Cigarette smoking and changes in the histopathology of lung cancer
Cigarette smoking and changes in the histopathology of lung cancer
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DOI：
10.1093/jnci/89.21.1580
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发表时间：
1997-11-05
影响因子：
10.3
通讯作者：
Heath, CW
中科院分区：
文献类型：
--
作者：
Thun, MJ;Lally, CA;Heath, CW
背景：肺腺癌，曾经被认为与吸烟关系最小，已经成为美国最常见的肺癌类型，这种癌症发病率的增加可能是由于诊断技术的进步(即，在更小、更远的呼吸道内对肿瘤进行活检的能力增强)、香烟设计的变化(例如，采用滤嘴)或吸烟习惯的变化，我们检查了康涅狄格州肿瘤登记处的数据和美国癌症协会的两项研究，以探索这些可能性。方法：分析康涅狄格州肿瘤登记处1959-1991年的数据，以确定在此期间观察到的肺腺癌增加是用出生队列效应(即吸烟的世代变化)还是日历周期效应(即诊断进展)来最好地描述，还检查了在癌症预防研究I(CPS-I)和癌症预防研究II(CPS-II)的头两年中吸烟与特定类型肺癌死亡之间的关系。结果：从1959年到1991年，康涅狄格州女性腺癌发病率增加了近17倍，男性腺癌发病率增加了近10倍，这种增长遵循了明显的出生队列模式，与吸烟的性别和代际变化平行，而不是诊断的进步。与CPS-I相比，吸烟与肺腺癌死亡的相关性变得更强。CPS-II中男性和女性的相对危险度分别为19.0(95%可信区间=8.3~47.7)和8.1(95%CI=4.5~14.6)，而CPS-I中男性和女性的相对危险度分别为4.6(95%CI 1.7~12.6)和1.5(0.3~7.7)。结论：20世纪50年代以来肺腺癌的增加更符合吸烟行为和香烟设计的变化，而不是诊断的进步。
Background: Adenocarcinoma of the lung, once considered minimally related to cigarette smoking, has become the most common type of lung cancer in the United States, The increased incidence of this cancer might be explained by advances in diagnostic technology (i.e., increased ability to perform biopsies on tumors in smaller, more distal airways), changes in cigarette design (e.g., the adoption of filtertips), or changes in smoking practices, We examined data from the Connecticut Tumor Registry and two American Cancer Society studies to explore these possibilities, Methods: Connecticut Tumor Registry data from 1959 through 1991 were analyzed to determine whether the increase in lung adenocarcinoma observed during that period could be best described by birth cohort effects (i.e., generational changes in cigarette smoking) or calendar period effects (i.e., diagnostic advances), Associations between cigarette smoking and death from specific types of lung cancer during the first 2 years of follow-up in Cancer Prevention Study I (CPS-I), initiated in 1959) and Cancer Prevention Study II (CPS-II, initiated in 1982) were also examined, Results: Adenocarcinoma incidence in Connecticut increased nearly 17-fold in women and nearly 10-fold in men from 1959 through 1991, The increases followed a clear birth cohort pattern, paralleling gender and generational changes in smoking more than diagnostic advances, Cigarette smoking became more strongly associated with death from lung adenocarcinoma in CPS-II compared with CPS-I, with relative risks of 19.0 (95% confidence interval [CI] = 8.3-47.7) for men and 8.1 (95% CI = 4.5-14.6) for women in CPS-II and 4.6 (95% CI 1.7-12.6) for men and 1.5 (0.3-7.7) for women in CPS-I, Conclusions: The increase in lung adenocarcinoma since the 1950s is more consistent with changes in smoking behavior and cigarette design than with diagnostic advances.