Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Int J Cancer. 2011 Jan 1;128(1):157-65. doi: 10.1002/ijc.25305.
Although some authorities consider smoking to be an established risk factor for colorectal cancer, the international literature is not entirely consistent. Further, only 1 study has addressed the association with smokeless tobacco and none with Scandinavian moist snuff (snus). This retrospective cohort study included 336,381 male Swedish construction workers with detailed information on tobacco use at cohort entry in 1971-1992. Complete follow-up through 2007 was accomplished by means of linkage to population and health registers. Hazard ratios (HRs) and 95% confidence intervals (CIs) derived from Cox proportional hazards regression models estimated relative risks, adjusted for age and body mass index. Subjects who were never-users of any tobacco served as reference. After up to 37 years of follow-up, pure smoking was associated with a marginally increased risk of colon cancer (HR 1.08, 95% CI 0.99-1.19), a modestly elevated risk of rectal cancer (HR 1.16, 95% CI 1.04-1.30) and a substantial excess risk of anal cancer (HR 2.41, 95% CI 1.06-5.48). Snus use was not significantly associated with an increased risk of colorectal or anal cancer, although the point estimate for colon cancer was similar to that observed among smokers. Swedish data provide meager support for the association between tobacco use and colorectal cancer. A general tendency among Swedish men to quit smoking in recent decades might have attenuated true associations. A link between smoking and anal cancer was confirmed.
尽管一些权威认为吸烟是结直肠癌的既定危险因素，但国际文献并非完全一致。此外，只有一项研究探讨了与无烟烟草的关联，而没有一项研究探讨与斯堪的纳维亚湿鼻烟（鼻烟）的关联。这项回顾性队列研究包括 336381 名瑞典建筑工人，他们在 1971 年至 1992 年的队列入组时详细记录了吸烟情况。通过与人口和健康登记册的链接，完成了截至 2007 年的完整随访。Cox 比例风险回归模型得出的风险比（HR）和 95%置信区间（CI）估计了相对风险，调整了年龄和体重指数。从未使用过任何烟草的受试者作为参考。在最多 37 年的随访后，纯吸烟与结肠癌风险略有增加相关（HR 1.08，95%CI 0.99-1.19），直肠癌风险适度升高（HR 1.16，95%CI 1.04-1.30），肛门癌风险显著升高（HR 2.41，95%CI 1.06-5.48）。鼻烟使用与结直肠癌或肛门癌的风险增加无关，但结肠癌的点估计值与吸烟者观察到的相似。瑞典数据对吸烟与结直肠癌之间的关联提供了微薄的支持。最近几十年来，瑞典男性普遍戒烟的趋势可能减弱了真正的关联。吸烟与肛门癌之间的联系得到了证实。
