Skip to main content
SpringerLink
Log in

Cigarette smoking and liver cancer among US veterans

  • Research Papers
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

The relationship of tobacco use with risk of primary liver cancer was investigated using data from a 26-year mortality follow-up of nearly 250,000 US veterans, mostly from World War I. Significantly increased risks for liver cancer (289 deaths) were associated with most forms of tobacco use, including pipe and cigar smoking. Elevated relative tisks (RRs) were seen for current cigarette smokers (RR=2.4; 95 percent confidence interval [CI] 1.6–3.5) and former cigarette smokers (RR=1.9, 1.2–2.9). A strong dose-response relationship (P<0.001) was found for cigarette smoking, with smokers of 40 or more cigarettes per day having almost a fourfold risk (RR=3.8, 1.9–8.0). Risks were also found to increase significantly with years of cigarette use and with earlier age at the start of cigarette smoking. These results are consistent with those of other cohort and case-control studies, suggesting that cigarette smoking may be related to the risk of liver cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Waterhouse J, Shanmugarathnam K, Muir C, Powell J, eds. Cancer Incidence in Five Continents. Volume IV. Lyon: International Agency for Research on Cancer, 1982; IARC Sci. Pub. No. 42.

    Google Scholar 

  2. Young JL, Percy CL, Asire AJ. Surveillance, Epidemiology, and End Results Program: Incidence and Mortality Data: 1973–1977. Natl Cancer Inst Monogr 1981; 57: 50–1, 144–5.

    Google Scholar 

  3. Beasley RP, Hwang L, Lin C, Chien C. Hepatocellular carcinoma and hepatitis B virus: a prospective study of 22,707 men in Taiwan. Lancet 1981; II: 1129–33.

    Google Scholar 

  4. Enwonwu CO. The role of dietary aflatoxin in the genesis of hepatocellular cancer in developing countries. Lancet 1984; II: 956–8.

    Google Scholar 

  5. Tabor E, Gerety RJ, Vogel CL, et al. Hepatitis B virus infection and primary hepatocellular carcinoma. JNCI 1977; 58: 1197–200.

    Google Scholar 

  6. Tabor E. Hepatocellular carcinoma: possible etiologies in patients without serologic evidence of hepatitis B virus infection. J Med Virology 1989; 27: 1–6.

    Google Scholar 

  7. Editorial. Hepatocellular cancer: differences between high and low incidence regions. Lancet 1987; II: 1183–4.

  8. Yu MC, Tong MJ, Coursaget P, Ross RK, Govindarajan S, Henderson BE. Prevalence of hepatitis B and C viral markers in black and white patients with hepatocellular carcinoma in the United States. JNCI 1990; 82: 1038–41.

    Google Scholar 

  9. Trichopoulos D, MacMahon B, Sparros L, Merikas G. Smoking and hepatitis B-negative primary hepatocellular carcinoma. JNCI 1980; 65: 111–4.

    Google Scholar 

  10. Lam KC, Yu MC, Leung JW, Henderson B. Hepatitis B virus and cigarette smoking: risk factors for hepatocellular carcinoma in Hong Kong. Cancer Res 1982; 42: 5246–8.

    Google Scholar 

  11. Yu MC, Mack T, Hanisch R, Peters RL, Henderson BE, Pike MC. Hepatitis, alcohol consumption, cigarette smoking, and hepatocellular carcinoma in Los Angeles. Cancer Res 1983; 43: 6077–9.

    Google Scholar 

  12. Trichopoulos D, Day NE, Kaklamani E, et al. Hepatitis B virus, tobacco smoking and ethanol consumption in the etiology of hepatocellular carcinoma. Int J Cancer 1987; 39: 45–9.

    Google Scholar 

  13. Tanaka K, Hirohata T, Takashita S. Blood transfusion, alcohol consumption, and cigarette smoking in causation of hepatocellular carcinoma: a case-control study in Fukuoka, Japan. Jpn J Cancer Res 1988; 79: 1075–82.

    Google Scholar 

  14. Yu HE, Harris RE, Kabat GC, Wynder EL. Cigarette smoking, alcohol consumption and primary liver cancer: a case-control study in the USA. Int J Cancer 1988; 42: 325–8.

    Google Scholar 

  15. Tsukuma H, Hiyama T, Oshima A, et al. A case-control study of hepatocellular carcinoma in Osaka, Japan. Int J Cancer 1990; 45: 231–6.

    Google Scholar 

  16. Stemhagen A, Slade J, Altman R, Bill J. Occupational risk factors and liver cancer. Am J Epidemiol 1983; 117: 443–54.

    Google Scholar 

  17. Hardell L, Bengtsson NO, Jonsson U, Eriksson S, Larsson LG. Aetiological aspects on primary liver cancer with special regard to alcohol, organic solvents and acute intermittent prophyria—an epidemiological investigation. Br J Cancer 1984; 50: 389–97.

    Google Scholar 

  18. Kew MC, DiBisceglie AM, Paterson A. Smoking as a risk factor for hepatocellular carcinoma. A case-control study in southern African blacks. Cancer 1985; 56: 2135–7.

    Google Scholar 

  19. Austin H, Delzell E, Grufferman S, et al. A case-control study of hepatocellular carcinoma and the hepatitis B virus, cigarette smoking and alcohol consumption. Cancer Res 1986; 46: 962–6.

    Google Scholar 

  20. Lu SN, Lin TM, Chen CJ, et al. A case-control study of primary hepatocellular carcinoma in Taiwan. Cancer 1988; 62: 2051–5.

    Google Scholar 

  21. LaVecchia C, Negri E, Decarli A, D'Avanzo B, Franceschi S. Risk factors for hepatocellular carcinoma in northern Italy. Int J Cancer 1988; 42: 872–6.

    Google Scholar 

  22. Oshima A, Tsukuma H, Hiyama T, Fujimoto I, Yamano H, Tanaka M. Follow-up study of HBsAg-positive blood donors with special reference to effect of drinking and smoking on development of liver cancer. Int J Cancer 1984; 34: 775–9.

    Google Scholar 

  23. Tu J, Gao R, Zhang D, Gu B. Hepatitis B Virus and Primary Liver Cancer on Chongming Island, People's Republic of China. Natl Cancer Inst Monogr 1985; 69: 213–5.

    Google Scholar 

  24. Shibata A, Hirohata T, Toshima H, Tashiro H. The role of drinking and cigarette smoking in the excess deaths from liver cancer. Jpn J Cancer Res 1986; 77: 287–95.

    Google Scholar 

  25. Hirayama T. A large-scale cohort study on risk factors for primary liver cancer, with special reference to the role of cigarette smoking. Cancer Chemother Pharmacol 1989; 23: S114–7.

    Google Scholar 

  26. International Agency for Research on Cancer. Tobacco Smoking. Lyon: IARC, 1986; Monogr Eval Carcinog Risk Chem Man, 38: 199–298.

    Google Scholar 

  27. A Report of the Surgeon General. The Health Consequences of Smoking: Cancer. Rockville, MD: US Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1982; DHHS Pub. No. 82-50179.

  28. Kahn HA. The Dorn Study of Smoking and Mortality among US Veterans: Report on Eight and One-half Years of Observation. Natl Cancer Inst Monogr 1966; 19: 1–125.

    Google Scholar 

  29. Rogot E, Murray JL. Smoking and causes of death among US veterans: 16 years of observation. Public Health Rep 1980; 95: 213–22.

    Google Scholar 

  30. World Health Organization. Manual of the Classification of Diseases, Injuries, and Causes of Death. 7th Revision. Geneva: WHO, 1957.

    Google Scholar 

  31. Breslow NE, Day NE. Statistical Methods in Cancer Research, Vol 2. The Design and Analysis of Cohort Studies. Lyon International Agency for Research on Cancer, 1987; IARC Sci. Pub. No. 82, 120–76.

  32. Monson RR. Analysis of relative survival and proportionate mortality. Comput Biomed Res 1974; 7: 325–32.

    Google Scholar 

  33. Seeff LB, Beebe GW, Hoofnagle JH, et al. A serologic follow-up of the 1942 epidemic of post-vaccination hepatitis in the United States Army. N Engl J Med 1987; 316: 965–70.

    Google Scholar 

  34. McQuillan GM, Townsend TR, Field HA, Carroll M, Leahy M, Polk BF. Seroepidemiology of hepatitis B virus infection in the United States 1976 to 1980. Am J Med 1989; 87 (Suppl 3A): 5–10.

    Google Scholar 

  35. Chung D, Ko Y, Chen C, et al. Seroepidemiological studies on hepatitis B and D viruses infection among five ethnic groups in southern Taiwan. J Med Virology 1988; 26: 411–8.

    Google Scholar 

  36. Rodricks J, Hesseltine C, Mehlman M. Mycotoxins in Human and Animal Health. Park Forest South, Illinois: Pathotox Publishers, Inc., 1977: 7–28.

    Google Scholar 

  37. International Agency for Research on Cancer. Alcohol Drinking. Lyon: IARC, 1988; Monogr Eval Carcinog Risk Chem Man, 44: 208–12.

    Google Scholar 

  38. Remer SG. The prevalence of alcoholism in a veterans administration medical center. Military Medicine 1983; 148: 735–9.

    Google Scholar 

  39. Richard MS, Goldberg J, Rodin MB, Anderson RJ. Alcohol consumption and problem drinking in white male veterans and non-veterans. Am J Public Health 1989; 79: 1011–15.

    Google Scholar 

  40. A Report of the Surgeon General. Reducing the Health Consequences of Smoking: 25 Years of Progress. Rockville, MD: US Department of Human Services, Public Health Service, Office on Smoking and Health 1989; DHHS Pub. No. 89-8411.

  41. Percy C, Stanek E, Gloeckler L. Accuracy of cancer death certificates and its effect on cancer mortality statistics. Am J Public Health 1981; 71: 242–50.

    Google Scholar 

Download references

Authors
  1. Ann W. Hsing
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph K. McLaughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zdenek Hrubec
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William J. Blot
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joseph F. Fraumeni Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

All authors are in the Epidemiology and Biostatistics Program, Division of Cancer Etiology, National Cancer Institute. Address correspondence to Dr Hsing at Executive Plaza North, Room 415, Bethesda, MD 20892, USA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hsing, A.W., McLaughlin, J.K., Hrubec, Z. et al. Cigarette smoking and liver cancer among US veterans. Cancer Causes Control 1, 217–221 (1990). https://doi.org/10.1007/BF00117473

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00117473

Key words

Search

Navigation