PATTERNS OF ABSOLUTE RISK OF LUNG-CANCER MORTALITY IN FORMER SMOKERS
PATTERNS OF ABSOLUTE RISK OF LUNG-CANCER MORTALITY IN FORMER SMOKERS
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DOI：
10.1093/jnci/85.6.457
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发表时间：
1993-03-17
影响因子：
10.3
通讯作者：
WARNER, KE
中科院分区：
文献类型：
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作者：
HALPERN, MT;GILLESPIE, BW;WARNER, KE
背景：众所周知，与继续吸烟的人相比，戒烟后肺癌死亡率的相对危险度（RR）降低。然而，戒烟后肺癌死亡绝对风险的变化并没有很好的记录。此外，很少有研究调查戒烟年龄对随后肺癌死亡风险的影响。目的：本研究的目的是检查和比较戒烟者的绝对和相对肺癌死亡风险与戒烟年龄的关系。方法：利用美国癌症协会的癌症预防研究II，一项为期6年的前瞻性队列研究，我们模拟了从未吸烟、现在和曾经吸烟的个体肺癌死亡率的绝对风险。模型采用人-年logistic回归分析拟合。结果：按年龄划分的肺癌死亡的绝对风险模式相似，在60岁中期之前的所有戒烟年龄中都有发现。早期戒烟者的肺癌死亡风险较低，所有戒烟者的风险明显低于当前吸烟者。对于那些在30岁至49岁之间戒烟的人来说，肺癌死亡风险随着年龄的增长而逐渐上升，其速度略高于从不吸烟的人。在50岁到64岁之间戒烟的前吸烟者的肺癌死亡风险在戒烟时的风险附近趋于稳定，直到75岁左右才急剧上升。在75岁时，60岁出头戒烟者与当前吸烟者的相对危险度约为45%，50岁出头戒烟者的相对危险度约为20%，30岁出头戒烟者的相对危险度不到10%。对于那些从不吸烟的人来说，75岁时的RR小于5%。结论：就降低肺癌死亡率而言，戒烟在任何年龄都是有益的，年轻时戒烟的益处更大。与之前的研究不同，之前的研究主要是将戒烟的影响作为戒烟年限的函数，我们的研究结果表明，戒烟年龄对随后的肺癌风险有重大影响。启示：应鼓励所有年龄的吸烟者戒烟，因为与目前吸烟者相比，任何年龄的戒烟都能降低肺癌的风险。
Background: It is well known that the relative risk (RR) of lung cancer mortality decreases following smoking cessation compared with the risk in persons who continue to smoke. However, changes in the absolute risk of lung cancer death following smoking cessation are not well documented. Further, few studies have examined the effect of age at smoking cessation on subsequent lung cancer death risk. Purpose: The purpose of this study was to examine and compare absolute and relative lung cancer death risks in former smokers as a function of age at cessation. Methods: Using the American Cancer Society's Cancer Prevention Study II, a prospective cohort study with 6 years of follow-up, we modeled absolute risk of lung cancer mortality in individuals who had never smoked and in current and former smokers. The model was fit with the use of person-years logistic regression analysis. Results: Similar patterns of absolute risk of lung cancer death by age were found for all ages of smoking cessation up to the mid-60s. Lower lung cancer death risk was observed for those quitting earlier in life, and the risk for all former smokers was significantly lower than that for current smokers. For those quitting between ages 30 and 49, lung cancer death risk rose gradually with age at a rate slightly greater than that for those who had never smoked. lung cancer death risk for former smokers quitting between ages 50 and 64 leveled off near the risk attained at the time of quitting until around age 75, when it rose sharply. At age 75, the RR for former smokers compared with current smokers was approximately 45% for those quitting in their early 60s, approximately 20% for those quitting in their early 50s, and less than 10% for those quitting in their 30s. For those who had never smoked, the RR at age 75 is less than 5%. Conclusion: In terms of reduced risk of lung cancer mortality, smoking cessation is beneficial at any age, with much greater benefits accruing to those quitting at younger ages. Unlike previous research, which has primarily examined the effects of cessation as a function of years since quitting, our results demonstrate that age at cessation has a major impact on subsequent lung cancer risks. Implications: Smokers of all ages should be encouraged to quit because cessation at any age decreases lung cancer risk relative to that of current smokers.