Chest

Chest

Volume 120, Issue 5, November 2001, Pages 1577-1583
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Clinical Investigations
LUNG CANCER
Effect of Smoking Cessation on Major Histologic Types of Lung Cancer

https://doi.org/10.1378/chest.120.5.1577Get rights and content

Study objectives

It is well-recognized that the risk of lung cancer declines after smoking cessation. However, the degree of decline in different histologic types of lung cancer is not well understood. We conducted a meta-analysis of peer-reviewed studies to assess the effect of smoking cessation on rates of major histologic types of lung cancer.

Design

Studies published in English between 1970 and 1999 were identified through searches of computerized databases (ie, MEDLINE and CANCERLIT). Combined estimates of relative risk and 95% confidence intervals were calculated for 27 studies using fixed and random effects models. Separate analyses were conducted for men and women.

Results

Smoking cessation was associated with a reduction in the risk of all the major histologic types of lung cancer. The highest reduction was in small cell lung carcinoma (SCLC) and squamous cell carcinoma (SQC), and the lowest reduction was seen in large cell cancer and adenocarcinoma. In women, the combined risks for SQC and SCLC were higher than those in men. The dose-response curve for intensity of smoking was steeper in women.

Conclusion

The findings of this study suggest that smoking cessation results in the greatest reductions for SCLC and SQC. This effect is most marked in heavy smokers, particularly among women.

Section snippets

Materials and Methods

The MEDLINE and CANCERLIT databases were searched using key words pertaining to smoking and to histologic type of lung cancer. In addition, the reference lists of identified studies as well as review articles were examined to identify additional studies. This search strategy identified over 600 articles on smoking and lung cancer. Only studies pertaining to lung histology and published in English were reviewed. We excluded case series studies from further review. The search was repeated until

Results

Forty-eight studies evaluating the association between smoking and major histologic types of lung cancer were reviewed. These studies were published between 1970 and 1999. Fifteen studies111213141516171819202122232425 were excluded because insufficient information was provided on the OR or the SE. Four studies26272829 were excluded because the histologic types were identified only as “Kreyberg I” and“ Kreyberg II.” One study30 presented a combined analysis of case-control studies in China and

Discussion

The findings of this study suggest that the risk of lung cancer decreases significantly after the cessation of smoking and for all histologic types of the disease. The magnitude of reduction varies among the histologic types of lung cancer. The cessation of smoking showed the greatest reduction in the risk of SQC or SCLC. The OR decreases progressively as the number of years of abstinence from smoking increases, and this is true for all histologic types. The risk reduction was most noticeable

References (64)

  • United States Surgeon General

    Reducing the health consequences of smoking: 25 years of progress

    (1989)
  • US Department of Health and Human Services

    The health benefit of smoking cessation: a report of the Surgeon General

    (1990)
  • JK Ockene et al.

    The relationship of smoking cessation to coronary heart disease and lung cancer in the multiple risk factor intervention trial (MRFIT)

    Am J Public Health

    (1990)
  • WG Cochran

    The combination of estimates from different experiments

    Biometrics

    (1954)
  • R DerSimonian et al.

    Meta-analysis in clinical trials

    Control Clin Trials

    (1987)
  • RL Tweedie et al.

    Meta-analytic approaches to dose-response relationship, with application in studies of lung cancer and exposure to environmental tobacco smoke

    Stat Med

    (1995)
  • CB Begg et al.

    Operating characteristics of a rank correlation test for publication bias

    Biometrics

    (1994)
  • M Kreuzer et al.

    Histologic types of lung carcinoma and age at onset

    Cancer

    (1999)
  • KT Hegmann et al.

    The effect of age at smoking initiation on lung cancer risk

    Epidemiology

    (1993)
  • S Tsugane et al.

    Smoking, occupation and family history in lung cancer patients under fifty years of age

    Jpn J Clin Oncol

    (1987)
  • O Auerbach et al.

    Changes in bronchial epithelium in relation to cigarette smoking, 1955–1960 vs 1970–1977

    N Engl J Med

    (1979)
  • WK Lam et al.

    Clinical features of bronchogenic carcinoma in Hong Kong: review of 480 patients

    Cancer

    (1983)
  • H Shimizu et al.

    Epidemiological characteristics of adenocarcinoma of the lung in Los Angeles County

    Natl Cancer Inst Monogr

    (1982)
  • A Kennedy

    Relationship between cigarette smoking and histological type of lung cancer in women

    Thorax

    (1973)
  • W Weiss et al.

    Risk of lung cancer according to histologic type and cigarette dosage

    JAMA

    (1972)
  • OJ Joly et al.

    Dark tobacco and lung cancer in Cuba

    J Natl Cancer Inst

    (1983)
  • R Doll et al.

    Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers

    J Epidemiol Commun Health

    (1978)
  • R MacLennan et al.

    Risk factors for lung cancer in Singapore Chinese: a population with high female incidence rates

    Int J Cancer

    (1977)
  • RG Vincent et al.

    The changing histopathology of lung cancer: a review of 1682 cases

    Cancer

    (1977)
  • WC Chan et al.

    Bronchial cancer in Hong Kong 1976–1977

    Br J Cancer

    (1979)
  • KE Osann

    Lung cancer in women: the importance of smoking, family history of cancer, and medical history of respiratory disease

    Cancer Res

    (1991)
  • S Benhamou et al.

    Lung cancer and use of cigarettes: a French case-control study

    J Natl Cancer Inst

    (1985)

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    Copyright © 2001 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.