Cigarette smoking and lung cancer—relative risk estimates for the major histological types from a pooled analysis of case–control studies
Corresponding Author
Beate Pesch
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Tel.: +49-(0)234-302-4536, Fax: +49-(0)234-302-4505
IPA, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, GermanySearch for more papers by this authorBenjamin Kendzia
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Search for more papers by this authorPer Gustavsson
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorKarl-Heinz Jöckel
Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
Search for more papers by this authorGeorg Johnen
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Search for more papers by this authorHermann Pohlabeln
Bremen Institute for Prevention Research and Social Medicine, University of Bremen, Bremen, Germany
Search for more papers by this authorAnn Olsson
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorWolfgang Ahrens
Bremen Institute for Prevention Research and Social Medicine, University of Bremen, Bremen, Germany
Search for more papers by this authorIsabelle Mercedes Gross
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Search for more papers by this authorIrene Brüske
Institute of Epidemiology, HelmholtzZentrum München, München, Germany
Search for more papers by this authorHeinz-Erich Wichmann
Institute of Epidemiology, HelmholtzZentrum München, München, Germany
Search for more papers by this authorFranco Merletti
Cancer Epidemiology Unit, CPO-Piemonte and University of Turin, Turin, Italy
Search for more papers by this authorLorenzo Richiardi
Cancer Epidemiology Unit, CPO-Piemonte and University of Turin, Turin, Italy
Search for more papers by this authorLorenzo Simonato
Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy
Search for more papers by this authorCristina Fortes
Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
Search for more papers by this authorJack Siemiatycki
University of Montreal Hospital Research Center (CRCHUM) and School of Public Health, Montreal, Canada
Search for more papers by this authorMarie-Elise Parent
University of Montreal Hospital Research Center (CRCHUM) and School of Public Health, Montreal, Canada
Institut National de la Recherche Scientifique (INRS), Institut Armand-Frappier, Laval, Canada
Search for more papers by this authorDario Consonni
Unit of Epidemiology, Fondazione IRCCS Ca' Granda—Ospedale Maggiore Policlinico, Milan, Italy
Search for more papers by this authorMaria Teresa Landi
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
Search for more papers by this authorNeil Caporaso
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
Search for more papers by this authorDavid Zaridze
Institute of Carcinogenesis, Russian Cancer Research Centre, Moscow, Russia
Search for more papers by this authorAdrian Cassidy
Roy Castle Lung Cancer Research Programme, Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
Search for more papers by this authorNeonila Szeszenia-Dabrowska
The Nofer Institute of Occupational Medicine, Lodz, Poland
Search for more papers by this authorPeter Rudnai
National Institute of Environment Health, Budapest, Hungary
Search for more papers by this authorJolanta Lissowska
The M Sklodowska-Curie Cancer Center and Institute of Oncology, Warsaw, Poland
Search for more papers by this authorEleonora Fabianova
Department of Occupational Health, Specialized State Health Institute, Regional Authority of Public Health, Banska Bystrica, Slovakia
Search for more papers by this authorRodica Stanescu Dumitru
National Institute of Public Health, Bucharest, Romania
Search for more papers by this authorVladimir Bencko
Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
Search for more papers by this authorLenka Foretova
Masaryk Memorial Cancer Institute, Brno, Czech Republic
Search for more papers by this authorVladimir Janout
Department of Preventive Medicine, Palacky University, Faculty of Medicine, Olomouc, Czech Republic
Search for more papers by this authorCharles M. Rudin
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
Search for more papers by this authorPaul Brennan
International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorPaolo Boffetta
The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
The International Prevention Research Institute, Lyon, France
Search for more papers by this authorKurt Straif
International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorThomas Brüning
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Search for more papers by this authorCorresponding Author
Beate Pesch
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Tel.: +49-(0)234-302-4536, Fax: +49-(0)234-302-4505
IPA, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, GermanySearch for more papers by this authorBenjamin Kendzia
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Search for more papers by this authorPer Gustavsson
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorKarl-Heinz Jöckel
Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
Search for more papers by this authorGeorg Johnen
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Search for more papers by this authorHermann Pohlabeln
Bremen Institute for Prevention Research and Social Medicine, University of Bremen, Bremen, Germany
Search for more papers by this authorAnn Olsson
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorWolfgang Ahrens
Bremen Institute for Prevention Research and Social Medicine, University of Bremen, Bremen, Germany
Search for more papers by this authorIsabelle Mercedes Gross
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Search for more papers by this authorIrene Brüske
Institute of Epidemiology, HelmholtzZentrum München, München, Germany
Search for more papers by this authorHeinz-Erich Wichmann
Institute of Epidemiology, HelmholtzZentrum München, München, Germany
Search for more papers by this authorFranco Merletti
Cancer Epidemiology Unit, CPO-Piemonte and University of Turin, Turin, Italy
Search for more papers by this authorLorenzo Richiardi
Cancer Epidemiology Unit, CPO-Piemonte and University of Turin, Turin, Italy
Search for more papers by this authorLorenzo Simonato
Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy
Search for more papers by this authorCristina Fortes
Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
Search for more papers by this authorJack Siemiatycki
University of Montreal Hospital Research Center (CRCHUM) and School of Public Health, Montreal, Canada
Search for more papers by this authorMarie-Elise Parent
University of Montreal Hospital Research Center (CRCHUM) and School of Public Health, Montreal, Canada
Institut National de la Recherche Scientifique (INRS), Institut Armand-Frappier, Laval, Canada
Search for more papers by this authorDario Consonni
Unit of Epidemiology, Fondazione IRCCS Ca' Granda—Ospedale Maggiore Policlinico, Milan, Italy
Search for more papers by this authorMaria Teresa Landi
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
Search for more papers by this authorNeil Caporaso
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
Search for more papers by this authorDavid Zaridze
Institute of Carcinogenesis, Russian Cancer Research Centre, Moscow, Russia
Search for more papers by this authorAdrian Cassidy
Roy Castle Lung Cancer Research Programme, Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
Search for more papers by this authorNeonila Szeszenia-Dabrowska
The Nofer Institute of Occupational Medicine, Lodz, Poland
Search for more papers by this authorPeter Rudnai
National Institute of Environment Health, Budapest, Hungary
Search for more papers by this authorJolanta Lissowska
The M Sklodowska-Curie Cancer Center and Institute of Oncology, Warsaw, Poland
Search for more papers by this authorEleonora Fabianova
Department of Occupational Health, Specialized State Health Institute, Regional Authority of Public Health, Banska Bystrica, Slovakia
Search for more papers by this authorRodica Stanescu Dumitru
National Institute of Public Health, Bucharest, Romania
Search for more papers by this authorVladimir Bencko
Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
Search for more papers by this authorLenka Foretova
Masaryk Memorial Cancer Institute, Brno, Czech Republic
Search for more papers by this authorVladimir Janout
Department of Preventive Medicine, Palacky University, Faculty of Medicine, Olomouc, Czech Republic
Search for more papers by this authorCharles M. Rudin
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
Search for more papers by this authorPaul Brennan
International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorPaolo Boffetta
The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
The International Prevention Research Institute, Lyon, France
Search for more papers by this authorKurt Straif
International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorThomas Brüning
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr Universität Bochum (IPA), Bochum, Germany
Search for more papers by this authorAbstract
Lung cancer is mainly caused by smoking, but the quantitative relations between smoking and histologic subtypes of lung cancer remain inconclusive. By using one of the largest lung cancer datasets ever assembled, we explored the impact of smoking on risks of the major cell types of lung cancer. This pooled analysis included 13,169 cases and 16,010 controls from Europe and Canada. Studies with population controls comprised 66.5% of the subjects. Adenocarcinoma (AdCa) was the most prevalent subtype in never smokers and in women. Squamous cell carcinoma (SqCC) predominated in male smokers. Age-adjusted odds ratios (ORs) were estimated with logistic regression. ORs were elevated for all metrics of exposure to cigarette smoke and were higher for SqCC and small cell lung cancer (SCLC) than for AdCa. Current male smokers with an average daily dose of >30 cigarettes had ORs of 103.5 (95% confidence interval (CI): 74.8–143.2) for SqCC, 111.3 (95% CI: 69.8–177.5) for SCLC and 21.9 (95% CI: 16.6–29.0) for AdCa. In women, the corresponding ORs were 62.7 (95% CI: 31.5–124.6), 108.6 (95% CI: 50.7–232.8) and 16.8 (95% CI: 9.2–30.6), respectively. Although ORs started to decline soon after quitting, they did not fully return to the baseline risk of never smokers even 35 years after cessation. The major result that smoking exerted a steeper risk gradient on SqCC and SCLC than on AdCa is in line with previous population data and biological understanding of lung cancer development.
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