Risk of bladder cancer by source and type of tobacco exposure: a case-control study

The association between tobacco use and risk of bladder cancer was investigated in a population-based case-control study conducted in Alberta and south-central Ontario, Canada, between 1979 and 1982. In all, 826 histologically-confirmed cancer cases and 792 randomly selected controls, individually matched to cases for age, sex, and area of residence, were recruited into the study. Compared to those who had never smoked cigarettes, males and females who had ever smoked cigarettes had a statistically highly significant 2-fold increase in risk of bladder cancer; for ex-smokers, the risk was intermediate between that for current smokers and never-smokers. There was a dose-dependent increase in risk of bladder cancer with total lifetime cigarette consumption, of similar magnitude for males and females. In males, risk increased with self-reported degree of inhalation in ex-smokers and in current smokers (statistically significant trend), while in females there was no association in current smokers, and a statistically significant inverse association in ex-smokers. Overall, risks of bladder cancer associated with lifetime consumption of plain and filter cigarettes were similar, and there was little evidence to suggest that switching from plain to filter cigarettes was beneficial. Neither passive smoking nor other forms of tobacco consumption (pipes, cigars, chewing tobacco, or snuff) were associated with altered risk of bladder cancer. The population attributable risk for cigarette smoking was about 47% in males and about 33% in females.     

Fluid intake and bladder cancer in Utah

A population-based, incident case-control study was conducted in Utah to assess the relationship between fluid intake and bladder cancer. Cancer cases (n = 419) were identified through the Utah Cancer Registry, and controls (n = 889) were obtained through random digit dialing and the Health Care Financing Administration. After adjustment for cigarette smoking, age, sex, history of diabetes, and history of bladder infections using multiple logistic regression analysis, total fluid intake was not found to be related to bladder cancer development. Specific fluids related to bladder cancer risk were milk intake (OR = 0.64) and caffeinated coffee intake (OR = 1.60). A linear trend for a dose-response protective effect was observed for milk, while coffee increased risk only when 40 or more cups were consumed per week. Alcohol increased risk only when consumed at high levels (over 3.64 ounces or 103 g per week) by people who never smoked cigarettes (OR = 2.37). Likewise, tea consumption in non-cigarette smokers increased bladder cancer risk (OR = 2.25). Results from this study suggest that types of fluids consumed may play a role in the development of bladder cancer. Furthermore, it is hypothesized that the dietary components of these beverages may be related to the development of bladder cancer.     

Coffee, green tea, and caffeine consumption and subsequent risk of bladder cancer in relation to smoking status: a prospective study in Japan

Coffee and caffeine consumption are thought to increase the risk of bladder cancer. However, few studies have stratified this risk by smoking status, which is a potential confounder. Here, we investigated the association between coffee, green tea (another major source of caffeine), and caffeine, and bladder cancer incidence in relation to smoking status. We conducted a population-based prospective study in a cohort of Japanese, comprising a total of 49 566 men and 54 874 women aged 40–69 years who reported their coffee and green tea consumption at baseline. During follow-up from 1990 through 2005, 164 men and 42 women were newly diagnosed with bladder cancer. Cigarette smoking was associated with an increased risk of bladder cancer, with a strong dose–response relationship. Coffee was positively associated with bladder cancer risk in men, without statistical significance. When stratified by smoking status, coffee and caffeine consumption were associated with an increased risk of bladder cancer in never- or former-smoking men, with hazard ratios (95% confidence interval) in the highest categories of coffee (one or more cups per day) and caffeine consumption compared with the lowest of 2.24 (95% CI = 1.21–4.16) and 2.05 (95% CI = 1.15–3.66), respectively. In conclusion, cigarette smoking was confirmed as a risk factor for bladder cancer. Coffee and caffeine may be associated with an increased bladder cancer risk in never or former smokers among Japanese men. ( Cancer Sci 2009; 100: 284–291)     

Risk of pancreatic cancer in relation to medical history and the use of tobacco, alcohol and coffee

A population-based case-control study was conducted to examine the relationship between certain medical conditions, the use of tobacco, alcohol and coffee, and the incidence of pancreatic cancer. Cases (N = 148) were married men ages 20 through 74 years diagnosed with pancreatic cancer from July 1982 through June 1986. Controls (N = 188) were identified by random digit dialing. Wives, responding as surrogates for both cases and controls, were interviewed by telephone and completed, alone, a food frequency questionnaire. The risk of pancreatic cancer was increased in individuals with a history of diabetes or pancreatitis, and decreased in those with a history of tonsillectomy. Individuals who had ever smoked cigarettes were at elevated risk of disease. This excess risk was confined to current smokers, in whom the odds ratio was 3.2 (95% CI 1.8-5.7); the risk among former smokers resembled that in those who had never smoked. There was no excess risk of pancreatic cancer among those who had ever used other forms of tobacco, including pipe tobacco, cigars and chewing tobacco. After adjustment for demographic and dietary characteristics, there was no association between pancreatic cancer risk and the intake of coffee, beer, red wine, hard liquor or all alcohol combined; a slight reduction in risk was seen among those consuming white wine daily.     

Gender- and smoking-related bladder cancer risk

BACKGROUND: There is growing evidence that, when smoking habits are comparable, women incur a higher risk of lung cancer than men. Because smokers are also at risk for bladder cancer, we investigated possible sex differences in the susceptibility to bladder cancer among smokers. METHODS: A population-based, case--control study was conducted in Los Angeles, CA, involving 1514 case patients with bladder cancer and 1514 individually matched population control subjects. Information on tobacco use was collected through in-person interviews. Peripheral blood was collected from study participants to measure 3- and 4-aminobiphenyl (ABP)-hemoglobin adducts, a marker of arylamine exposure. Data were analyzed to determine whether the risk of bladder cancer differs between male and female smokers and whether female smokers exhibit higher levels of ABP-hemoglobin adducts than male smokers with comparable smoking habits. All statistical tests were two-sided. RESULTS: Cigarette smokers had a statistically significant 2.5-fold higher risk (95% confidence interval = 2.1 to 3.0) of bladder cancer than never smokers. Use of filtered versus nonfiltered cigarettes, low-tar versus higher tar cigarettes, or the pattern of inhalation did not modify the risk. The risk of bladder cancer in women who smoked was statistically significantly higher than that in men who smoked comparable numbers of cigarettes (P =.016 for sex-lifetime smoking interaction). Consistent with the sex difference in smoking-related bladder cancer risk, the slopes of the linear regression lines of the 3- and 4-ABP--hemoglobin adducts by cigarettes per day were statistically significantly steeper in women than in men (P values for sex differences <.001 and.006, respectively). CONCLUSION: The risk of bladder cancer may be higher in women than in men who smoked comparable amounts of cigarettes.     

The Copenhagen case-control study of bladder cancer. II. Effect of coffee and other beverages

During the years 1979-1981 a population-based case-control study of bladder cancer including papilloma was performed in greater Copenhagen. A total of 371 patients (280 males; 91 females), and a comparable age- and sex-stratified group of 771 controls (577 males; 194 females) remained for logistic regression analysis. Controls were selected at random from the general population of the study area. All persons were questioned about their drinking habits with respect to coffee, tea and other beverages, as well as their exposure to a number of known or suspected risk factors for bladder cancer. After adjustment for tobacco smoking, the relative risk of bladder cancer in relation to coffee drinking was not statistically significant among either men or women. A significant association was found between bladder cancer and tea drinking among men, but with no regular trend for increasing consumption. An association was found between risk of bladder cancer and both total daily liquid intake and non-cola soft drinks. This population-based case-control study provides no evidence of an isolated influence of coffee drinking or caffeine intake on bladder cancer risk.     

吸烟和环境烟草烟雾暴露与膀胱癌关系的病例对照研究

目的研究分析吸烟及环境烟草烟雾暴露与膀胱癌的关系。方法自1996年1月~1999年6月,上海市区开展了一项大规模的基于全人群的膀胱癌病例对照研究,共访问到608例膀胱癌病例和607例健康人群对照。使用非条件logistic回归分析,调整可能的混杂因素,估计吸烟及环境烟草烟雾暴露对膀胱癌发生的比数比和95%可信区间。结果男性吸烟者患膀胱癌的危险性是不吸烟者的1.67倍(95%CI1.23~2.27),且随着每天吸烟量、累积吸烟量、吸烟年限和吸烟深度的增加而增加,吸烟开始年龄越小危险性越大;戒烟后膀胱癌危险性有所降低。吸烟也显著增加女性膀胱癌的危险性,调整OR为4.19(95%CI1.65~10.65)。吸烟者的调整人群归因危险度男性、女性分别为32.04%和15.61%。未发现环境烟草暴露增加非吸烟者膀胱癌的危险性。结论进一步证实吸烟是膀胱癌发生的重要危险因素。环境烟草烟雾暴露是否增加膀胱癌危险性尚难定论。     

Dark tobacco and lung cancer in Cuba

A retrospective epidemiologic study of 826 cytologically and/or histologically confirmed lung cancer cases (219 females and 607 males), 979 hospital controls, and 539 neighborhood controls was undertaken in Havana, Cuba, to investigate whether the high lung cancer mortality rates in this country could be explained by the cigarette and cigar consumption habits, including the smoking of dark-tobacco cigarettes. Relative risk(s)(RR) of lung cancer among cigarette smokers were 7.3 in women and 14.1 in men and increased consistently with various measures of exposure to smoke. The findings suggested that duration of smoking, daily number of cigarettes consumed, and inhalation practices have independent effects. Most Cubans smoked dark tobacco. RR were higher for dark-tobacco users than for light-tobacco users (RR = 8.6 vs. 4.6 for women and 14.3 vs. 11.3 for men), but the differences were reduced after adjustment for amount smoked. Cigarette smoking was associated with all histologic types of lung cancer, although the risk for adenocarcinoma was lower than that for the other types. Men who smoked exclusively cigars had a fourfold risk of lung cancer. Mixed smokers (i.e., cigar and cigarette smoker) had a greater RR than cigarette-only smokers (15.0 vs. 14.1), which was perhaps related to the unusually deep and frequent inhalation of cigar smoke. The data support the hypothesis that smoking patterns account for the higher lung cancer mortality in Cuba than in other Latin American countries.     

Effect of different types of smoking and synergism with hepatitis C virus on risk of hepatocellular carcinoma in American men and women: case-control study

The International Agency for Research on Cancer has declared smoking to be a risk factor for hepatocellular carcinoma (HCC). However, passive exposure to cigarette smoke and use of noncigarette tobacco products on the risk of HCC has not been examined. Therefore, we evaluated the independent effects of different types of smoking exposure along with multiple risk factors for HCC and determined whether the magnitude of smoking was modified by other risk factors in men and women. We conducted a case-control study at The University of Texas M. D. Anderson Cancer Center where 319 HCC patients and 1,061 healthy control subjects were personally interviewed for several HCC risk factors. Multivariate logistic regression analysis was performed to estimate the adjusted odds ratio (AOR) and 95% confidence interval (CI) for each potential risk factor. Use of smokeless tobacco (chewing tobacco and snuff), cigars, pipes and passive smoking exposure were not related to HCC among noncigarette smokers. However, regular cigarette smoking was associated with HCC in men: AOR, 1.9 (95% CI, 1.1-3.1). Heavy alcohol consumption was associated with HCC in women: AOR, 7.7 (95% CI, 2.3-25.1). Cigarette smoking interacted synergistically with chronic infection of hepatitis C virus in men: AOR, 136.3 (95% CI, 43.2-429.6) and with heavy alcohol consumption in women: AOR, 13.7 (95% CI, 3.2-57.9). We conclude that sex differences were observed in HCC relationship with cigarette smoking and alcohol consumption. Controlling for smoking exposure might be a prudent approach to the prevention of HCC, especially in patients with chronic viral hepatitis infections.     

Smokeless and other noncigarette tobacco use and pancreatic cancer: a case-control study based on direct interviews.

Cigarette smoking is an important and well-established cause of pancreatic cancer. In contrast, little is known about the effects of smoking cigars, pipes, and use of smokeless tobacco on pancreatic cancer risk. The objective of the present study was to examine the association between noncigarette tobacco use (i.e., cigars, pipes, smokeless tobacco) and pancreatic cancer risk among nonsmokers of cigarettes. A population-based case-control study of pancreatic cancer was conducted during 1986-1989 among residents of Atlanta, Georgia, Detroit, Michigan, and 10 counties in New Jersey. Direct interviews were successfully completed with 526 newly diagnosed pancreatic cancer patients and 2153 controls ages 30-79 years. This analysis was restricted to lifelong nonsmokers of cigarettes and based on interviews with 154 cases newly diagnosed with carcinoma of the exocrine pancreas and 844 population controls who reported no history of cigarette smoking. We observed a consistent pattern of increased risk associated with cigar smoking, although these elevations were not statistically significant. Participants who smoked cigars regularly (i.e., at least one cigar/week for >/=6 months) experienced a 70% increased risk [95% confidence interval (CI): 0.9-3.3], and those who never used other form of tobacco had a 90% increased risk (95% CI: 0.8-4.3). Risk was elevated among those who smoked more than one cigar/day [odds ratio (OR) = 1.8; 95% CI: 0.8-4.2) and among those who smoked cigars > 20 years (OR = 1.9; 95% CI: 0.9-3.9). Trends in risk with increasing amount and duration smoked were consistent but not statistically significant (P = 0.17 and P = 0.16, respectively). Subjects who used smokeless tobacco regularly had a 40% increased risk of pancreatic cancer (95% CI: 0.5-3.6) compared with nonusers of tobacco. We observed a marginally significant increasing risk with increased use of smokeless tobacco (P = 0.04); participants who used >2.5 oz of smokeless tobacco a week had an OR of 3.5 (95% CI: 1.1-11). Long-term use of smokeless tobacco (i.e., >20 years) was also associated with a nonsignificant increased risk (OR = 1.5; 95% CI: 0.6-4.0). In contrast, pipe smokers experienced no increased risk (OR = 0.6; 95% CI: 0.1-2.8). Our results suggest that heavy use of smokeless tobacco, and to a lesser extent, cigar smoking may increase the risk of pancreatic cancer among nonsmokers of cigarettes.     

Bladder cancer risk and pipes, cigars, and smokeless tobacco

Interview data from 2982 patients with bladder cancer and 5782 controls selected from the general population were used to assess the effects of non-cigarette tobacco use on bladder cancer risk. Compared to men who had never smoked, those who had smoked pipes but not cigars or cigarettes had a relative risk estimated at 1.23 (95% confidence interval [CI] = 0.75-2.00). Those who smoked cigars but not pipes or cigarettes were estimated to have a relative risk of 1.33 (95% CI = 0.92-1.94). Little evidence of dose response was observed. The excess relative risk to pipe smokers was limited to those who inhaled deeply.     

Cigarette smoking and subtypes of bladder cancer

There is little information regarding associations between suspected bladder cancer risk factors and tumor subtypes at diagnosis. Some, but not all, studies have found that bladder cancer among smokers is often more invasive than it is among nonsmokers. This population-based case-control study was conducted in Los Angeles, California, involving 1,586 bladder cancer patients and their individually matched controls. Logistic regression was used to conduct separate analyses according to tumor subtypes defined by stage and grade. Cigarette smoking increased risk of both superficial and invasive bladder cancer, but the more advanced the stage, the stronger the effect. The odds ratios associated with regular smokers were 2.2 (95% confidence intervals, 1.8-2.8), 2.7 (2.1-3.6) and 3.7 (2.5-5.5) for low-grade superficial, high-grade superficial and invasive tumors respectively. This pattern was consistently observed regardless of the smoking exposure index under examination. Women had higher risk of invasive bladder cancer than men even they smoked comparable amount of cigarettes as men. There was no gender difference in the association between smoking and risk of low-grade superficial bladder cancer. The heterogeneous effect of cigarette smoking was attenuated among heavy users of NSAIDs. Our results indicate that cigarette smoking was more strongly associated with increased risk of invasive bladder cancer than with low-grade superficial bladder cancer.     

Associations between smoking, passive smoking, GSTM-1, NAT2, and rectal cancer.

Cigarette smoking has been identified as a risk factor for colon cancer, however, much less is known about the association between cigarette smoking and rectal cancer. The purpose of this article is to evaluate the associations between rectal cancer and active and passive cigarette smoking and other forms of tobacco use. We also evaluate how genetic variants of GSTM-1 and NAT2 alter these associations. A population-based case-control study of 952 incident rectal cancer cases and 1205 controls was conducted. Detailed tobacco use information was collected as part of an interviewer-administered questionnaire. DNA was extracted from blood to examine genetic variants of GSTM-1 and NAT2. Cigarette smoking was associated with an increased risk of rectal cancer in men [odds ratio (OR)=1.5, 95% confidence interval (CI), 1.1-2.1 for current smokers; OR=1.7, 95% CI, 1.3-2.3 for smoking >20 pack-years of cigarettes relative to never-smokers]. After adjusting for active smoking, exposure to cigarette smoke of others also was associated with increased risk among men (OR=1.5, 95% CI, 1.1-2.0). Neither GSTM-1 genotype nor NAT2-imputed phenotype was independently associated with rectal cancer. However, the risk associated with smoking cigarettes among those who were GSTM-1 null relative to those who never smoked and had the GSTM-1 present genotype was OR=2.0 (95% CI, 1.2-3.3). This interaction was of borderline significance (P=0.08). Men who had the combined GSTM-1 present genotype and who were rapid acetylators had no increased risk from cigarette smoking. There were no significant associations between cigarette smoking and rectal cancer among women. This study shows that men who smoke cigarettes, especially those who smoke >20 pack-years, are at increased risk of rectal cancer. This association may be influenced by GSTM-1 genotype. Furthermore, exposure to cigarette smoke of others may increase risk of rectal cancer among men who do not smoke.     

Risk factors for cancer of the tongue and the mouth. A case-control study from northern Italy.

BACKGROUND. The role of tobacco and alcohol consumption and the frequency of intake of a selected number of indicator foods as causes of cancer were investigated in a case-control study conducted in northern Italy. METHODS. One hundred two men with cancer of the tongue, 104 patients with cancer of the mouth, and 726 control subjects (the latter admitted to the hospital for acute nonneoplastic disease without respiratory illness) were interviewed. RESULTS. Similarly strong associations were observed with cigarette smoking (odds ratio [OR], 10.5 and 11.8 for current smokers versus never smokers in cancer of the tongue and mouth, respectively) and alcohol (OR, 3.4 and 3.0 for > or = 60 versus < or = 19 drinks/week). The risk conferred by pipe or cigar smoking, although based on only 12 smokers who did not smoke cigarettes, seemed, however, to be lower for cancer of the tongue (OR, 3.4) than cancer of the mouth (OR, 21.9). Selected indicator foods and beverages, including green vegetables, carrots, fresh fruits, whole-grain bread and pasta, coffee, and tea also affected the cancer risk similarly in the two sites. The beneficial influence of such foods and beverages seemed, however, to be more marked for cancer of the mouth than for cancer of the tongue. CONCLUSIONS. This study suggested that, although none of the differences in the effects between cancer sites was statistically significant, tobacco from pipes and cigars and the cleansing effect of some foods of plant origin and nonalcoholic beverages may influence the risk of cancer of the tongue less strongly than the risk of cancer of the mouth.     

Cigar, pipe, and cigarette smoking and bladder cancer risk in European men

Objective: Estimating the risk of bladder cancer from cigar and pipe smoking is complicated by a small number of non-cigarette smokers included in most relevant studies. Methods: We undertook a pooled analysis of the data on men from six published case–control studies from Denmark, France, Germany, and Spain, to assess the association between pipe and cigar smoking and bladder cancer, and to compare it with the risk from cigarette smoking. Complete history of tobacco smoking was ascertained separately for cigarettes, cigars, and pipe. Odds ratios (ORs) were estimated after adjusting for age, study, and employment in high-risk occupations. Results: The pooled data set comprised 2279 cases and 5268 controls, of whom 88 cases and 253 controls smoked only cigars or pipe. The OR for pure cigarette smoking was 3.5 (95% confidence interval [CI] 2.9–4.2), that for pure pipe smoking was 1.9 (95% CI 1.2–3.1) and that for pure cigar smoking was 2.3 (95% CI 1.6–3.5). The increase in the OR of bladder cancer that was observed with duration of smoking was non-significantly lower for cigars than for cigarettes. Conclusion: Our results suggest that smoking of cigars and pipe is carcinogenic to the urinary bladder, although the potency might be lower than for cigarettes.     

Increased risk of colorectal cancer among smokers: Results of a 26-year follow-up of us veterans and a review

To clarify the relationship between tobacco use and risk of colorectal cancer, we evaluated a cohort of 248,046 American veterans followed prospectively for 26 years. In comparison with veterans who had never used tobacco, the risk of death was significantly increased for colon cancer and rectal cancer among current and former cigarette smokers and among pipe or cigar smokers, controlling for social class and occupational physical activity. Rectal-cancer risk was also significantly elevated among users of chewing tobacco or snuff. For both sites, risk increased significantly with pack-years, earlier age at first use, and number of cigarettes. These results reinforce 2 recent reports of the association of cigarette smoking and colorectal cancer in men and women. Inconsistencies in the findings of earlier epidemiologic studies appear to be due in large part to differences in length of follow-up or in choice of controls. Studies with at least 20 years of follow-up or population-based controls have tended to find elevated risk with tobacco smoking, while those with shorter follow-up or hospital controls have not. This, plus the strength and consistency of the association of smoking and colon polyps, suggest that smoking may primarily affect an early stage in the development of colon cancer. If this association is causal, tobacco use may be responsible for 16% of colon-cancer and 22% of rectal-cancer deaths among these veterans.     

Alcohol consumption and risk of bladder cancer in Los Angeles County

The role of alcoholic beverages in bladder carcinogenesis is still unclear, with conflicting evidence from different studies. We investigated the relationship between alcohol consumption and bladder cancer, and the potential interaction between alcohol consumption and other exposures. In a population-based case-control study conducted in Los Angeles County, 1,586 pairs of cases and their matched neighborhood controls were interviewed. Data were analyzed to determine whether bladder cancer risk differs by alcohol consumption, and whether different alcoholic beverages have different effects. The risk of bladder cancer decreased with increasing frequency (p for trend = 0.003) and duration of alcohol consumption (p for trend = 0.017). Subjects who drank more than 4 drinks per day had a 32% lower (odds ratio, 0.68; 95% confidence interval, 0.52-0.90) risk of bladder cancer than those who never drank any alcoholic beverage. Beer (p for trend = 0.002) and wine (p for trend = 0.054) consumption were associated with reduced risk of bladder cancer, while hard liquor was not. The reduction in risk was mostly seen among shorter-term smokers who urinated frequently. Alcohol consumption was strongly associated with a reduced risk of bladder cancer. The effect was modified by the type of alcoholic beverage, cigarette smoking and frequency of urination.     

Bladder cancer in nonsmokers

Potential risk factors for bladder cancer were studied in a series of 76 male and 76 female bladder cancer cases and 238 male and 254 female controls who reported never having smoked. Risk factors included usual occupation, smoking by the spouse, sidestream smoke exposure at home and at work and in transportation, coffee drinking (caffeinated and decaffeinated), artificial sweetener use, body mass index, and a history of diabetes and high blood pressure. No association was found with spouse's smoking or reported sidestream smoke exposure, coffee drinking, artificial sweetener use, or a number of other variables; however, there was some indication that several occupations were overrepresented in the cases. A positive association was found with snuff use in women, but the numbers were small (three cases and one control). Restriction of the study to lifetime nonsmokers permitted the assessment of potential risk factors in the absence of potential confounding and interactive effects of smoking. The study had adequate statistical power to detect moderately small elevated risks due to the main factors examined.     

Risk of stomach cancer in relation to consumption of cigarettes, alcohol, tea and coffee in Warsaw, Poland.

To identify reasons for the high incidence rates of stomach cancer in Poland, we conducted a population-based case-control study in Warsaw. Cases were residents aged 21 to 79 years who were newly diagnosed with stomach cancer between March 1, 1994, and April 30, 1997. Controls were randomly selected from Warsaw residents registered at the nationwide Polish Electronic System of Residence Evidency, frequency-matched to cases by age and sex. Information on demographic characteristics; consumption of cigarettes, alcohol, tea and coffee; diet; medical history; family history of cancer; occupational history; and living conditions during adolescence was elicited by trained interviewers using a structured questionnaire. Included were 464 cases (90% of eligible) and 480 controls (87% of eligible). Among men, the risk of stomach cancer was significantly elevated among current smokers (OR = 1.7, 95% CI = 1.1-2.7) but not among former smokers. The excess risk was largely confined to long-term and heavy smokers, with significant 2-fold excess risk among men who smoked 40 or more pack-years. Among women, an 80% increase in risk was observed in both current and former smokers but dose-response trends were less consistent than among men. Alcohol consumption was not clearly related to risk, and no association was found for drinking regular coffee or herbal tea or using milk/cream in coffee or tea. A significant reduction in risk was linked to daily tea drinking among women, but not among men. Our findings confirm an association with cigarette smoking, which is estimated to account for approximately 20% of stomach cancers diagnosed among Warsaw residents during the study period.     

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.