Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 6120 Executive Blvd, EPS/320, MSC 7232, Rockville, MD 20852, USA.
JAMA. 2011 Aug 17;306(7):737-45. doi: 10.1001/jama.2011.1142.
Previous studies indicate that the population attributable risk (PAR) of bladder cancer for tobacco smoking is 50% to 65% in men and 20% to 30% in women and that current cigarette smoking triples bladder cancer risk relative to never smoking. During the last 30 years, incidence rates have remained stable in the United States in men (123.8 per 100,000 person-years to 142.2 per 100,000 person-years) and women (32.5 per 100,000 person-years to 33.2 per 100,000 person-years); however, changing smoking prevalence and cigarette composition warrant revisiting risk estimates for smoking and bladder cancer.
To evaluate the association between tobacco smoking and bladder cancer.
DESIGN, SETTING, AND PARTICIPANTS: Men (n = 281,394) and women (n = 186,134) of the National Institutes of Health-AARP (NIH-AARP) Diet and Health Study cohort completed a lifestyle questionnaire and were followed up between October 25, 1995, and December 31, 2006. Previous prospective cohort studies of smoking and incident bladder cancer were identified by systematic review and relative risks were estimated from fixed-effects models with heterogeneity assessed by the I(2) statistic.
Hazard ratios (HRs), PARs, and number needed to harm (NNH).
During 4,518,941 person-years of follow-up, incident bladder cancer occurred in 3896 men (144.0 per 100,000 person-years) and 627 women (34.5 per 100,000 person-years). Former smokers (119.8 per 100,000 person-years; HR, 2.22; 95% confidence interval [CI], 2.03-2.44; NNH, 1250) and current smokers (177.3 per 100,000 person-years; HR, 4.06; 95% CI, 3.66-4.50; NNH, 727) had higher risks of bladder cancer than never smokers (39.8 per 100,000 person-years). In contrast, the summary risk estimate for current smoking in 7 previous studies (initiated between 1963 and 1987) was 2.94 (95% CI, 2.45-3.54; I(2) = 0.0%). The PAR for ever smoking in our study was 0.50 (95% CI, 0.45-0.54) in men and 0.52 (95% CI, 0.45-0.59) in women.
Compared with a pooled estimate of US data from cohorts initiated between 1963 and 1987, relative risks for smoking in the more recent NIH-AARP Diet and Health Study cohort were higher, with PARs for women comparable with those for men.
先前的研究表明，膀胱癌的人群归因风险（PAR）在男性中为 50%至 65%，在女性中为 20%至 30%，且目前吸烟使膀胱癌的风险相对于从不吸烟增加了两倍。在过去的 30 年中，美国男性的膀胱癌发病率保持稳定（每 100000 人年 123.8 至每 100000 人年 142.2），女性（每 100000 人年 32.5 至每 100000 人年 33.2）；然而，吸烟流行率和香烟成分的变化使得有必要重新评估吸烟和膀胱癌的风险估计。
评估吸烟与膀胱癌之间的关联。
设计、地点和参与者：美国国立卫生研究院-美国退休人员协会（NIH-AARP）饮食与健康研究队列的男性（n=281394）和女性（n=186134）完成了一份生活方式问卷，并在 1995 年 10 月 25 日至 2006 年 12 月 31 日期间进行了随访。通过系统回顾确定了之前前瞻性队列研究中吸烟与膀胱癌发病的关系，并使用固定效应模型估算了相对风险，并通过 I(2)统计量评估了异质性。
风险比（HRs）、PAR 和需要治疗的人数（NNH）。
在 4518941 人年的随访期间，3896 名男性（每 100000 人年 144.0）和 627 名女性（每 100000 人年 34.5）发生了膀胱癌。与从不吸烟者相比，前吸烟者（每 100000 人年 119.8；HR，2.22；95%置信区间 [CI]，2.03-2.44；NNH，1250）和当前吸烟者（每 100000 人年 177.3；HR，4.06；95%CI，3.66-4.50；NNH，727）的膀胱癌风险更高。相比之下，之前的 7 项研究（始于 1963 年至 1987 年）的当前吸烟汇总风险估计为 2.94（95%CI，2.45-3.54；I(2)=0.0%）。我们的研究中，终生吸烟的 PAR 为男性 0.50（95%CI，0.45-0.54），女性 0.52（95%CI，0.45-0.59）。
与 1963 年至 1987 年期间启动的美国队列数据的汇总估计相比，最近 NIH-AARP 饮食与健康研究队列中吸烟的相对风险更高，女性的 PAR 与男性相当。
