Abstract
Recent changes in the histology of lung cancer, namely a relative increase of adenocarcinoma compared to squamous cell carcinoma, might be due to a temporal shift from nonfilter to filter cigarettes. To investigate the association between type of cigarette and lung cancer by histological type, we conducted a case–control study in Japan, comprising 356 histologically confirmed lung cancer cases and 162 controls of male current smokers, who provided complete smoking histories. Overall, logistic regression analysis after controlling for age and prefecture revealed decreased risk, as shown by adjusted odds ratios, for both squamous cell carcinoma and adenocarcinoma among lifelong filter-exclusive smokers as compared to nonfilter or mixed smokers. This decrease was greater for squamous cell carcinoma than for adenocarcinoma. Among men under 54 years, filter-exclusive smokers displayed increased risk of adenocarcinoma, but decreased risk of squamous cell carcinoma. The recent shift in histology from squamous cell carcinoma to adenocarcinoma, particularly among younger smokers, might be due to changes in cigarette type. However, among subjects aged 65 years or more, no differences in histological type appeared related to type of cigarette smoked, implying that other factors are associated with increases in adenocarcinoma among older Japanese population.
Highlights
Changes in the composition of cigarettes, such as content of tar and nicotine, might influence lung cancer trends
The present study explored the relationship between type of cigarettes smoked and lung cancer histology in Japan, focusing on differences between squamous cell carcinoma (SCC) and AC, by means of a multicentre, hospital-based case – control study
Current cigarette smoking was associated with increased risk of overall lung cancer, SCC and AC; adjusted odds ratios (ORs) of current smokers as compared to nonsmokers were 4.56 for all lung cancers, 24.5 for SCC, and 2.56 for AC, respectively, for men, and 2.29 for all lung cancers, 10.9 for SCC, and 1.48 for AC, respectively, for women
Summary
Changes in the composition of cigarettes, such as content of tar and nicotine, might influence lung cancer trends. The market share held by high-tar nonfilter cigarettes was almost completely taken over by low-tar filter cigarettes in the 1960s in both Japan and Western countries (Wynder et al, 1991). The links between changes in histology of lung cancer and type of cigarettes have led to the hypothesis that the type of cigarette, that is, filter or nonfilter, is associated with changing histological patterns of lung
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