Effect of cigarette smoking on major histological types of lung cancer in men
Introduction
Lung cancer is the most common malignancy in the United States and is the leading cause of cancer deaths in males in the United States and world-wide [1]. The association between smoking and lung cancer is studied extensively and is well established. Almost 87–90% of lung cancer cases are attributable to cigarette smoking and smokers are 22 times more likely to die from lung cancer than non-smokers [2].
Although it is certain that tobacco smoking increases the risk of lung cancer, the aspects of smoking that determine the development of specific type of lung cancer have not been well understood. Tobacco smoking is associated with almost all the different histological types of lung cancer [3]; however, the strength of the association varies with the type of lung cancer. Most studies suggest that the strength of association between smoking and squamous cell carcinoma or small cell carcinoma is stronger than between smoking and adenocarcinoma. However, there is no consensus about the relative risk by histological type for duration of smoking or the amount smoked. Moreover, the effect of quitting smoking on the risk of the three major histological types of lung cancer is not clearly understood. Smoking at an early age is associated with increased risk of lung cancer 4, 5. However, little is known about the significance of age at the start of smoking for different histological types. In this analysis, we evaluated the relationships of age at the start of smoking, quantity smoked, and duration of smoking with various histological types of lung cancer.
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Subjects and methods
The cases for this study included men with a newly diagnosed and histologically confirmed lung cancer admitted to one of the 15 hospitals in Philadelphia between 1985 and 1987. Trained medical staff working under the direction of one of the co-authors (Hari H. Dayal) were assigned to visit the hospitals once a week to review pathology logs in order to identify newly diagnosed male lung cancer cases. Since, by design, the study was restricted to cases from Philadelphia, cases identified from
Results
There were a total of 482 cases (342 Whites, 140 Blacks) and 1094 matched controls. The mean age of the cases was 65.7 years (range, 36–89 years) and did not vary markedly by histological type. The mean age of the control subject was 64.9 years (range, 36–88 years). Table 1 shows the distribution of cases and control subjects by demographic variables. Cases of adenocarcinoma were slightly younger than cases of other types of lung cancer. There were no significant differences between cases and
Discussion
This study examined the influence of various smoking parameters on the risk of different histological types of lung cancers. All smoking-related variables (age at the start of smoking, number of cigarettes smoked per day, duration of smoking, inhalation pattern, smoking filtered or non-filtered cigarettes) were significantly associated with the risk of lung cancer (all histologies combined). These findings are generally in agreement with other case-control studies 4, 5, 10, 11, 12, 13, 14, 15.
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- 1
Formerly at Fox Chase Cancer Centre, Philadelphia.