Epidemiological evidence suggests that airway obstruction is an independent risk factor for lung cancer and that this cannot be explained by active or passive smoking alone. Chlamydia pneumoniae infection has been associated with chronic bronchitis and its exacerbates. Our aim was to evaluate the association between chronic C. pneumoniae infection and risk of lung cancer among male smokers. Smoking males with lung cancer (n 5 230) and their age-and locality-matched controls were selected among participants of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The presence of C. pneumoniae infection was assessed by analyzing specific antibodies and immune complexes in 2 serum samples collected with a 3-year interval before the lung cancer diagnosis. The diagnosis of chronic infection was based on stable levels of positive specific IgA antibody (titer H 16) and immune complex (titer H 4). Relative risks were estimated by odds ratios (OR) adjusted for age, locality and smoking history by a conditional logistic regression model. Markers suggesting chronic C. pneumoniae infection were present in 52% of cases and 45% of controls and hence were positively associated with the incidence of lung cancer (OR 1.6; 95% confidence interval [CI] 1.0-2.3). The incidence was especially increased in men younger than 60 years (OR 2.9; 95% CI 1.5-5.4) but not in the older age group (OR 0.9; 95% CI 0.5-1.6). Before concluding that C. pneumoniae infection is a new independent risk factor for lung cancer, corroboration from other studies with larger number of cases and longer follow-up is needed. Int. J. Cancer 74:31-34.Chlamydia pneumoniae is a common intracellular bacterium that causes pneumonia and other respiratory infections world-wide. Like all Chlamydia organisms, it has a tendency to cause persistent and chronic infections. C. pneumoniae has been serologically associated with chronic lung diseases such as chronic bronchitis (von Hertzen et al., 1995) and adult onset asthma (Hahn et al., 1991), as well as and with atherosclerosis (Saikku et al., 1988), in which the organism has been demonstrated in atherosclerotic plaques (Kuo et al., 1993). Chronic bronchitis has been suggested as an independent etiologic factor in lung cancer (Osann, 1991), the effect of which cannot be explained by either active or passive exposure to cigarette smoke. Smoking does, however, appear to promote chronic C. pneumoniae infection, probably through immunosuppression (Karvonen et al., 1994a).In Finland, nearly 30,000 male smokers were followed for 5-8 years in 1985-1993 in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study Group, 1994). We analyzed baseline and 3-year follow-up serum samples from 230 men diagnosed with lung cancer after the third year and their age-, timeand locality-matched controls for C. pneumoniae-specific IgG and IgA antibodies and immune complexes to study the association between markers suggestive of chronic C. pneumoniae infection and lung cancer.
MATERIAL AND METHODS
Base population and follow-u...