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.     

Cancer, cardiovascular disease and diabetes mortality among women with a history of endometrial cancer

Among 7182 women with endometrial cancer in Scotland, standardised mortality ratios (and 95% confidence intervals (CI)) were 6.38 (5.74-7.15) for all cancers and 1.10 (1.00-1.22) for circulatory diseases as underlying cause of death and 2.81 (2.19-3.70) for diabetes as underlying/contributory cause of death.     

Tuberculosis,smoking and risk for lung cancer incidence and mortality

Among the exposures associated with risk for lung cancer, a history of tuberculosis (TB) is one potentially important factor, given the high prevalence of TB worldwide. A prospective cohort study was conducted to evaluate the associations of preexisting pulmonary TB with lung cancer incidence and mortality. The cohort consisted of 1,607,710 Korean adults covered by the National Health Insurance System who had a biennial national medical examination during 1997–2000. During up to 16 years of follow‐up, there were 12,819 incident cases of lung cancer and 9,562 lung cancer deaths. Using Cox proportional hazards models and controlling for age, cigarette smoking and other covariates, the presence of underlying TB was significantly associated with increased risk for lung cancer incidence (HR 1.37 in men with 95% CI 1.29–1.45; HR 1.49 in women with 95% CI 1.28–1.74) and mortality (HR 1.43 in men with 95% CI 1.34–1.52; HR 1.53 in women with 95% CI 1.28–1.83). We also observed a dose‐response relationship between number of cigarettes smoked daily and lung cancer risk. There was no evidence for synergism between a history of TB and smoking. The elevation in risk is relatively modest, particularly in comparison to that from smoking, and a prior history of TB is not likely to be useful risk indicator for clinical purposes. In populations with high prevalence of TB, it can be considered for incorporation into models for lung cancer risk prediction.     

Death from high‐risk prostate cancer versus cardiovascular mortality with hormonal therapy

BACKGROUND:

Randomized trials have demonstrated improved survival when hormonal therapy (HT) is added to radiation therapy (RT) for high‐risk prostate cancer. However, it is still unknown whether men who have a history of myocardial infarction (MI) or MI risk factors achieve a superior outcome from HT.

METHODS:

A Markov decision analysis model was used to compare quality‐adjusted life expectancy (QALE) in men aged 50, 60, and 70 years who received RT and no HT, 6 months of HT (short‐term), or 3 years of HT (long‐term) for high‐risk prostate cancer stratified by cardiac risk group.

RESULTS:

In men with a history of MI, there was a decrease of 0.1 to 0.2 quality‐adjusted life years and 0.5 to 0.6 quality‐adjusted life years across all ages with short‐term HT and long‐term HT, respectively, compared with no HT. In men without MI, receipt of short‐term or long‐term HT was associated with a QALE benefit versus no HT in all cohorts. Among men without MI, the optimal duration of HT was a function of age and the number of MI risk factors. Long‐term HT improved QALE (range, 1.4‐5.4 years) for men aged 50 or 60 years except those with MI; whereas, for men aged 70 years with 4 cardiac risk factors, short‐term and long‐term HT yielded identical QALE.

CONCLUSIONS:

Men who received RT for high‐risk prostate cancer and had a history of MI experienced net harm when they received HT. Men without MI gained a QALE benefit from HT, even if they had up to 4 cardiac risk factors. The optimal duration of HT is a function of patient age and the number of cardiac risk factors. Cancer 2013. © 2013 American Cancer Society.     

Cigarette smoking and colorectal cancer incidence and mortality: Systematic review and meta‐analysis

The association between cigarette smoking and colorectal cancer (CRC) has been controversial. To synthesize the available data, we conducted a comprehensive meta‐analysis of all prospective studies. A total of 36 studies were included in our meta‐analysis. We examined the association between smoking and CRC, colon cancer and rectal cancer in terms of incidence and mortality. Separate analyses were conducted for smoking status, daily cigarette consumption, duration, pack‐years and age of initiation. Relative to nonsmokers, current and former smokers had a significantly increased risk of CRC incidence and mortality, respectively. When CRC data were combined with colon/rectal cancer data, current smokers had a significantly increased risk of CRC incidence. All 4 dose–response variables examined—daily cigarette consumption (RR = 1.38 for an increase of 40 cigarettes/day), duration (RR = 1.20 for an increase of 40 years of duration), pack‐years (RR = 1.51 for an increase of 60 pack‐years) and age of initiation (RR = 0.96 for a delay of 10 years in smoking initiation)—were significantly associated with CRC incidence (all p‐values < 0.0001). The relationship between duration of smoking and rectal cancer incidence was also significant. Among the subset of studies that distinguished cancer by site, a higher risk was seen for rectal cancer than for colon cancer for all analyses. Among prospective studies, a consistent association exists between smoking and CRC. The association is stronger for rectal cancer than for colon cancer in the subset of studies that differentiated cancer by site. © 2008 Wiley‐Liss, Inc.     

Burden of disease from breast cancer attributable to smoking and second-hand smoke exposure in Europe

Smoking and second-hand smoke (SHS) exposure have been recently linked to a higher risk of breast cancer in women. The aim of this work is to estimate the number of deaths and disability-adjusted life years (DALYs) from breast cancer attributable to these two risk factors in the European Union (EU-28) in 2017. The comparative risk assessment method was used. Data on prevalence of smoking and SHS exposure were extracted from the Eurobarometer surveys, relative risks from a recent meta-analysis, and data on mortality and DALYs from breast cancer were estimated from the Global Burden of Disease, Injuries and Risk Factors Study. In 2017, 82 239 DALYs and 3354 deaths from breast cancer in the EU-28 could have been avoided by removing exposure to these two risk factors (smoking and SHS exposure). The proportion of DALYs from breast cancer lost respectively from smoking and SHS exposure was 2.6% and 1.0%, although geographically distributed with significant heterogeneity. These results represent the first estimates of breast cancer burden in women attributable to smoking and SHS exposure for the EU-28. It is important to increase awareness among women, health professionals and wider society of the association between smoking, SHS exposure and breast cancer, a relationship that is not widely recognised or discussed.     

伴有慢性基础病的老年低位直肠癌患者围手术期处理

目的：探讨合并心血管病老年低位直肠癌患者的围手术期处理。方法：回顾性分析2003年7月至2008年3月间在兰州军区兰州总医院普外科手术的107例合并心血管病的老年低位直肠癌患者临床资料。结果：术后合并并发症者86例：重度血压升高3例,充血性心力衰竭1例,心绞痛1例,各类心律失常57例。切121裂开1例,吻合121瘘6例,吻合口出血4例,肺部感染6例,应激性溃疡3例,肾功能不全2例,泌尿系感染2例。围手术期死亡0例。结论：术前合并心血管疾病增加了手术风险,加强围手术期的处理可提高手术的安全性,降低手术死亡率和并发症发生率。     

Active cigarette smoking and risk of breast cancer

Although epidemiological evidence on the role of active cigarette smoking in breast cancer risk has been inconsistent, recent literature supports a modest association between smoking and breast cancer. This association is particularly observed in women who smoke for a long duration, or who smoke for a long time prior to their first pregnancy. Here, we provide updated results on cigarette smoking and breast cancer risk in the Canadian National Breast Screening Study (NBSS). The NBSS is a large cohort of 89,835 women, aged 40–59, who were followed for a mean of 22.1 years, resulting in the ascertainment of 6,549 incident cases of breast cancer. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of cigarette smoking variables with breast cancer risk. We found breast cancer to be associated with duration (40 years vs. 0: HR = 1.57; 95%CI = 1.29–1.92), intensity (40 cigarettes per day vs. 0: HR = 1.21; 95%CI = 1.04–1.40), cumulative exposure (40 pack‐years vs. 0: HR = 1.19; 95%CI = 1.06–1.13) and latency (40 years since initiation vs. 0: HR = 1.19; 95%CI = 1.10–1.53) of cigarette smoking. Number of years smoked prior to first full‐term pregnancy was associated with higher risk of breast cancer than comparative years smoked post‐pregnancy (among parous women, 5 years pre pregnancy vs. 0: HR = 1.18; 95%CI = 1.10–1.26). These results strongly support a role for cigarette smoking in breast cancer etiology and emphasize the importance of timing of this exposure.     

Associations of daily walking and television viewing time with liver cancer mortality: findings from the Japan Collaborative Cohort Study

Background and purpose

Several studies have suggested that daily vigorous physical activity reduces the risk of liver cancer, whereas sedentary behavior increases the risk of several cancers. However, the link between liver cancer and low-intensity physical activity (walking) and sedentary behavior is unclear. Therefore, we explored the links between liver cancer mortality and daily walking time/television (TV) viewing time in Japanese adults aged 40–79 years in a large-scale nationwide cohort study.

Methods

We excluded participants with a history of liver disease, cancer, stroke, or myocardial infarction at baseline (1988–1990) and those who died within the first 5 years of follow-up. A total of 69,752 adults (28,642 men and 41,110 women) were enrolled and followed for a median of 19.4 years. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95 % confidence intervals (CI) for liver cancer mortality adjusted for age, sex, and other possible confounding factors.

Results

During the study period, 267 participants died of liver cancer. The HRs of participants who walked for >0.5 h/day and watched TV for 2–4 versus <2 h/day were 0.58 (95 % CI 0.39–0.89) and 0.58 (95 % CI 0.35–0.98), respectively, compared with those who walked for <0.5 h/day and watched TV for >4 h/day.

Conclusions

Our findings suggest that longer walking times and shorter TV viewing times may reduce the risk of liver cancer.     

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。     

Differential effects of smoking on lung cancer mortality before and after household stove improvement in Xuanwei,China

Background:

In Xuanwei County, Yunnan Province, China, lung cancer mortality rates in both males and females are among the highest in China.

Methods:

We evaluated differential effects of smoking on lung cancer mortality before and after household stove improvement with chimney to reduce exposure to smoky coal emissions in the unique cohort in Xuanwei, China. Effects of independent variables on lung cancer mortality were measured as hazard ratios and 95% confidence intervals using a multivariable Cox regression model that included separate time-dependent variables for smoking duration (years) before and after stove improvement.

Results and conclusion:

We found that the effect of smoking on lung cancer risk becomes considerably stronger after chimney installation and consequent reduction of indoor coal smoke exposure.     

Impact of smoking on patients with stage III colon cancer

BACKGROUND:

Cigarette smoking has been shown to increase the risk of developing colorectal cancer, particularly smoking early in life. Little is known about the impact of tobacco use on colon cancer recurrence among colon cancer survivors.

METHODS:

The authors prospectively collected lifetime smoking history from stage III colon cancer patients enrolled in a phase 3 trial via self‐report questionnaires during and 6 months after completion of adjuvant chemotherapy. Smoking status was defined as never, current, or past. Lifetime pack‐years were defined as number of lifetime packs of cigarettes. Patients were followed for recurrence or death.

RESULTS:

Data on smoking history were captured on 1045 patients with stage III colon cancer receiving adjuvant therapy (46% never smokers; 44% past; 10% current). The adjusted hazard ratio (HR) for disease‐free survival (DFS) was 0.99 (95% confidence interval [CI], 0.70‐1.41), 1.17 (95% CI 0.89‐1.55), and 1.22 (95% CI 0.92‐1.61) for lifetime pack‐years 0‐10, 10‐20, and 20+, respectively, compared with never smoking (P = .16). In a preplanned exploratory analysis of smoking intensity early in life, the adjusted HR for 12+ pack‐years before age 30 years for DFS was 1.37 (95% CI, 1.02‐1.84) compared with never smoking (P = .04). The adjusted HR for DFS was 1.18 (95% CI, 0.92‐1.50) for past smokers and 1.10 (95% CI, 0.73‐1.64) for current smokers, compared with never smokers.

CONCLUSIONS:

Total tobacco usage early in life may be an important, independent prognostic factor of cancer recurrences and mortality in patients with stage III colon cancer. Cancer 2010. © 2010 American Cancer Society.     

Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease

Few population-based case-control studies have assessed etiologic factors for penile cancer. Past infection with high-risk human papillomavirus (HPV) is a known risk factor for penile cancer; however, few previous studies have related the HPV DNA status of the tumor to potential demographic and behavioral risk factors for the disease or evaluated whether in situ and invasive penile cancer share risk factors. Little information is available on the role and timing of circumcision in the etiology of penile cancer. We conducted a population-based case-control study in western Washington state that included 137 men diagnosed with in situ (n = 75) or invasive (n = 62) penile cancer between January 1, 1979, and December 31, 1998, and 671 control men identified through random digit dialing. Cases and controls were interviewed in person and provided peripheral blood samples. Case and control blood samples were tested for antibodies to HPV16 and HSV-2, and tumor specimens from cases were tested for HPV DNA. Men not circumcised during childhood were at increased risk of invasive (OR = 2.3, 95% CI 1.3-4.1) but not in situ (OR = 1.1, 95% CI 0.6-1.8) penile cancer. Approximately 35% of men with penile cancer who had not been circumcised in childhood reported a history of phimosis compared to 7.6% of controls (OR = 7.4, 95% CI 3.7-15.0). Penile conditions such as tear, rash and injury were associated with increased risk of disease. Among men not circumcised in childhood, phimosis was strongly associated with development of invasive penile cancer (OR = 11.4, 95% CI 5.0-25.9). When we restricted our analysis to men who did not have phimosis, the risk of invasive penile cancer associated with not having been circumcised in childhood was not elevated (OR = 0.5, 95% CI 0.1-2.5). Cigarette smoking was associated with a 4.5-fold risk (95% CI 2.0-10.1) of invasive penile cancer. HPV DNA was detected in 79.8% of tumor specimens, and 69.1% of tumors were HPV16-positive. The proportion of HPV DNA-positive tumors did not vary by any risk factors evaluated. Many risk factors were common for both in situ and invasive disease. However, 3 factors that did not increase the risk for in situ cancer proved significant risk factors for invasive penile cancer: lack of circumcision during childhood, phimosis and cigarette smoking. The high percentage of HPV DNA-positive tumors in our study is consistent with a strong association between HPV infection and the development of penile cancer regardless of circumcision status. Circumcision in early childhood may help prevent penile cancer by eliminating phimosis, a significant risk factor for the disease.