-smokers, and former/current smokers who started smoking at ages 18-22, and 33 654 men aged 40-79 years were included. We modeled the mortality rates in non-smokers and current smokers, and compared the rates in ex-smokers with those expected from the model if they had continued smoking. During the mean follow-up of 8.0 years, 341 men died from lung cancer. The mortality rate ratio for current smokers, compared to non-smokers, was 5.16, and those for ex-smokers who had quit smoking 0-4, 5-9,10-14,15-19 and >20 years before were 4.84, 3.19, 2.03,1.29 and 0.99, respectively. The functions of 3.20×l0^-7×(age)⁴⁵ and 1.96×lO^-5×(age-29.6)^4.5 fitted the observed mortality rates (per 100 000 person-years) in non-smokers and continuing smokers, respectively. A greater decrease in lung cancer mortality was estimated among those who quit smoking at younger ages. Stopping smoking earlier in life appears preferable to keep the individual risk low. The absolute rate, however, substantially decreased after smoking cessation even in those who quit at ages 60-69, reflecting the high mortality rate among continuing smokers in the elderly.     

A Case-Control Study of Single and Multiple Stomach Cancers in Saitama Prefecture, Japan

A case-control study of stomach cancer was done in Saitama Prefecture, Japan, in relation to dietary, smoking, and drinking habits. The study was based on two sets of cases (216 male single and 35 male multiple stomach cancer cases newly diagnosed and of adenocarcinoma type), and 483 male controls derived from residents of Saitama Prefecture. Dietary habits were investigated for the intake of 12 separate foods and 12 food groups by means of a food frequency questionnaire, including individual taste preferences. Among the single stomach cancer series, dose-response relationships were observed for 7 dietary items (preference for salty foods, miso soup, boiled fish, pickled vegetables, nuts, raw vegetables, and seaweed) in the multiple logistic regession analysis. As for the multiple stomach cancer case series, dose-response relationships were observed for 3 dietary items (miso soup, fruits, and seaweed) in the multiple logistic regression analysis. Cigarette smoking and alcohol use were not significantly related to the risk of either single or multiple stomach cancer.     

北京市肺癌危险因素的病例对照研究

「目前」探索北京市肺癌主要危险因素。「方法」抽取３５０例原发性肺癌患者进行１：１配对病低对照研究,并用条件Ｌｏｇｉｓｔｉｃ回归模型对所获资料进行单因素和多因素分析。「结果」研究揭示效应暗强的危险因素有肺部疾病史,吸烟史,住宅附近５００米内有大气污染,因亲人不和、工作失意等导致的精神创伤以及家族肿瘤史等;而保护性因素有经常食用新鲜水果和体育锻炼。「结论」为了解北京市肺癌的流行规律并为其防治和研究提供     

Obesity,Diet and Physical Inactivity and Risk of Breast Cancer in Thai Women

To evaluate the relationship between obesity, diet, physical activity and breast cancer in Thai women, weconducted a case control study with 1,130 cases and 1,142 controls. Informed consent was obtained from allparticipants and a structured questionnaire was performed by trained interviewers to collect information ondemographic and anthropometric data, reproductive and medical history, residential history, physical activityand occupation as well as dietary habits. A significant positive association with an increased risk of breast cancerwas observed in women body mass index (BMI) of ≥25 mg/m2 (OR=1.33, 95%CI 1.07-1.65), the risk beinghigher in postmenopausal women (OR=1.67, 95%CI 1.24-2.25). In addition, underweight BMI at ages 10 and 20years showed an inverse association in all women (OR=0.70, 95%CI 0.56-0.88 and OR=0.74, 95%CI 0.59-0.93,respectively) and in those with a premenopausal status (OR=0.69, 95%CI 0.51-0.93 and OR=0.76, 95%CI 0.56-0.99, respectively). Regular exercise was associated with a decreased risk of breast cancer (OR=0.78, 95%CI0.68-0.98). Interestingly, analysis by type of activity revealed significant protective effects for women who reportedthe highest levels of walking for shopping (OR=0.58, 95%CI 0.38-0.88). High consumption of vegetables andfruit were associated with a decreased risk of breast cancer, while high consumption of animal fat showed anincreased risk in postmenopausal women. In conclusion, our results indicate that obesity and high consumptionof animal fat are associated with breast cancer risk, particularly in postmenopausal women, while recreationalphysical activity has protective effects. It seems that primary prevention of breast cancer should be promotedin an integrated manner. Effective strategies need to be identified to engage women in healthy lifestyles.     

晚期肺癌患者肺部感染死亡危险因素分析

目的 分析肺癌伴肺部感染患者死亡的相关危险因素。方法　回顾2010年1月—2017年5月收治的186例晚期肺癌患者临床资料,其中肺部感染死亡者52例,并收集肺部感染死亡的相关危险因素。结果　晚期肺癌患者肺部感染死亡率为27.96%（52/186）。在诸多因素中,年龄（P=0.039）、BMI值（P=0.000）、组织分化程度低（P=0.003）、功能状态评分（P=0.022）、转移部位≥3（P=0.029）、合并症（P=0.034）、多重耐药菌感染（P=0.000）、血红蛋白浓度<90 g/L（P=0.014）等在死亡组和非死亡组之间差异具有统计学意义。结论　年龄（≥60岁）、BMI值（<20 kg/m²）、组织分化程度（低）、抗肿瘤治疗药物（≥3种）、靶向药物治疗、转移部位（≥3）、合并症、多重耐药菌感染、血红蛋白浓度（<90 g/L）等是晚期肺癌患者肺部感染死亡的主要危险因素。