Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, 100191, China.
Environ Res. 2022 Sep;212(Pt C):113371. doi: 10.1016/j.envres.2022.113371. Epub 2022 Apr 30.
Involuntary smoking was a major public health problem for women in China. Previous studies mainly focused on secondhand smoke (SHS), which referred to direct exposure to smoke from burning cigarettes. Little evidence existed about the relationship between thirdhand smoke (THS), the residual tobacco smoke remaining in the environment after tobacco had been smoked, and cervical cancer. The China Kadoorie Biobank (CKB) study recruited 0.3 million female participants from 10 areas across China during 2004-2008. After an 11.2-year median follow-up, we documented 1094 cervical cancer cases. Multivariable Cox regression yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of SHS and THS with cervical cancer incidence, respectively and jointly. Overall, 60.3% reported weekly SHS exposure, and 83.2% had been exposed to THS. Daily SHS exposure and THS exposure at the enrollment were associated with elevated risks of cervical cancer incidence, with adjusted HRs (95% CI) of 1.22 (1.06,1.42) and 1.24 (1.03,1.49), respectively. The longer the exposure duration, the higher the risks (P for trend = 0.006, 0.035, respectively). Compared with those who were neither exposed to SHS nor THS, those exposed to both SHS and THS had the highest risk, with adjusted HRs (95% CI) of 1.29 (1.05,1.58). Area of residence, breastfeeding duration and heating fuel types are potential effect modifiers. Among Chinese females, both SHS and THS were associated with higher risks of cervical cancer incidence, and a dose-response relationship was found between the exposure duration and cervical cancer risk. Our findings reinforce the need for proactive strategies for tobacco control, to protect women health.
在中国，女性面临的主要公共卫生问题是被动吸烟。之前的研究主要集中在二手烟（SHS）上，它是指直接暴露在燃烧香烟产生的烟雾中。而有关三手烟（THS），即吸烟后残留在环境中的烟草烟雾，与宫颈癌之间的关系的证据很少。中国慢性病前瞻性研究（CKB）于 2004 年至 2008 年期间在全国 10 个地区招募了 30 万名女性参与者。在中位随访 11.2 年后，我们记录了 1094 例宫颈癌病例。多变量 Cox 回归分析分别和联合分析了 SHS 和 THS 与宫颈癌发病率的关系，得出了调整后的危险比（HR）和 95%置信区间（CI）。总体而言，60.3%的人报告每周有 SHS 暴露，83.2%的人有 THS 暴露。每天的 SHS 暴露和登记时的 THS 暴露与宫颈癌发病率的升高有关，调整后的 HR（95%CI）分别为 1.22（1.06，1.42）和 1.24（1.03，1.49）。暴露时间越长，风险越高（趋势检验 P 值分别为 0.006、0.035）。与既不暴露于 SHS 也不暴露于 THS 的人相比，同时暴露于 SHS 和 THS 的人风险最高，调整后的 HR（95%CI）为 1.29（1.05，1.58）。居住地、母乳喂养持续时间和取暖燃料类型是潜在的效应修饰剂。在中国女性中，SHS 和 THS 均与宫颈癌发病率升高有关，并且暴露持续时间与宫颈癌风险之间存在剂量-反应关系。这些发现强化了采取积极的烟草控制策略以保护女性健康的必要性。
