减少吸烟对肺癌风险的影响。

Effect of smoking reduction on lung cancer risk.

作者信息

Godtfredsen Nina S, Prescott Eva, Osler Merete

机构信息

The Copenhagen Centre for Prospective Population Studies, Danish Epidemiology Science Centre at the Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark.

出版信息

JAMA. 2005 Sep 28;294(12):1505-10. doi: 10.1001/jama.294.12.1505.

DOI:10.1001/jama.294.12.1505

PMID:16189363

Abstract

CONTEXT

Many smokers are unable or unwilling to completely quit smoking. A proposed means of harm reduction is to reduce the number of cigarettes smoked per day. However, it is not clear whether this strategy decreases the risk for tobacco-related diseases.

OBJECTIVE

To assess the effects of smoking reduction on lung cancer incidence.

DESIGN, SETTING, AND PARTICIPANTS: Observational population-based cohort study with up to 31 years of follow-up from the Copenhagen Centre for Prospective Population Studies, which administrates data from 3 longitudinal studies conducted in Copenhagen and suburbs, the Copenhagen City Heart Study, the Copenhagen Male Study, and the Glostrup Population Studies, Denmark. Participants were 11,151 men and 8563 women (N = 19,714) aged 20 to 93 years, who attended 2 consecutive examinations with a 5- to 10-year interval between 1964 and 1988. Participants underwent a physical examination and completed self-filled questionnaires about lifestyle habits. The study population was divided into 6 groups according to smoking habits: continued heavy smokers (> or =15 cigarettes/d), reducers (reduced from > or =15 cigarettes/d by minimum of 50% without quitting), continued light smokers (1-14 cigarettes/d), quitters (stopped between first and second examination), stable ex-smokers, and never smokers.

MAIN OUTCOME MEASURE

Incident primary lung cancer cases assessed by record linkage with the National Cancer Registry until December 31, 2003.

RESULTS

There were 864 incident lung cancers during follow-up. Using Cox regression, the adjusted hazard ratio (HR) for lung cancer in reducers was 0.73 (95% confidence interval [CI], 0.54-0.98) compared with persistent heavy smokers. The HR for light smokers was 0.44 (95% CI, 0.35-0.56); for quitters, HR 0.50 (95% CI, 0.36-0.69), for stable ex-smokers, HR 0.17 (95% CI, 0.13-0.23), and for never smokers, HR 0.09 (95% CI, 0.06-0.13).

CONCLUSION

Among individuals who smoke 15 or more cigarettes per day, smoking reduction by 50% significantly reduces the risk of lung cancer.

摘要

背景

许多吸烟者无法或不愿完全戒烟。一种提议的降低危害的方法是减少每日吸烟量。然而，尚不清楚这种策略是否能降低与烟草相关疾病的风险。

目的

评估减少吸烟量对肺癌发病率的影响。

设计、地点和参与者：基于人群的观察性队列研究，由哥本哈根前瞻性人口研究中心进行长达31年的随访，该中心管理来自丹麦哥本哈根及其郊区进行的3项纵向研究的数据，即哥本哈根市心脏研究、哥本哈根男性研究和格罗斯楚普人口研究。参与者为11151名男性和8563名女性（N = 19714），年龄在20至93岁之间，他们在1964年至1988年期间间隔5至10年连续参加了2次检查。参与者接受了体格检查并填写了关于生活习惯的自填问卷。根据吸烟习惯，研究人群分为6组：持续重度吸烟者（≥15支/天）、减少吸烟者（从≥15支/天减少至少50%且未戒烟）、持续轻度吸烟者（1 - 14支/天）、戒烟者（在第一次和第二次检查之间戒烟）、稳定的既往吸烟者和从不吸烟者。

主要结局指标

通过与国家癌症登记处记录链接评估的原发性肺癌发病病例，截至2003年12月31日。

结果

随访期间有864例肺癌发病病例。使用Cox回归分析，与持续重度吸烟者相比，减少吸烟者患肺癌的校正风险比（HR）为0.73（95%置信区间[CI]，0.54 - 0.98）。轻度吸烟者的HR为0.44（95% CI，0.35 - 0.56）；戒烟者的HR为0.50（95% CI，0.36 - 0.69），稳定的既往吸烟者的HR为0.17（95% CI，0.13 - 0.23），从不吸烟者的HR为0.09（95% CI，0.06 - 0.13）。