Mortality in relation to smoking: 40 years' observations on male British doctors

Doll, Richard; Pető, Richárd; Wheatley, Keith; Gray, Richard; Sutherland, Isabelle

doi:10.1136/bmj.309.6959.901

Cited by 2,973 publications

(1,100 citation statements)

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“…[12][13][14][15][16][17][18][19][20][21][27][28][29][30][31][32][33][34][35][36] The magnitude of relative risk in Japan ranged from 3.7-5.1 for all histologic types combined, either from cohort or case-control studies. When divided by histologic type, findings from a case-control study indicated that odds ratios ranged from 4.3-21.4 for squamous cell and small cell carcinoma and from 1.5-3.7 for adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

Cigarette smoking and subsequent risk of lung cancer by histologic type in middle‐aged Japanese men and women: The JPHC study

Sobue

Yamamoto

Hara

et al. 2002

Intl Journal of Cancer

142

115

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In order to update the findings of relative risk associated with cigarette smoking for lung cancer by histologic type in Japan, the data from a population-based cohort study of 91,738 men and women were analyzed. During 1990 -1999, 422 lung cancer incident cases were identified. The relative risk for all incident cases associated with current smokers versus non-smokers was 4.5 [95% confidence interval (CI): 3.0 -6.8] and 4.2 (95% CI: 2.4 -7.2), for men and women, respectively. When divided by histologic type, relative risk for squamous cell carcinoma and small cell carcinoma was 12.7 (95% CI: 4.7-34.7) and 17.5 (95% CI: 4.9 -62.1), while for adenocarcinoma it was 2.8 (95% CI: 1.6 -4.9) and 2.0 (95% CI: 0.8 -5.0) for men and women, respectively. We confirmed that the lung cancer risk in men rose with increasing cigarette smoking, especially the duration of smoking among current smokers and decreased after the cessation of smoking among former smokers. Unlike the US or European countries, the relative risk did not increase in this updated study, compared with previous studies in 1960s to 1990s in Japan either for all incident cases or for specific histologic types and the magnitude of relative risks was substantially lower than that observed in the US or European countries, especially for adenocarcinoma. © 2002 Wiley-Liss, Inc. Key words: lung cancer; histologic type; cigarette smoking; relative riskRecent trends in lung cancer incidence showed a relative increase in adenocarcinoma as compared with squamous cell carcinoma for both men and women in various countries. [1][2][3][4][5][6] It is hypothesized that this trend is mainly due to the dissemination of low-tar filter cigarettes, 7-9 since filters mainly remove the larger particles in cigarette smoke, which tend to be deposited in the central large bronchus where most squamous cell carcinomas arise. However, such filters do not remove smaller particles, which tend to reach the peripheral region of the lung where adenocarcinomas arise. Moreover, in order to compensate for nicotine intake, smokers of low-tar filter cigarettes tend to inhale more deeply than those of nonfilter cigarettes, which results in more cigarette smoke reaching the peripheral region. Switching from nonfilter to filter cigarettes occurred mostly during in the US, the UK and Japan, where market share of filtered cigarette exceeded that of nonfilter cigarette in 1959, 1967 and 1965, respectively. 10,11 In the US and European countries, this hypothesis is supported by the finding that the magnitude of the relative risk of lung adenocarcinoma associated with cigarette smoking increased in recent studies, just when the usage of low-tar filter cigarette became more widespread among study subjects. It is reported from the US that the risk of lung adenocarcinoma is many times higher for current smokers than non-smokers, i.e., 19.0-fold for men and 8.1-fold for women in the Cancer Prevention Study (CPS) II (1982II ( -1984, while in CPS I (1959 -1961) corresponding estimates were 4.6 and 1.5 for me...

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Section: Discussionmentioning

confidence: 99%

Cigarette smoking and subsequent risk of lung cancer by histologic type in middle‐aged Japanese men and women: The JPHC study

Sobue

Yamamoto

Hara

et al. 2002

Intl Journal of Cancer

142

115

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“…If all smokers age 40 -44 in a particular birth cohort continued smoking, that cohort's B/A would be the maximum value of about 12, according to longitudinal follow-up studies of smokers. 2,11 In contrast, if all smokers in a cohort quit at ages 40 -44, its B/A would be at a minimum of 4. 2,12 A B/A of 4 reflects the persisting rise in lung cancer from prior smoking and other causes.…”

Section: Methodsmentioning

confidence: 99%

Impact of the American anti‐smoking campaign on lung cancer mortality

Rodu¹,

Cole²

2001

Intl Journal of Cancer

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Customary statistics on smoking practices are limited because they do not correlate well with the frequency of smoking-related diseases. Our study developed outcome measures based on lung cancer mortality and used them to assess the anti-smoking campaign. Changes in mortality from lung cancer were used to assess significant smoking among 5-year birth cohorts of white men born from 1901 to 1942. We used each cohort's lung cancer mortality rate at ages 40 -44 to indicate its earlier smoking. A lung cancer mortality ratio was developed to describe each cohort's continued smoking from ages 40 -44 to 55-59. These ratios were then compared with the durations of the cohorts' exposure to the antismoking campaign that began in 1965. Lung cancer mortality in white men ages 40 -44 peaked in 1970 and declined continuously thereafter, indicating that the anti-smoking campaign promptly reduced significant smoking among younger men. However, the lung cancer mortality ratio indicates that only half of smokers in the specified birth cohorts were able to quit by ages 55-59, despite receiving ever more intense anti-smoking messages. The anti-smoking campaign produced moderate benefits among younger white male smokers but fewer benefits among older smokers because of the existence of a large number of inveterate smokers. © 2002 Wiley-Liss, Inc. Key words: smoking; lung cancer mortality; inveterate smokersThe anti-smoking campaign is intended to prevent morbidity and mortality caused by smoking. Yet, the campaign usually is evaluated by changes in measures such as population smoking rates and per-capita cigarette consumption. These statistics provide an overview of the amount of smoking in society, but they are only process measures. Both rely on surveys with inherent limitations including selection bias and progressive underreporting as smoking becomes less acceptable socially. 1,2 Specifically, neither measure describes the amount or duration of smoking by individuals or migration in and out of the "current smoker" category. Per-capita cigarette consumption data are limited further because the composition of cigarettes (e.g., filters, tobacco and tar content) has changed considerably over time. 3,4 In fact, neither smoking prevalence nor cigarette consumption is well correlated with the amount of disease that smoking causes. This is true even when accounting for an appropriate lag time. For example, smoking prevalence was 42% in 1965 and declined to 26% in 1990. 5 During that interval the prevalence of former smokers increased from 14% to 25%. Per capita cigarette consumption fell by one third from 4,258 in 1965 to 2,817 in 1990. Yet lung cancer mortality increased 78% from 23 per 100,000 person-years (py) in 1965 to 41 in 1990. 6 Thus, there is a need for outcome measures that describe meaningful changes in smoking. Our study develops such measures and uses them to describe the effects of the anti-smoking campaign. METHODSWe used mortality from lung cancer, the sentinel disease of cigarette smoking, to describe changes in smokin...

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“…Should tobacco smoking act as a liver carcinogen, the risk associated with the habit is probably weak, difficult to detect and easily confounded by other risk factors. An association between alcohol drinking and tobacco smoking has in fact been observed in Western countries (Doll et al, 1994), and thence the former may confound the risk of HCC due to tobacco smoking. Furthermore, although no association has been noted between tobacco smoking and HBV or HCV infection, these factors too may confound the effect of smoking.…”

Section: Tobacco Smokingmentioning

confidence: 99%

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

et al. 2006

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Hepatitis B virus (HBV), hepatitis C virus (HCV) and alcohol consumption are major causes of hepatocellular carcinoma (HCC) worldwide. We performed a systematic review of epidemiologic studies carried out on HCC aetiology in Southern Europe, an area with an intermediatehigh prevalence of these agents as well as of putative risk factors such as tobacco smoking, diabetes and obesity. To retrieve the articles, we performed a Medline search for titles and abstracts of articles. After the Medline search, we reviewed the papers and reference lists to identify additional articles. A synergism between HCV infection and HBV infection, overt (hepatitis B virus antigen (HbsAg) positivity) or occult (HBsAg negativity with presence of HBV DNA in liver or serum), is suggested by the results of some studies. The pattern of the risk for HCC due to alcohol intake shows a continuous dose-effect curve without a definite threshold, although most studies found that HCC risk increased only for alcohol consumption above 40-60 g of ethanol per day. Some evidence supports a positive interaction of alcohol intake probably with HCV infection and possibly with HBV infection. A few studies found that coffee has a protective effect on HCC risk due to various risk factors. Some data also support a role of tobacco smoking, diabetes and obesity as single agents or preferably cofactors in causing HCC. In countries with a relatively high alcohol consumption and intermediate levels of HCV and HBV infections (1-3% of population infected by each virus), such as Mediterranean countries, the three main risk factors together account for about 85% of the total HCC cases, leaving little space to other known risk factors, such as haemochromatosis, and to new, still unrecognised, factors as independent causes of HCC.

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Mortality in relation to smoking: 40 years' observations on male British doctors

Abstract: Results from the first 20 years of this study, and of other studies at that time, substantially underestimated the hazards of long term use of tobacco. It now seems that about half of all regular cigarette smokers will eventually be killed by their habit.

Cited by 2,973 publications

References 45 publications

Cigarette smoking and subsequent risk of lung cancer by histologic type in middle‐aged Japanese men and women: The JPHC study

Cigarette smoking and subsequent risk of lung cancer by histologic type in middle‐aged Japanese men and women: The JPHC study

Impact of the American anti‐smoking campaign on lung cancer mortality

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

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