Thun M J, Lally C A, Flannery J T, Calle E E, Flanders W D, Heath C W
Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA 30329-4251, USA.
J Natl Cancer Inst. 1997 Nov 5;89(21):1580-6. doi: 10.1093/jnci/89.21.1580.
Adenocarcinoma of the lung, once considered minimally related to cigarette smoking, has become the most common type of lung cancer in the United States. The increased incidence of this cancer might be explained by advances in diagnostic technology (i.e., increased ability to perform biopsies on tumors in smaller, more distal airways), changes in cigarette design (e.g., the adoption of filtertips), or changes in smoking practices. We examined data from the Connecticut Tumor Registry and two American Cancer Society studies to explore these possibilities.
Connecticut Tumor Registry data from 1959 through 1991 were analyzed to determine whether the increase in lung adenocarcinoma observed during that period could be best described by birth cohort effects (i.e., generational changes in cigarette smoking) or calendar period effects (i.e., diagnostic advances). Associations between cigarette smoking and death from specific types of lung cancer during the first 2 years of follow-up in Cancer Prevention Study I (CPS-I), initiated in 1959) and Cancer Prevention Study II (CPS-II, initiated in 1982) were also examined.
Adenocarcinoma incidence in Connecticut increased nearly 17-fold in women and nearly 10-fold in men from 1959 through 1991. The increases followed a clear birth cohort pattern, paralleling gender and generational changes in smoking more than diagnostic advances. Cigarette smoking became more strongly associated with death from lung adenocarcinoma in CPS-II compared with CPS-I, with relative risks of 19.0 (95% confidence interval [CI] = 8.3-47.7) for men and 8.1 (95% CI = 4.5-14.6) for women in CPS-II and 4.6 (95% CI = 1.7-12.6) for men and 1.5 (0.3-7.7) for women in CPS-I.
The increase in lung adenocarcinoma since the 1950s is more consistent with changes in smoking behavior and cigarette design than with diagnostic advances.
肺癌腺癌曾被认为与吸烟关系不大，但现已成为美国最常见的肺癌类型。这种癌症发病率的上升可能是由于诊断技术的进步（即对更小、更远端气道肿瘤进行活检的能力增强）、香烟设计的改变（如采用过滤嘴）或吸烟习惯的改变。我们分析了康涅狄格肿瘤登记处的数据以及两项美国癌症协会的研究，以探究这些可能性。
分析了1959年至1991年康涅狄格肿瘤登记处的数据，以确定该时期观察到的肺腺癌增加是否能用出生队列效应（即吸烟的代际变化）或日历时期效应（即诊断进展）来最好地描述。还研究了1959年启动的癌症预防研究I（CPS-I）和1982年启动的癌症预防研究II（CPS-II）随访的前两年中吸烟与特定类型肺癌死亡之间的关联。
1959年至1991年，康涅狄格州女性肺腺癌发病率增加了近17倍，男性增加了近10倍。这种增加呈现出明显的出生队列模式，与吸烟的性别和代际变化的平行程度超过了诊断进展。与CPS-I相比，CPS-II中吸烟与肺腺癌死亡的关联更强，CPS-II中男性的相对风险为19.0（95%置信区间[CI]=8.3-47.7），女性为8.1（95%CI=4.5-14.6）；CPS-I中男性为4.6（95%CI=1.7-12.6），女性为1.5（0.3-7.7）。
自20世纪50年代以来肺腺癌的增加与吸烟行为和香烟设计的变化比与诊断进展更一致。
