Differences in lung cancer risk between men and women: Examination of the evidence
Differences in lung cancer risk between men and women: Examination of the evidence
复制标题
DOI：
10.1093/jnci/88.3-4.183
复制
发表时间：
1996-02-21
影响因子：
10.3
通讯作者：
Wynder, EL
中科院分区：
文献类型：
--
作者：
Zang, EA;Wynder, EL
背景：美国男性肺癌发病率逐渐趋于平稳，但美国女性肺癌发病率持续上升。美国女性吸烟人数的增加超出了女性吸烟率下降速度放缓的预期。最近的流行病学和生化研究表明，对烟草致癌物的易感性存在性别差异。目的：我们对早期观察到的吸烟引起的肺癌相对风险 (RR) 的潜在性别差异进行了最新、更深入的评估。我们添加了来自其他几个病例和对照受试者的信息，包括更精确的癌症类型组织学分类、烟雾暴露的准确定量以及体型调整。方法：本调查是美国健康基金会正在进行的基于医院的病例对照研究的一部分。它包括 1889 名患有鳞状/表皮样、小细胞/燕麦细胞、大细胞和腺癌类型肺癌的病例受试者（1108 名男性和 781 名女性）以及 2070 名患有与吸烟无关疾病的对照受试者（1122 名男性和 948 名女性）的数据。病例和对照受试者于1981年至1994年入住参与医院，并按年龄、性别、医院和入院时间进行配对。为了避免混淆，戒烟者和非白人被排除在分析之外。 RR 和 95% 置信区间是通过使用无条件多元 Logistic 回归分析根据调整后的比值比 (OR) 估计的，并通过双边检验确定统计显着性。主要组织学类型的 OR 是根据香烟烟雾暴露水平的增加来估计的。结果：我们的结果表明，女性比男性更有可能从不吸烟，尤其是患有鳞状/表皮样癌的女性（55 岁或以上女性为 8.3%，男性为 2.9%）。男性比女性更早开始吸烟，吸得更深，并且每天吸更多的香烟。相比之下，对于三种主要组织学类型，女性累积吸烟暴露的剂量反应 OR 比男性高 1.2 倍至 1.7 倍；这些差异对于小细胞/燕麦细胞癌和腺癌比鳞状/表皮样癌更明显。体重、身高或体重指数的调整不会改变 OR。结论：这些结果证实了我们之前的发现，即在每种香烟烟雾暴露水平下，女性主要肺癌类型的 OR 始终高于男性。此外，这种性别差异不能用基线暴露、吸烟史或体型的差异来解释，但很可能是由于女性对烟草致癌物的易感性更高。
Background: Lung cancer incidence is gradually leveling off in U.S. men but is continuing to rise in U.S. women. This increase in U.S. women exceeds that expected from a slower decline of smoking among women. Recent epidemiologic and biochemical studies suggest gender differences in susceptibility to tobacco carcinogens. Purpose: We conducted an up-to-date, more in-depth evaluation of our earlier observation of a potential gender difference in relative risk (RR) of lung cancer due to smoking. We added information from several additional case and control subjects and included more precise histologic classification of the cancer type, accurate quantitation of smoke exposure, and adjustments for body size. Methods: The present investigation was a part of an ongoing hospital-based, case-control study by the American Health Foundation. It included data from 1889 case subjects (1108 males and 781 females) with lung cancer of squamous/epidermoid, small-cell/oat cell, large-cell, and adenocarcinoma types and 2070 control subjects (1122 males and 948 females) with diseases unrelated to smoking. The case and control subjects were admitted to participating hospitals from 1981 to 1994 and were pair-matched by age, sex, hospital, and the time of hospital admission. Ex-smokers and non-Caucasians were excluded from analyses to avoid confounding. The RRs and 95% confidence intervals were estimated from adjusted odds ratios (ORs) by use of unconditional multiple logistic regression analysis, and statistical significance was determined by two-sided tests. The ORs for major histologic types were estimated at increasing levels of exposure to cigarette smoke. Results: Our results indicated that women were more likely to be never-smokers than men, particularly those with the squamous/epidermoid-type cancer (8.3% for women versus 2.9% for men 55 years old or older). Men started smoking earlier, reported inhaling more deeply, and smoked more cigarettes per day than women. In contrast, dose-response ORs over cumulative exposure to cigarette smoking were 1.2-fold to 1.7-fold higher in women than in men for the three major histologic types; these differences were more pronounced for small-cell/oat cell carcinomas and adenocarcinomas than for squamous/ epidermoid carcinomas. Adjustments for weight, height, or body mass index did not alter the ORs. Conclusions: These results confirm our earlier finding that the ORs for major lung cancer types are consistently higher for women than for men at every level of exposure to cigarette smoke. Furthermore, this gender difference cannot be explained by differences in base-line exposure, smoking history, or body size, but it is likely due to the higher susceptibility to tobacco carcinogens in women.