Jemal Ahmedin, Travis William D, Tarone Robert E, Travis Lois, Devesa Susan S
Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA 30329-4251, USA.
Int J Cancer. 2003 May 20;105(1):101-7. doi: 10.1002/ijc.11020.
Age-specific rates of lung cancer have been consistently higher for men than for women in the United States, due primarily to different patterns of cigarette smoking. Gender differences in cigarette smoking have diminished in recent birth cohorts, however, especially among whites. We used U.S. population-based incidence and mortality data and examined trends in age-specific rates of lung cancer by birth cohort according to gender, ethnic group, and histology to evaluate the generational changes in U.S. lung cancer risk for men vs. women. All tests of statistical significance are 2-sided (95% confidence interval [CI]). Lung cancer mortality rates have converged between men and women born after 1960, especially in whites. The male-to-female (M:F) mortality rate ratio for ages 35-39 years decreased from 3.0 (95% CI = 2.7-3.4) around the 1915 birth cohort to 1.1 (95% CI = 1.0-1.1) around the 1960 birth cohort among whites and from 4.0 (95% CI = 3.2-5.0) around the 1925 birth cohort to 1.5 (95% CI = 1.3-1.7) around the 1960 birth cohort among blacks. Similarly, incidence rates for white men and women converged rapidly for adenocarcinoma, small cell carcinoma, and large cell carcinoma, but less so for squamous cell carcinoma. These findings reflect the smoking patterns among white and black men and women: cigarette smoking prevalence at age 24 was essentially equal among white men and women born after 1960 but continued to be higher in black men than women. The convergence of lung cancer death rates among men and women born after 1960s supports the idea that males and females maybe equally susceptible to develop lung cancer from a given amount of cigarette smoking, rather than the hypothesis that women are more susceptible.
在美国,肺癌的年龄别发病率男性一直高于女性,这主要归因于不同的吸烟模式。然而,在最近出生的人群中,吸烟的性别差异有所减小,尤其是在白人中。我们使用基于美国人群的发病率和死亡率数据,按性别、种族和组织学检查了不同出生队列的肺癌年龄别发病率趋势,以评估美国男性和女性肺癌风险的代际变化。所有统计学显著性检验均为双侧检验(95%置信区间[CI])。1960年后出生的男性和女性的肺癌死亡率已趋同,尤其是在白人中。白人中,35 - 39岁年龄组的男性与女性(M:F)死亡率之比从1915年左右出生队列的3.0(95%CI = 2.7 - 3.4)降至1960年左右出生队列的1.1(95%CI = 1.0 - 1.1),黑人中则从1925年左右出生队列的4.0(95%CI = 3.2 - 5.0)降至1960年左右出生队列的1.5(95%CI = 1.3 - 1.7)。同样,白人男性和女性的腺癌、小细胞癌和大细胞癌发病率迅速趋同,但鳞状细胞癌的趋同程度较小。这些发现反映了白人和黑人男性与女性的吸烟模式:1960年后出生的白人男性和女性在24岁时的吸烟率基本相等,但黑人男性的吸烟率仍高于女性。20世纪60年代后出生的男性和女性肺癌死亡率的趋同支持了这样一种观点,即男性和女性可能对一定量的吸烟同样易患肺癌,而不是女性更易患肺癌的假说。