Minami Yuko, Tateno Hiroo
Division of Epidemiology, Miyagi Cancer Center Research Institute, Medeshima-Shiode, Natori 981-1293, Japan.
Cancer Sci. 2003 Jun;94(6):540-7. doi: 10.1111/j.1349-7006.2003.tb01480.x.
Although cigarette smoking is a well-known risk factor of lung cancer, associations of cigarette smoking with the risk of other sites have not been fully elucidated in Japan. To simultaneously evaluate the associations of cigarette smoking with the risks of cancers of the stomach, lung, colon, and rectum, which have been the leading cancer sites in recent years in Miyagi Prefecture, Japan, we conducted a hospital-based case-control study. Study subjects consisted of 614 stomach, 515 lung, 324 colon, and 164 rectal cancer cases and 2444 hospital controls admitted to a single hospital in Miyagi Prefecture from 1997 to 2001. Information on smoking habit and other lifestyle factors was collected using a self-administered questionnaire. Distributions of referral base among cases and controls were also investigated. For each site, odds ratios (ORs) and 95% confidence intervals (95% CIs) for smoking habit were estimated with adjustment for age, year of survey, history of alcohol drinking, family history of index cancer, and occupational history, respectively, using an unconditional logistic regression model. Cigarette smoking (ever vs. never) was associated with an increased risk of stomach (OR = 1.62; 95% CI 1.20-2.19) and lung (OR = 3.82; 95% CI 2.49-5.86) cancer among males and lung cancer among females (OR = 2.02; 95% CI 1.28-3.18). For female stomach cancer, the association with cigarette smoking was uncertain (OR = 0.65, P = 0.1533). For rectal cancer, a significant increased risk was observed in both-sex-combined analysis. There was no association between cigarette smoking and the risk of colon cancer. Detailed analysis showed that the association of cigarette smoking with cancer risk might be modified by the patient referral pattern, i.e., screened or not screened. The present results indicate that the association of cigarette smoking with cancer risk may differ among sites and sexes. In terms of the population attributable risk, a large proportion of leading cancers in males appears to be related to cigarette smoking.
尽管吸烟是肺癌的一个众所周知的风险因素，但在日本，吸烟与其他部位癌症风险之间的关联尚未完全阐明。为了同时评估吸烟与胃癌、肺癌、结肠癌和直肠癌风险之间的关联，这些癌症近年来一直是日本宫城县的主要癌症发病部位，我们开展了一项基于医院的病例对照研究。研究对象包括614例胃癌患者、515例肺癌患者、324例结肠癌患者和164例直肠癌患者，以及1997年至2001年期间在宫城县一家医院住院的2444名对照者。使用自填问卷收集吸烟习惯和其他生活方式因素的信息。还调查了病例组和对照组之间的转诊来源分布情况。对于每个部位，分别使用无条件逻辑回归模型，在调整年龄、调查年份、饮酒史、索引癌症家族史和职业史后，估计吸烟习惯的优势比（OR）和95%置信区间（95%CI）。吸烟（曾经吸烟与从不吸烟）与男性胃癌（OR = 1.62；95%CI 1.20 - 2.19）、男性肺癌（OR = 3.82；95%CI 2.49 - 5.86）以及女性肺癌（OR = 2.02；95%CI 1.28 - 3.18）风险增加相关。对于女性胃癌，吸烟与之的关联不明确（OR = 0.65，P = 0.1533）。对于直肠癌，在两性合并分析中观察到风险显著增加。吸烟与结肠癌风险之间无关联。详细分析表明，吸烟与癌症风险之间的关联可能因患者转诊模式（即是否经过筛查）而有所改变。目前的结果表明，吸烟与癌症风险之间的关联可能因部位和性别而异。就人群归因风险而言，男性主要癌症中的很大一部分似乎与吸烟有关。
