Siemiatycki J, Krewski D, Franco E, Kaiserman M
Institut Armand-Frappier, Université du Québec, Laval-des-Rapides, Canada.
Int J Epidemiol. 1995 Jun;24(3):504-14. doi: 10.1093/ije/24.3.504.
Although the effects of cigarette smoking on cancer risk have been well documented, there remain several outstanding issues to be clarified, including the determination of which types of cancer are associated with smoking and estimation of the magnitude of the effect of smoking on different types of cancer. A further issue is whether the effects seen elsewhere can be demonstrated in Canada, where tobacco products differ somewhat from those in other countries.
A case-control study was undertaken in Montreal to investigate the associations between a large number of environmental and occupational exposures on the one hand, and several types of cancer on the other. Between 1979 and 1985, interviews were carried out with incident male cases of 21 types of cancer, including 15 anatomical sites and six histological subtypes. The interview was designed to obtain detailed information on smoking histories, job histories, and other potential confounders. Altogether, 3730 cancer patients and 533 population controls were interviewed. For each type of cancer analysed, two control groups were used: population controls and cancer controls (selected from among other cancer patients). The purpose of the present analysis is to estimate the relative risk of each of 21 types of cancer in relation to smoking and to estimate the percentage of cancer cases attributable to cigarette smoking.
Separate analyses conducted with the two control groups produced similar results. Of the many sites of cancer examined, the following were not associated with cigarette smoking: colon, rectum, liver, prostate, kidney and skin (melanoma). Within the lymphoreticular system, there was no excess risk of Hodgkin's lymphoma, although the results for non-Hodgkin's lymphoma were weakly suggestive of an association with smoking. The following sites were clearly associated with smoking: lung (odds ratio [OR] = 12.1), bladder (OR = 2.4), oesophagus (OR = 2.4), stomach (OR = 1.7), and pancreas (OR = 1.6). Population attributable risk percentages due to smoking were 90% for lung, 53% for bladder, 54% for oesophagus, 35% for stomach, and 33% for pancreas.
Of the 21 types of cancer examined, the following were associated with smoking among men in Montreal: lung (including all major histological subtypes), bladder (and its main histological subtypes), oesophagus, stomach and pancreas. Smoking likely accounts for a large proportion of cancers occurring at these sites.
尽管吸烟对癌症风险的影响已有充分记录，但仍有几个突出问题有待澄清，包括确定哪些类型的癌症与吸烟有关，以及估计吸烟对不同类型癌症影响的程度。另一个问题是，在加拿大能否证明在其他地方观察到的影响，因为加拿大的烟草产品与其他国家的有所不同。
在蒙特利尔进行了一项病例对照研究，以调查一方面大量环境和职业暴露与另一方面几种癌症类型之间的关联。1979年至1985年间，对21种癌症的男性新发病例进行了访谈，包括15个解剖部位和6种组织学亚型。访谈旨在获取吸烟史、工作史和其他潜在混杂因素的详细信息。总共对3730名癌症患者和533名人群对照进行了访谈。对于每种分析的癌症类型，使用了两个对照组：人群对照和癌症对照（从其他癌症患者中选取）。本分析的目的是估计21种癌症类型中每种癌症与吸烟相关的相对风险，并估计归因于吸烟的癌症病例百分比。
对两个对照组进行的单独分析得出了相似的结果。在检查的众多癌症部位中，以下部位与吸烟无关：结肠、直肠、肝脏、前列腺、肾脏和皮肤（黑色素瘤）。在淋巴网状系统内，霍奇金淋巴瘤没有额外风险，尽管非霍奇金淋巴瘤的结果微弱地提示与吸烟有关。以下部位与吸烟明显相关：肺（比值比[OR]=12.1）、膀胱（OR=2.4）、食管（OR=2.4）、胃（OR=1.7）和胰腺（OR=1.6）。吸烟导致的人群归因风险百分比在肺癌中为90%，在膀胱癌中为53%，在食管癌中为54%，在胃癌中为35%，在胰腺癌中为33%。
在检查的21种癌症类型中，以下癌症在蒙特利尔男性中与吸烟有关：肺（包括所有主要组织学亚型）、膀胱（及其主要组织学亚型）、食管、胃和胰腺。吸烟可能占这些部位发生的癌症的很大比例。
