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Comparison of aspects of smoking among the four histological types of lung cancer
  1. S A Kenfield1,2,
  2. E K Wei2,
  3. M J Stampfer1,2,
  4. B A Rosner2,3,
  5. G A Colditz4
  1. 1
    Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2
    Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  3. 3
    Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
  4. 4
    Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
  1. S A Kenfield, Channing Laboratory, 181 Longwood Ave, Fourth Floor, Boston, MA 02115, USA; skenfiel{at}


Background: The magnitude of the link between cigarette smoking and lung cancer may vary by histological type.

Methods: We used polytomous logistic regression to evaluate whether aspects of smoking have different effects across four histological types in the Nurses’ Health Study.

Results: From 1976 to 2002, we identified 1062 cases of lung cancer: squamous cell (n  201), small cell (n  236), adenocarcinoma (n  543) and large cell carcinoma (n  82), among 65 560 current or former smokers. Risk reduction after quitting ranged from an 8 reduction (relative risk (RR): 0.92, 95 CI 0.91 to 0.94) to a 17 reduction (RR: 0.83, 95 CI 0.80 to 0.86) per year for adenocarcinoma and small cell carcinoma, respectively, with a 9 reduction observed for large cell carcinoma and an 11 reduction observed for squamous cell carcinoma. The association of age at smoking initiation and former cigarette smoking was similar across types, while the association of smoking duration differed. The risk of adenocarcinoma increased by 6 per year of smoking, compared to 7 for large cell, 10 for squamous cell and 12 for small cell. The 6 difference between adenocarcinoma and small cell carcinoma is equivalent to a 3.2 to 9.7-fold increase in risk for 20 years of smoking.

Conclusions: The effects of the number of cigarettes smoked per day and years since quitting smoking are different across the major types of lung cancer, which are fully appreciated at long durations of smoking and smoking cessation. Smoking prevention and cessation should continue to be the focus of public health efforts to reduce lung cancer incidence and mortality.

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  • Funding: The research for this article was funded by grants CA87969 and T32CA09001 from the National Institutes of Health, the Association of Schools of Public Health, and the Legacy Foundation. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute of the National Institutes of Health, the Association of Schools of Public Health, the Legacy Foundation, the Legacy Foundation staff or its Board of Directors.

  • Competing interests: None.

  • Ethics approval: The Partners Human Research Committee in Boston, Massachusetts approved this study.