Frobisher Clare, Winter David L, Lancashire Emma R, Reulen Raoul C, Taylor Aliki J, Eiser Christine, Stevens Michael C G, Hawkins Michael M
Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, University of Birmingham, Birmingham B15 2TT, UK.
J Natl Cancer Inst. 2008 Aug 6;100(15):1068-81. doi: 10.1093/jnci/djn210. Epub 2008 Jul 29.
Smoking should be particularly discouraged among survivors of childhood cancer, who are at increased risk of adverse effects of the cancer and its treatment. We examined the extent of cigarette smoking, factors associated with being a current smoker, and age at initiation of regular smoking among adult survivors of childhood cancer and compared the survivors' smoking habits with those of the general population.
We used data from the British Childhood Cancer Survivor Study (BCCSS), a population-based cohort of 17 981 individuals who were diagnosed with childhood cancer between 1940 and 1991 in Britain and had survived for at least 5 years after diagnosis. The 14 836 cohort members who were alive and aged 16 years or older up to September 2006 were eligible to receive a mailed questionnaire that ascertained smoking status and other factors. The general population data were from the 2002 General Household Survey in Britain. Logistic regression was used to investigate factors associated with being a current regular smoker and to compare the prevalence of current regular smoking in the study cohort with that in the general population. Cox regression was used to examine associations between explanatory factors and age at smoking initiation. All statistical tests were two-sided.
Of the 10 326 childhood cancer survivors who returned completed questionnaires, 20.0% were current regular smokers and 29.8% were ever regular smokers, whereas in the comparable general population 28.1% were current regular smokers and 48.8% were ever regular smokers. Current regular smoking was more prevalent among survivors of Wilms tumor or Hodgkin lymphoma than survivors of a central nervous system (CNS) neoplasm; in those aged 10-14 years at diagnosis than 0-4 years; in those not treated with radiotherapy; in those in manual occupations; in those who were separated, widowed, or divorced; in those with lower educational attainment; and in those not currently on long-term regular hospital follow-up. Rates of smoking initiation were lower in women; in those treated with chemotherapy or radiotherapy; and in those with a third party-completed questionnaire. The rate of smoking initiation was highest among those diagnosed at 10-14 years of age. The odds ratio for being a current regular smoker among the survivors compared with the general population was 0.51 (99% confidence interval [CI] = 0.46 to 0.57). Survivors who smoked, smoked fewer cigarettes per day than smokers in the general population; the difference in the multivariable model was 1.5 fewer cigarettes per day (95% CI = 1.03 to 1.99).
The prevalence of smoking varies by subgroup among adult survivors of childhood cancer in the BCCSS but is substantially less overall than that in the general population.
尤其应劝阻儿童癌症幸存者吸烟，因为他们患癌症及其治疗产生不良反应的风险更高。我们调查了儿童癌症成年幸存者中吸烟的程度、当前吸烟者的相关因素以及开始定期吸烟的年龄，并将幸存者的吸烟习惯与普通人群进行了比较。
我们使用了英国儿童癌症幸存者研究（BCCSS）的数据，该研究基于人群队列，纳入了1940年至1991年在英国被诊断为儿童癌症且诊断后存活至少5年的17981名个体。截至2006年9月，14836名年龄在16岁及以上且在世的队列成员有资格收到一份邮寄问卷，问卷确定了吸烟状况及其他因素。普通人群数据来自2002年英国综合住户调查。采用逻辑回归研究与当前定期吸烟相关的因素，并比较研究队列中当前定期吸烟的患病率与普通人群的患病率。采用Cox回归研究解释因素与开始吸烟年龄之间的关联。所有统计检验均为双侧检验。
在10326名返回完整问卷的儿童癌症幸存者中，20.0%为当前定期吸烟者，29.8%曾经是定期吸烟者，而在可比普通人群中，28.1%为当前定期吸烟者，48.8%曾经是定期吸烟者。肾母细胞瘤或霍奇金淋巴瘤幸存者中当前定期吸烟的患病率高于中枢神经系统（CNS）肿瘤幸存者；诊断时年龄在10 - 14岁的幸存者高于0 - 4岁的幸存者；未接受放疗的幸存者；从事体力劳动的幸存者；分居、丧偶或离婚的幸存者；教育程度较低的幸存者；以及目前未接受长期定期医院随访的幸存者。女性、接受化疗或放疗的幸存者以及由第三方填写问卷的幸存者开始吸烟的比例较低。开始吸烟的比例在诊断时年龄为10 - 14岁的人群中最高。与普通人群相比，幸存者中当前定期吸烟者的优势比为0.51（99%置信区间[CI]=0.46至0.57）。吸烟的幸存者每天吸烟的支数比普通人群中的吸烟者少；多变量模型中的差异为每天少1.5支（95%CI = 1.03至1.99）。
在BCCSS中，儿童癌症成年幸存者中吸烟的患病率因亚组而异，但总体上远低于普通人群。
