Smoking and lung cancer: some unresolved issues.
Smoking and lung cancer: some unresolved issues.
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DOI：
10.1093/oxfordjournals.epirev.a036258
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发表时间：
1983
影响因子：
5.5
通讯作者：
E. Wynder;M. Goodman
中科院分区：
文献类型：
--
作者：
E. Wynder;M. Goodman
心理证据是以科赫假设的方式提出的，即一致性、强度、特异性、时间关系和关联的连贯性。烟草使用与几种类型的癌症、心血管疾病和肺气肿的关联清楚地证明了这些原则。例如，一项在英国医生中进行的关于戒烟的前瞻性研究(28)表明，吸烟时间和吸烟量直接影响肺癌风险。虽然肺癌的发病机制没有传染病的病因机制那么清楚，但疾病的衰落与疑似病原体的清除蕴含着因果关系。在肺癌的研究中，当其他已知的病因和混杂因素被控制时，因果关系的概念得到了额外的支持。吸烟在心肌梗塞和肺气肿的发病和进展中的作用与吸烟在肺癌中的作用明显不同。尽管关联的特殊性强化了因果假设，但它不被认为是必要的标准(1)。为了支持烟草烟雾的多因素影响，已有研究表明，随着戒烟，心肌梗死的风险下降得更快；这尤其适用于猝死的风险(29)。相比之下，对于吸烟至少20年的人来说，戒烟在大约三年内不会改变患肺癌的风险，然后在10-15年后逐渐下降，接近不吸烟者的风险(图1)(28，30)。下降的速度取决于吸烟量和吸烟期的历史。记录与戒烟相关的风险降低的滞后期是由于纳入了最近因吸烟相关疾病而不得不戒烟的前吸烟者(13，30)。
mental evidence are proposed in the manner of Koch's postulates, that is, consistency, strength, specificity, temporal relationship, and coherence of the association. These principles are clearly exemplified by the association of tobacco use with several types of cancer, cardiovascular disease, and emphysema. For example, a prospective study of smoking cessation among British physicians (28) demonstrated that lung cancer risk was affected directly by duration and amount of smoking. Although the etiologic mechanism of the pathogenesis of lung cancer is not as well defined as that of infectious diseases, decline of a disease with removal of the suspected agent implies causality. When other known etiologic and confounding factors are controlled for in the investigation of lung cancer, the concept of causation receives added support. The role of smoking in the pathogenesis and progression of myocardial infarction and emphysema is obviously different from the role of smoking in lung cancer. Although the specificity of an association reinforces the causal hypothesis, it is not to be considered a necessary criterion (1). In support of the multifactorial effects of tobacco smoke, it has been shown that the risk for myocardial infarction declines far more rapidly with smoking cessation; this applies particularly to risk for sudden death (29). In contrast, for individuals who have smoked at least 20 years, cessation of cigarette smoking does not alter the risk for lung cancer for about three years, followed by a gradual decline approaching the risk of a nonsmoker after 10-15 years (figure 1)(28, 30). The speed of the decline depends on the history of amount and duration of smoking. The recording of a lag period for the reduction in risk associated with smoking cessation is brought about by the inclusion of recent ex-smokers who had to give up the habit because of a smoking-related disease (13, 30).Case-control studies of both men and