Thun Michael J, Henley S Jane, Burns David, Jemal Ahmedin, Shanks Thomas G, Calle Eugenia E
Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA 30229-4251, USA.
J Natl Cancer Inst. 2006 May 17;98(10):691-9. doi: 10.1093/jnci/djj187.
Few studies have directly measured the age-, sex-, and race-specific risks of lung cancer incidence and mortality among never tobacco smokers. Such data are needed to quantify the risks associated with smoking and to understand racial and sex disparities and temporal trends that are due to factors other than active smoking.
We measured age-, sex-, and race-specific rates (per 100,000 person-years at risk) of death from lung cancer among more than 940,000 adults who reported no history of smoking at enrollment in either of two large American Cancer Society Cancer Prevention Study cohorts during 1959-1972 (CPS-I) and 1982-2000 (CPS-II). We compared lung cancer death rates between men and women and between African Americans and whites and analyzed temporal trends in lung cancer death rates among never smokers across the two studies by using directly age-standardized rates as well as Poisson and Cox proportional hazards regression analyses. All statistical tests were two-sided.
The age-standardized lung cancer death rates among never-smoking men and women in CPS-II were 17.1 and 14.7 per 100,000 person-years, respectively. Men who had never smoked had higher age-standardized lung cancer death rates than women in both studies (CPS-I: hazard ratio [HR] = 1.52, 95% confidence interval [CI] = 1.28 to 1.79; CPS-II: HR = 1.21, 95% CI = 1.09 to 1.36). The rate was higher among African American women than white women in CPS-II (HR = 1.43, CI = 1.11 to 1.85). A small temporal increase (CPS-II versus CPS-I) in lung cancer mortality was seen for white women (HR = 1.25, CI = 1.12 to 1.41) and African American women (HR = 1.22, CI = 0.64 to 2.33), but not for white men (HR = 0.89, CI = 0.74 to 1.08). Among white and African American women combined, the temporal increase was statistically significant only among those aged 70-84 years (P < .001).
Contrary to clinical perception, the lung cancer death rate is not higher in female than in male never smokers and shows little evidence of having increased over time in the absence of smoking. Factors that affect the interpretation of lung cancer trends are discussed. Our novel finding that lung cancer mortality is higher among African American than white women never smokers should be confirmed in other studies.
很少有研究直接测量从不吸烟者中肺癌发病和死亡的年龄、性别及种族特异性风险。需要此类数据来量化与吸烟相关的风险，并了解由主动吸烟以外的因素导致的种族和性别差异以及时间趋势。
我们测量了超过940,000名成年人中肺癌的年龄、性别及种族特异性死亡率（每100,000人年风险），这些成年人在1959 - 1972年（癌症预防研究I [CPS - I]）和1982 - 2000年（癌症预防研究II [CPS - II]）这两个美国癌症协会大型队列研究中登记时均无吸烟史。我们比较了男性和女性以及非裔美国人和白人之间的肺癌死亡率，并通过直接年龄标准化率以及泊松和Cox比例风险回归分析，分析了两项研究中从不吸烟者肺癌死亡率的时间趋势。所有统计检验均为双侧检验。
CPS - II中从不吸烟的男性和女性的年龄标准化肺癌死亡率分别为每100,000人年17.1例和14.7例。在两项研究中，从不吸烟的男性的年龄标准化肺癌死亡率均高于女性（CPS - I：风险比[HR] = 1.52，95%置信区间[CI] = 1.28至1.79；CPS - II：HR = 1.21，95% CI = 1.09至1.36）。在CPS - II中，非裔美国女性的肺癌死亡率高于白人女性（HR = 1.43，CI = 1.11至1.85）。白人女性（HR = 1.25，CI = 1.12至1.41）和非裔美国女性（HR = 1.22，CI = 0.64至2.33）的肺癌死亡率有小幅时间上升（CPS - II与CPS - I相比），但白人男性没有（HR = 0.89，CI = 0.74至1.08）。在白人女性和非裔美国女性中，仅70 - 84岁年龄段的时间上升具有统计学意义（P <.001）。
与临床认知相反，从不吸烟女性的肺癌死亡率并不高于从不吸烟男性，且几乎没有证据表明在无吸烟情况下肺癌死亡率随时间增加。讨论了影响肺癌趋势解读的因素。我们的新发现——从不吸烟的非裔美国女性肺癌死亡率高于白人女性——应在其他研究中得到证实。
