Are Women Who Smoke at Higher Risk for Lung Cancer Than Men Who Smoke?
Are Women Who Smoke at Higher Risk for Lung Cancer Than Men Who Smoke?
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DOI：
10.1093/aje/kws445
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发表时间：
2013-04-01
影响因子：
5
通讯作者：
Landi, Maria Teresa
中科院分区：
文献类型：
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作者：
De Matteis, Sara;Consonni, Dario;Landi, Maria Teresa
全球男性肺癌发病率正在下降或趋于平稳，但女性肺癌发病率却在上升。人们已经假设烟草致癌物与肺癌风险之间存在性别差异，但流行病学证据相互矛盾。我们在一项基于人群的病例对照研究——肺癌病因学环境与遗传学 (EAGLE) 研究（意大利伦巴第，2002-2005 年）中测试了性吸烟相互作用与肺癌风险的关系。通过个人访谈收集了 2,100 名肺癌病例和 2,120 名对照者的详细终生吸烟史。通过逻辑回归估计吸烟包年的比值比和 95% 置信区间，并根据年龄、居住地区和戒烟后的时间进行调整。为了评估性吸烟相互作用，我们在男性和女性组合模型中比较了包年对数的优势比斜率。总体而言，男性吸烟年数的斜率更陡（女性与吸烟互动的优势比 = 0.39，95% 置信区间：0.24、0.62；P < 0.0001）；对曾经吸烟者进行限制后，斜率差异要小得多（交互优势比 = 0.63，95% 置信区间：0.29、1.37；P = 0.24）。通过组织学类型也发现了类似的结果。当评估其他混杂因素（例如烟草类型、吸入深度、Fagerstrom 评估的尼古丁依赖性）时，结果没有变化。这些发现并不支持女性对烟草相关肺癌的易感性较高。
Worldwide lung cancer incidence is decreasing or leveling off among men, but rising among women. Sex differences in associations of tobacco carcinogens with lung cancer risk have been hypothesized, but the epidemiologic evidence is conflicting. We tested sex-smoking interaction in association with lung cancer risk within a population-based case-control study, the Environment and Genetics in Lung Cancer Etiology (EAGLE) Study (Lombardy, Italy, 2002-2005). Detailed lifetime smoking histories were collected by personal interview in 2,100 cases with incident lung cancer and 2,120 controls. Odds ratios and 95% confidence intervals for pack-years of cigarette smoking were estimated by logistic regression, adjusted for age, residence area, and time since quitting smoking. To assess sex-smoking interaction, we compared the slopes of odds ratios for logarithm of pack-years in a model for men and women combined. Overall, the slope for pack-years was steeper in men (odds ratio for female-smoking interaction = 0.39, 95% confidence interval: 0.24, 0.62; P < 0.0001); after restriction to ever smokers, the difference in slopes was much smaller (odds ratio for interaction = 0.63, 95% confidence interval: 0.29, 1.37; P = 0.24). Similar results were found by histological type. Results were unchanged when additional confounders were evaluated (e.g., tobacco type, inhalation depth, Fagerstrom-assessed nicotine dependence). These findings do not support a higher female susceptibility to tobacco-related lung cancer.