Mezzoiuso Angelo Giosuè, Odone Anna, Signorelli Carlo, Russo Antonio Giampiero
Epidemiology Unit, Agency for Health Protection of Milan, Corso Italia 52, 20122, Milan, Italy.
Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
J Cancer. 2021 Mar 31;12(11):3136-3144. doi: 10.7150/jca.54624. eCollection 2021.
Smoking is one of the leading causes of death worldwide, and it is strongly associated with several human cancers. However, the differential effects of cigarette smoke on the development and progression of different types of cancer remain unclear, and related data are limited. In this longitudinal cohort study conducted among 75,324 women aged 41-76 years, we aimed to evaluate the effect of exposure to tobacco smoke on cancer development. The participants completed a questionnaire assessing socio-demographic characteristics, anthropometric measures, health status, and lifestyle habits, including smoking and dietary habits; Cox proportional hazards regression modelling was used to evaluate the association between smoking and 21 different types of cancer. After a 15-year follow-up, we identified 9,487 cases of cancer through record linkage with the Cancer Registry of Milan. Smoking was found to be positively associated with all neoplasms, with a Hazard Ratio (HR) of 1.10 (95% Confidence Interval (CI), 1.04-1.16). Regarding the specific types, we found the following associations: cancer of the oral cavity HR = 2.63 ( 95% CI 1.72-4.01]), oesophagus HR = 3.09 (95% CI 1.37-6.96), stomach HR = 1.52 (95% CI 1.10-2.11), pancreas HR = 1.69 (95% CI 1.29-2.21), larynx HR= 34.81 (95% CI 8.07-150.14), lung HR = 8.48 (95% CI 7.09-10.14), cervix uteri HR = 2.51 (95% CI 1.38-4.57), and bladder and urinary tract HR = 5.67 ( 95% CI 3.96-8.14); lymphoma HR = 1.37 (95% CI 1.03-1.83); and colorectal cancer HR = 1.30 (95% CI 1.11-1.51). Our results thus demonstrate how smoke exposure increases the risk of several types of cancer. Considering the increasing prevalence of smoking among women, our results highlight the need to prioritize the development of anti-smoking campaigns targeted at women in order to contrast the evident gender inequality with respect to healthcare.
吸烟是全球主要死因之一，且与多种人类癌症密切相关。然而，香烟烟雾对不同类型癌症发生和发展的差异影响仍不明确，相关数据有限。在这项针对75324名年龄在41至76岁女性的纵向队列研究中，我们旨在评估接触烟草烟雾对癌症发生的影响。参与者完成了一份问卷，评估社会人口学特征、人体测量指标、健康状况和生活方式习惯，包括吸烟和饮食习惯；采用Cox比例风险回归模型评估吸烟与21种不同类型癌症之间的关联。经过15年的随访，我们通过与米兰癌症登记处的记录链接确定了9487例癌症病例。发现吸烟与所有肿瘤呈正相关，风险比（HR）为1.10（95%置信区间（CI），1.04 - 1.16）。关于具体类型，我们发现以下关联：口腔癌HR = 2.63（95% CI 1.72 - 4.01），食管癌HR = 3.09（95% CI 1.37 - 6.96），胃癌HR = 1.52（95% CI 1.10 - 2.11），胰腺癌HR = 1.69（95% CI 1.29 - 2.21），喉癌HR = 34.81（95% CI 8.07 - 150.14），肺癌HR = 8.48（95% CI 7.09 - 10.14），子宫颈癌HR = 2.51（95% CI 1.38 - 4.57），膀胱和尿路癌HR = 5.67（95% CI 3.96 - 8.14）；淋巴瘤HR = 1.37（95% CI 1.03 - 1.83）；结直肠癌HR = 1.30（95% CI 1.11 - 1.51）。因此，我们的结果表明接触烟雾会增加多种类型癌症的风险。考虑到女性吸烟率不断上升，我们的结果凸显了优先开展针对女性的反吸烟运动的必要性，以消除医疗保健方面明显的性别不平等。
