Cigarette smoking and cancer: Intensity patterns in the alpha-tocopherol, beta-carotene cancer prevention study in Finnish men
Cigarette smoking and cancer: Intensity patterns in the alpha-tocopherol, beta-carotene cancer prevention study in Finnish men
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DOI：
10.1093/aje/kwm392
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发表时间：
2008-04-15
影响因子：
5
通讯作者：
Albanes, Demetrius
中科院分区：
文献类型：
--
作者：
Lubin, Jay H.;Virtamo, Jarmo;Albanes, Demetrius
吸烟强度导致肺癌和膀胱癌的相对风险在每天吸烟超过 15-20 支时趋于稳定。以包年和强度为单位的三参数超额相对风险模型量化了这种水平（Lubin 等人，Am J Epidemiol 2007；166：479-89）。每天超过 15-20 支香烟是一种“反向暴露率”效应，即对于相同的包年数，每包年的超额相对风险随着强度的增加而降低；也就是说，长时间低强度吸烟比短时间高强度吸烟危害更大。在对包年进行调整后，在肺癌、膀胱癌、口腔癌、胰腺癌和食道癌的多项病例对照研究中，强度效应在数量上是同质的。作者将这些分析扩展到膀胱癌、食道癌、肾癌、喉癌、肝癌、肺癌、口咽癌和胰腺癌的发病强度模式，方法是使用芬兰的一个前瞻性队列（α-生育酚、β-胡萝卜素癌症预防研究）的数据，并从 1985 年至 1988 年至 2004 年 4 月的入组进行随访。在每天吸烟超过 10 支香烟的情况下，他们发现每个癌症部位的逆暴露率模式。经过包年调整后，不同癌症部位的强度效应在数量上是同质的，并且与之前多项研究分析的强度效应是同质的。强度模式的一致性表明了一种普遍现象，并可能为吸烟相关癌症风险的分子基础提供线索。
Relative risks for lung and bladder cancers by smoking intensity level off at more than 15-20 cigarettes per day. A three-parameter excess relative risk model in pack-years and intensity quantified this leveling (Lubin et al., Am J Epidemiol 2007;166:479-89). Above 15-20 cigarettes per day was an "inverse exposure rate" effect whereby, for equal pack-years, the excess relative risk/pack-year decreased with increasing intensity; that is, smoking at a lower intensity for a longer duration was more deleterious than smoking at a higher intensity for a shorter duration. After adjustment for pack-years, intensity effects were quantitatively homogeneous across multiple case-control studies of lung, bladder, oral cavity, pancreas, and esophagus cancers. The authors extended those analyses to examine intensity patterns for incident bladder, esophagus, kidney, larynx, liver, lung, oropharynx, and pancreas cancers by using data from a single prospective cohort in Finland, the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, with follow-up from enrollment, which occurred between 1985 and 1988, through April 2004. At more than 10 cigarettes per day, they found an inverse exposure rate pattern for each cancer site. After adjustment for pack-years, intensity effects were quantitatively homogeneous across the diverse cancer sites and homogeneous with intensity effects from the prior analysis of multiple studies. Consistency of intensity patterns suggested a general phenomenon and may provide clues to the molecular basis of smoking-related cancer risk.