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吸烟减少、戒烟和复吸对癌症风险的影响：一项全国性队列研究。

Effect of smoking reduction, cessation, and resumption on cancer risk: A nationwide cohort study.

机构信息

Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea.

Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.

出版信息

Cancer. 2022 Jun 1;128(11):2126-2137. doi: 10.1002/cncr.34172. Epub 2022 Mar 17.

DOI:10.1002/cncr.34172

PMID:35298026

Abstract

BACKGROUND

The objective of this study was to investigate the effects of reduction, cessation, and resumption of smoking on cancer development.

METHODS

The authors identified 893,582 participants who currently smoked, had undergone a health screening in 2009, and had a follow-up screening in 2011. Among them, 682,996 participated in a third screening in 2013. Participants were categorized as quitters, reducers I (≥50% reduction), reducers II (<50% reduction), sustainers (referent), or increasers (≥20% increase). Outcome data were obtained through December 31, 2018.

RESULTS

Reducers I exhibited a decreased risk of all cancers (adjusted hazard ratio [aHR], 0.96; 95% confidence interval [CI], 0.93-0.99), smoking-related cancers (aHR, 0.95; 95% CI, 0.92-0.99), and lung cancer (aHR, 0.83; 95% CI, 0.77-0.88). Quitters had the lowest risk of all cancers (aHR, 0.94; 95% CI, 0.92-0.96), smoking-related cancers (aHR, 0.91; 95% CI, 0.89-0.93), and lung cancer (aHR, 0.79; 95% CI, 0.76-0.83). In further analysis with 3 consecutive screenings, additional smoking reduction (from reducers II to reducers I) lowered the risk of lung cancer (aHR, 0.74; 95% CI, 0.58-0.94) in comparison with sustainers. Quitting among reducers I further decreased the risk of all cancers (aHR, 0.90; 95% CI, 0.80-1.00), smoking-related cancers (aHR, 0.81; 95% CI, 0.81-0.92), and lung cancer (aHR, 0.66; 95% CI, 0.52-0.84) in comparison with sustainers. Smoking resumption after quitting, even at a lower level, increased the risk of smoking-related cancers (aHR, 1.19; 95% CI, 1.06-1.33) and lung cancer (aHR, 1.48; 95% CI, 1.21-1.80) in comparison with sustained quitting.

CONCLUSIONS

Smoking cessation and, to a lesser extent, smoking reduction decreased the risks of cancer. Smoking resumption increased cancer risks in comparison with sustained quitting.

LAY SUMMARY

Worldwide, tobacco use is the single leading preventable risk factor for cancer and cancer death. This study examined the effects of reduction, cessation, and resumption of smoking on cancer development by measuring smoking behavior repetitively. Although smoking reduction has a substantial cancer prevention benefit for those who cannot quit, cessation should be encouraged whenever possible. Quitters should be monitored to ensure that they do not resume smoking.

摘要

背景

本研究旨在探讨吸烟量减少、戒烟和复吸对癌症发展的影响。

方法

作者共纳入 893582 名当前吸烟者，这些参与者在 2009 年进行了健康筛查，并在 2011 年进行了随访筛查。其中，682996 名参与者在 2013 年进行了第三次筛查。将参与者分为戒烟者、减量 I 组（≥50%减量）、减量 II 组（<50%减量）、持续吸烟者（参照组）或增量组（≥20%增量）。研究结果截止至 2018 年 12 月 31 日。

结果

与持续吸烟者相比，减量 I 组的所有癌症（调整后的危险比 [aHR]，0.96；95%置信区间 [CI]，0.93-0.99）、与吸烟相关的癌症（aHR，0.95；95%CI，0.92-0.99）和肺癌（aHR，0.83；95%CI，0.77-0.88）风险降低。戒烟者的所有癌症（aHR，0.94；95%CI，0.92-0.96）、与吸烟相关的癌症（aHR，0.91；95%CI，0.89-0.93）和肺癌（aHR，0.79；95%CI，0.76-0.83）风险最低。进一步对连续 3 次筛查进行分析，与持续吸烟者相比，额外的吸烟量减少（从减量 II 组到减量 I 组）可降低肺癌风险（aHR，0.74；95%CI，0.58-0.94）。与持续吸烟者相比，减量 I 组的戒烟者的所有癌症（aHR，0.90；95%CI，0.80-1.00）、与吸烟相关的癌症（aHR，0.81；95%CI，0.81-0.92）和肺癌（aHR，0.66；95%CI，0.52-0.84）风险进一步降低。与持续戒烟相比，即使吸烟量减少，复吸也会增加与吸烟相关的癌症（aHR，1.19；95%CI，1.06-1.33）和肺癌（aHR，1.48；95%CI，1.21-1.80）的风险。