Abstract
BackgroundWe examined the association between active and passive smoking and lung cancer risk and the population attributable fraction (PAF) of lung cancer due to active smoking, in the Norwegian Women and Cancer Study, a nationally representative prospective cohort study.MethodsWe followed 142,508 women, aged 31–70 years, who completed a baseline questionnaire between 1991 and 2007, through linkages to national registries through December 2015. We used Cox proportional hazards models, to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). We calculated PAF to indicate what proportion of lung cancer cases could have been prevented in the absence of smoking.ResultsDuring the more than 2.3 million person-years of observation, we ascertained 1507 lung cancer cases. Compared with never smokers, current (HR 13.88, 95% CI 10.18–18.91) smokers had significantly increased risk of lung cancer. Female never smokers exposed to passive smoking had a 1.3-fold (HR 1.34, 95% CI 0.89–2.01) non- significantly increased risk of lung cancer, compared with never smokers. The PAF of lung cancer was 85.3% (95% CI 80.0–89.2).ConclusionMore than 8 in 10 lung cancer cases could have been avoided in Norway, if the women did not smoke.
Highlights
We examined the association between active and passive smoking and lung cancer risk and the population attributable fraction (PAF) of lung cancer due to active smoking, in the Norwegian Women and Cancer Study, a nationally representative prospective cohort study
Few prospective cohort studies have been able to study both active and passive smoking, and the lung cancer risk they confer among women
Female never smokers exposed to passive smoking had a hazard ratio of 1.34 compared with never smokers without any passive exposure
Summary
Lung cancer is the third most common cancer in women worldwide.[1]. Active smoking is the main cause of lung cancer. The incidence of lung cancer among women in Western Europe has plateaued in recent years.[2] In Norway, the incidence rate for lung cancer in women decreased in 2017. If this reduction continues, 2015 will be the top year with the highest incidence of lung cancer among Norwegian women, with a rate of 53.1 per 100,000.3 In 2017, the incidence rate of lung cancer among Norwegian women were 52.0 per 100,000.4 The incidence trend of lung cancer among. Few prospective cohort studies have been able to study both active and passive smoking, and the lung cancer risk they confer among women. We utilised the Norwegian Women and Cancer Study, a nationally representative prospective cohort, to estimate the risk of lung cancer associated with active and passive smoking. We estimated the number of lung cancer cases that could have been avoided in the absence of smoking in Norway in 2015
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