Abstract
BackgroundFew epidemiologic findings are as well established as the association between smoking and lung cancer. It is therefore somewhat surprising that there is not yet a clear consensus about the exposure-response relationships between various metrics of smoking and lung cancer risk. In part this is due to heterogeneity of how exposure-response results have been presented and the relative paucity of published results using any particular metric of exposure. The purposes of this study are: to provide new data on smoking-lung cancer associations and to explore the relative impact of different dimensions of smoking history on lung cancer risk.MethodsBased on a large lung cancer case-control study (1203 cases and 1513 controls) conducted in Montreal in 1996–2000, we estimated the lifetime prevalence of smoking and odds ratios in relation to several smoking metrics, both categorical and continuous based on multivariable unconditional logistic regression.ResultsOdds ratios (ORs) for ever vs never smoking were 7.82 among males and 11.76 among females. ORs increased sharply with every metric of smoking examined, more so for duration than for daily intensity. In models using continuous smoking variables, all metrics had strong effects on OR and mutual adjustment among smoking metrics did not noticeably attenuate the OR estimates, indicating that each metric carries some independent risk-related information. Among all the models tested, the one based on a smoking index that integrates several smoking dimensions, provided the best fitting model. Similar patterns were observed for the different histologic types of lung cancer.ConclusionsThis study provides many estimates of exposure-response relationships between smoking and lung cancer; these can be used in future meta-analyses. Irrespective of the histologic type of lung cancer and the smoking metric examined, high levels of smoking led to high levels of risk, for both men and women.
Highlights
Few epidemiologic findings are as well established as the association between smoking and lung cancer
Remen et al BMC Cancer (2018) 18:1275 because such information will be useful for public health purposes, to build lung cancer risk prediction models that can be used to advise healthy patients about their risks related to their past and possible future smoking behaviors, to understand mechanisms of carcinogenesis, and to provide information that may be useful in a legal context, for compensation or litigation purposes
In carrying out a large case-control study of lung cancer in the Montreal area to explore the possible etiologic role of scores of occupational and environmental factors in lung cancer [6], we collected a detailed smoking history from each subject. We use this dataset to address two objectives: a) provide evidence of exposure-response relationships between smoking history and lung cancer, using a variety of smoking metrics and formats that might be used in future meta-analyses; b) explore the relative impact of different dimensions of smoking history and how these interact in predicting risk [7,8,9,10]
Summary
Few epidemiologic findings are as well established as the association between smoking and lung cancer. In carrying out a large case-control study of lung cancer in the Montreal area to explore the possible etiologic role of scores of occupational and environmental factors in lung cancer [6], we collected a detailed smoking history from each subject We use this dataset to address two objectives: a) provide evidence of exposure-response relationships between smoking history and lung cancer, using a variety of smoking metrics and formats that might be used in future meta-analyses; b) explore the relative impact of different dimensions of smoking history and how these interact in predicting risk [7,8,9,10]
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