See the Notes section for the full list of authors' affiliations.
J Natl Cancer Inst. 2019 Aug 1;111(8):811-819. doi: 10.1093/jnci/djy206.
We previously found that African Americans and Native Hawaiians were at highest lung cancer risk compared with Japanese Americans and Latinos; whites were midway in risk. These differences were more evident at relatively low levels of smoking intensity, fewer than 20 cigarettes per day (CPD), than at higher intensity.
We apportioned lung cancer risk into three parts: age-specific background risk (among never smokers), an excess relative risk term for cumulative smoking, and modifiers of the smoking effect: race and years-quit smoking. We also explored the effect of replacing self-reports of CPD with a urinary biomarker-total nicotine equivalents-using data from a urinary biomarker substudy.
Total lung cancers increased from 1979 to 4993 compared to earlier analysis. Estimated excess relative risks for lung cancer due to smoking for 50 years at 10 CPD (25 pack-years) ranged from 21.9 (95% CI = 18.0 to 25.8) for Native Hawaiians to 8.0 (95% CI = 6.6 to 9.4) for Latinos over the five groups. The risk from smoking was higher for squamous cell carcinomas and small cell cancers than for adenocarcinomas. Racial differences consistent with earlier patterns were seen for overall cancer and for cancer subtypes. Adjusting for predicted total nicotine equivalents, Japanese Americans no longer exhibit a lower risk, and African Americans are no longer at higher risk, compared to whites. Striking risk differences between Native Hawaiians and Latinos persist.
Racial differences in lung cancer risk persist in the Multiethnic Cohort study that are not easily explained by variations in self-reported or urinary biomarker-measured smoking intensities.
与日本裔美国人和拉丁裔相比，非裔美国人和夏威夷原住民的肺癌风险最高；而白种人则处于中等风险。与较高的吸烟强度相比，在相对较低的吸烟强度（每天少于 20 支香烟）下，这些差异更为明显。
我们将肺癌风险分为三部分：从未吸烟者的特定年龄背景风险、累积吸烟的超额相对风险项，以及吸烟效应的修饰剂：种族和戒烟年限。我们还使用尿液生物标志物子研究的数据，探索用尿液生物标志物总尼古丁当量替代每日吸烟支数（CPD）自我报告的效果。
与早期分析相比，1979 年至 4993 年总肺癌病例有所增加。在五种人群中，每天 10 支香烟（25 包年）吸烟 50 年的肺癌超额相对风险估计值范围从 21.9（95%置信区间=18.0 至 25.8）的夏威夷原住民到 8.0（95%置信区间=6.6 至 9.4）的拉丁裔。与腺癌相比，鳞状细胞癌和小细胞癌的吸烟风险更高。总体癌症和癌症亚型均存在与早期模式一致的种族差异。与预测的总尼古丁当量相比，日本裔美国人不再表现出较低的风险，而非裔美国人也不再处于更高的风险，而白种人则处于中间位置。与拉丁裔相比，夏威夷原住民之间的风险差异仍然显著。
在多民族队列研究中，肺癌风险的种族差异仍然存在，这些差异不易用自我报告或尿液生物标志物测量的吸烟强度变化来解释。
