Lung cancer death rates by smoking status: comparison of the Three-Prefecture Cohort study in Japan to the Cancer Prevention Study II in the USA

Cigarette smoking is an established risk factor for lung cancer. However, the magnitude of the relative risk (RR) on lung cancer mortality in relation to cigarette smoking is reported to be lower in Japan than in Western countries. We investigated whether this discrepancy could be explained by differences in the exposure to cigarettes smoked, by differences in sensitivity to smoking, or by differences in lung cancer mortality among non-smokers. We examined the 10-year follow-up data on 88,153 participants in a Japanese population-based prospective study conducted in three prefectures. Data used as a Western counterpart was retrieved from a published report of the US Cancer Prevention Study (CPS)-II. Although there was a significant increased risk of lung cancer death among current smokers compared with non-smokers, the observed RR in the Three-Prefecture Study were much lower than RR reported in the CPS-II. Lung cancer mortality of our Japanese sample was lower among current smokers and higher among non-smokers regardless of age and sex. Current smokers in our sample had initiated smoking at an older age and smoked fewer cigarettes per day for shorter durations than those in the CPS-II sample. The Poisson regression model (controlling for age, number of cigarettes smoked per day and duration of smoking) showed that male current smokers in our sample had a lower risk of lung cancer compared with those in the CPS-II sample (rate ratio 0.34 95%CI 0.27-0.43]). These findings might explain why Japanese risks of lung cancer are lower than those observed in Western countries.