Top

BMC Cancer

Published in:

Open Access 01-12-2018 | Research article

Risk of lung cancer in relation to various metrics of smoking history: a case-control study in Montreal

Authors: T. Remen, J. Pintos, M. Abrahamowicz, J. Siemiatycki

Published in: BMC Cancer | Issue 1/2018

Abstract

Background

Few epidemiologic findings are as well established as the association between smoking and lung cancer. It is therefore somewhat surprising that there is not yet a clear consensus about the exposure-response relationships between various metrics of smoking and lung cancer risk. In part this is due to heterogeneity of how exposure-response results have been presented and the relative paucity of published results using any particular metric of exposure. The purposes of this study are: to provide new data on smoking-lung cancer associations and to explore the relative impact of different dimensions of smoking history on lung cancer risk.

Methods

Based on a large lung cancer case-control study (1203 cases and 1513 controls) conducted in Montreal in 1996–2000, we estimated the lifetime prevalence of smoking and odds ratios in relation to several smoking metrics, both categorical and continuous based on multivariable unconditional logistic regression.

Results

Odds ratios (ORs) for ever vs never smoking were 7.82 among males and 11.76 among females. ORs increased sharply with every metric of smoking examined, more so for duration than for daily intensity. In models using continuous smoking variables, all metrics had strong effects on OR and mutual adjustment among smoking metrics did not noticeably attenuate the OR estimates, indicating that each metric carries some independent risk-related information. Among all the models tested, the one based on a smoking index that integrates several smoking dimensions, provided the best fitting model. Similar patterns were observed for the different histologic types of lung cancer.

Conclusions

This study provides many estimates of exposure-response relationships between smoking and lung cancer; these can be used in future meta-analyses. Irrespective of the histologic type of lung cancer and the smoking metric examined, high levels of smoking led to high levels of risk, for both men and women.

Available only for authorised users

U.S. Department of Health Education and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington: U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control; 1964. PHS Publication No. 1103’

Houston KA, Henley SJ, Li J, White MC, Richards TB. Patterns in lung cancer incidence rates and trends by histologic type in the United States, 2004-2009. Lung Cancer. 2014;86(1):22–8. https://doi.org/10.1016/j.lungcan.2014.08.001.CrossRefPubMedPubMedCentral

Lee PN, Forey BA, Coombs KJ. Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer. BMC Cancer. 2012;12:385. https://doi.org/10.1186/1471-2407-12-385.CrossRefPubMedPubMedCentral

Iarc Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum. 2004;83:1–1438.PubMedCentral

Siemiatycki J, Karp I, Sylvestre MP, Pintos J. Estimating the proportion of cases of lung cancer legally attributable to smoking: a novel approach for class actions against the tobacco industry. Am J Public Health. 2014;104(8):e60–6. https://doi.org/10.2105/AJPH.2014.302040.CrossRefPubMedPubMedCentral

Lacourt A, Pintos J, Lavoue J, Richardson L, Siemiatycki J. Lung cancer risk among workers in the construction industry: results from two case-control studies in Montreal. BMC Public Health. 2015;15:941. https://doi.org/10.1186/s12889-015-2237-9.CrossRefPubMedPubMedCentral

Leffondre K, Abrahamowicz M, Siemiatycki J, Rachet B. Modeling smoking history: a comparison of different approaches. Am J Epidemiol. 2002;156(9):813–23.CrossRef

Thurston SW, Liu G, Miller DP, Christiani DC. Modeling lung cancer risk in case-control studies using a new dose metric of smoking. Cancer Epidemiol Biomark Prev. 2005;14(10):2296–302. https://doi.org/10.1158/1055-9965.EPI-04-0393.CrossRef

Lubin JH, Caporaso NE. Cigarette smoking and lung cancer: modeling total exposure and intensity. Cancer Epidemiol Biomark Prev. 2006;15(3):517–23. https://doi.org/10.1158/1055-9965.epi-05-0863.CrossRef

10.

Rachet B, Siemiatycki J, Abrahamowicz M, Leffondre K. A flexible modeling approach to estimating the component effects of smoking behavior on lung cancer. J Clin Epidemiol. 2004;57(10):1076–85. https://doi.org/10.1016/j.jclinepi.2004.02.014.CrossRefPubMed

11.

World Health Organization/International Agency for Research on Cancer. Histological groups for comparative studies. Lyon: International Agency for Research on Cancer; 1998.

12.

Nkosi TM, Parent ME, Siemiatycki J, Rousseau MC. Socioeconomic position and lung cancer risk: how important is the modeling of smoking? Epidemiology. 2012;23(3):377–85. https://doi.org/10.1097/EDE.0b013e31824d0548.CrossRefPubMed

13.

Hoffmann K, Bergmann MM. Re: “Modeling smoking history: a comparison of different approaches”. Am J Epidemiol. 2003;158(4):393 author reply −4.CrossRef

14.

Leffondre K, Abrahamowicz M, Xiao Y, Siemiatycki J. Modelling smoking history using a comprehensive smoking index: application to lung cancer. Stat Med. 2006;25(24):4132–46. https://doi.org/10.1002/sim.2680.CrossRefPubMed

15.

Siemiatycki J, Wacholder S, Richardson L, Dewar R, Gerin M. Discovering carcinogens in the occupational environment. Methods of data collection and analysis of a large case-referent monitoring system. Scand J Work Environ Health. 1987;13(6):486–92.CrossRef

16.

Siemiatycki J. Risk factors for cancer in the workplace. FL: Boca Raton: CRC Press; 1991.

17.

Royston P, Ambler G, Sauerbrei W. The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol. 1999;28(5):964–74.CrossRef

18.

Benichou J. Methods of adjustment for estimating the attributable risk in case-control studies: a review. Stat Med. 1991;10(11):1753–73.CrossRef

19.

Sauerbrei W, Meier-Hirmer C, Benner A, Royston P. Multivariable regression model building by using fractional polynomials: description of SAS, STATA and R programs. Comput Stat Data Anal. 2006;50(12):3464–85. https://doi.org/10.1016/j.csda.2005.07.015.CrossRef

20.

Siemiatycki J, Krewski D, Franco E, Kaiserman M. Associations between cigarette smoking and each of 21 types of cancer: a multi-site case-control study. Int J Epidemiol. 1995;24(3):504–14.CrossRef

21.

Burns DM, Lee L, Shen LZ, Gilpin E, Tolley HD, Vaughn J, et al. Cigarette smoking behavior in the United States. In: Shopland R, Burns DM, Garfinkel L, Samet JM, editors. Changes in Cigarette Related Disease Risks and Their Implication for Prevention and Control. Smoking and Tobacco Control Monograph 8. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute: NIH Publication; 1997. p. 13–42.

22.

De Matteis S, Consonni D, Pesatori AC, Bergen AW, Bertazzi PA, Caporaso NE, et al. Are women who smoke at higher risk for lung cancer than men who smoke? Am J Epidemiol. 2013;177(7):601–12. https://doi.org/10.1093/aje/kws445.CrossRefPubMedPubMedCentral

23.

Khuder SA. Effect of cigarette smoking on major histological types of lung cancer: a meta-analysis. Lung Cancer. 2001;31(2–3):139–48.CrossRef

24.

Pesch B, Kendzia B, Gustavsson P, Jockel KH, Johnen G, Pohlabeln H, et al. Cigarette smoking and lung cancer--relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer. 2012;131(5):1210–9. https://doi.org/10.1002/ijc.27339.CrossRefPubMed

25.

Yu Y, Liu H, Zheng S, Ding Z, Chen Z, Jin W, et al. Gender susceptibility for cigarette smoking-attributable lung cancer: a systematic review and meta-analysis. Lung Cancer. 2014;85(3):351–60. https://doi.org/10.1016/j.lungcan.2014.07.004.CrossRefPubMed

26.

Powell HA, Iyen-Omofoman B, Hubbard RB, Baldwin DR, Tata LJ. The association between smoking quantity and lung cancer in men and women. Chest. 2013;143(1):123–9. https://doi.org/10.1378/chest.12-1068.CrossRefPubMed

27.

Shiffman S. How many cigarettes did you smoke? Assessing cigarette consumption by global report, time-line follow-Back, and ecological momentary assessment. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2009;28(5):519–26. https://doi.org/10.1037/a0015197.CrossRef

28.

Iarc Working Group on the Evaluation of Carcinogenic Risks to Humans. Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum. 2012;100(Pt E):1–538.PubMedCentral

29.

Peto J. That the effects of smoking should be measured in pack-years: misconceptions 4. Br J Cancer. 2012;107(3):406–7. https://doi.org/10.1038/bjc.2012.97.CrossRefPubMedPubMedCentral

30.

Vlaanderen J, Portengen L, Schuz J, Olsson A, Pesch B, Kendzia B, et al. Effect modification of the association of cumulative exposure and cancer risk by intensity of exposure and time since exposure cessation: a flexible method applied to cigarette smoking and lung cancer in the SYNERGY study. Am J Epidemiol. 2014;179(3):290–8. https://doi.org/10.1093/aje/kwt273.CrossRefPubMed

31.

Lubin JH, Caporaso NE. Misunderstandings in the misconception on the use of pack-years in analysis of smoking. Br J Cancer. 2013;108(5):1218–20. https://doi.org/10.1038/bjc.2013.76.CrossRefPubMedPubMedCentral

32.

Thomas DC. Invited commentary: is it time to retire the “pack-years” variable? Maybe not! Am J Epidemiol. 2014;179(3):299–302. https://doi.org/10.1093/aje/kwt274.CrossRefPubMed

33.

Siemiatycki J. Synthesizing the lifetime history of smoking. Cancer Epidemiol Biomark Prev. 2005;14(10):2294–5. https://doi.org/10.1158/1055-9965.EPI-05-0775.CrossRef

34.

Dietrich T, Hoffmann K. A comprehensive index for the modeling of smoking history in periodontal research. J Dent Res. 2004;83(11):859–63. https://doi.org/10.1177/154405910408301107.CrossRefPubMed

35.

Chyou PH, Nomura AM, Stemmermann GN. A prospective study of the attributable risk of cancer due to cigarette smoking. Am J Public Health. 1992;82(1):37–40.CrossRef

36.

Samet JM, Alberg AJ, Ford JG. Epidemiology of lung cancer and mesothelioma. In: Spiro SG, Huber RM, Janes SM, editors. European Respiratory Monograph 44: Thoracic Malignancies. European Respiratory Society; 2009. p. 349–91.

Title: Risk of lung cancer in relation to various metrics of smoking history: a case-control study in Montreal
Authors: T. Remen
J. Pintos
M. Abrahamowicz
J. Siemiatycki
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-018-5144-5

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Genomic analysis of DNA repair genes and androgen signaling in prostate cancer

Long-term trastuzumab (Herceptin®) treatment in a continuation study of patients with HER2-positive breast cancer or HER2-positive gastric cancer

Rational development of synergistic combinations of chemotherapy and molecular targeted agents for colorectal cancer treatment

Suppressed OGT expression inhibits cell proliferation while inducing cell apoptosis in bladder cancer

PD-L1 assessment in pediatric rhabdomyosarcoma: a pilot study

MiR-30a-5p confers cisplatin resistance by regulating IGF1R expression in melanoma cells

Keynote webinar | Spotlight on antibody–drug conjugates in cancer