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. 2016 Jun;45(3):846-56.
doi: 10.1093/ije/dyv175. Epub 2015 Sep 27.

Impact of changing US cigarette smoking patterns on incident cancer: risks of 20 smoking-related cancers among the women and men of the NIH-AARP cohort

Neal D Freedman  1 , Christian C Abnet  2 , Neil E Caporaso  2 , Joseph F Fraumeni Jr  2 , Gwen Murphy  2 , Patricia Hartge  2 , Albert R Hollenbeck  3 , Yikyung Park  4 , Meredith S Shiels  2 , Debra T Silverman  2
Affiliations

Impact of changing US cigarette smoking patterns on incident cancer: risks of 20 smoking-related cancers among the women and men of the NIH-AARP cohort

Neal D Freedman et al. Int J Epidemiol. 2016 Jun.

Abstract

Background: Historically, US women started smoking at a later age than men and had lower relative risks for smoking-related cancers. However, more recent birth cohorts of women and men have similar smoking histories and have now reached the high-risk age for cancer. The impact of these changes on cancer incidence has not been systematically examined.

Methods: Relative risks (RR), 95% confidence intervals (CI) and attributable fractions were calculated for cigarette smoking and incidence of 20 smoking-related cancers in 186 057 women and 266 074 men of the National Institutes of Health-AARP cohort, aged 50 to 71 years in 1995 and followed for 11 years.

Results: In the cohort, which included participants born between 1924 and 1945, most women and men started smoking as teenagers. RRs for current vs never smoking were similar in women and men for the following cancers: lung squamous-cell (RR women: 121.4, 95% CI: 57.3-257.4; RR men:114.6, 95% CI: 61.2-214.4), lung adenocarcinoma (RR women: 11.7, 95% CI: 9.8-14.0; RR men: 15.6, 95% CI: 12.5-19.6), laryngeal (RR women: 37.0, 95% CI: 14.9-92.3; RR men: 13.8, 95% CI: 9.3-20.2), oral cavity-pharyngeal (RR women:4.4, 95% CI: 3.3-6.0; RR men: 3.8, 95% CI: 3.0-4.7), oesophageal squamous cell (RR women: 7.3, 95% CI: 3.5-15.5; RR men: 6.2, 95% CI: 2.8-13.7), bladder (RR women: 4.7, 95% CI: 3.7-5.8; RR men: 4.0, 95% CI: 3.5-4.5), colon (RR women: 1.3, 95% CI: 1.2-1.5; RR men: 1.3, 95% CI: 1.1-1.4), and at other sites, with similar attributable fractions.

Conclusions: RRs for current smoking and incidence of many smoking-related cancers are now similar in US women and men, likely reflecting converging smoking patterns.

Keywords: Cigarette smoking; cancer; cohort; men and women.

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Figures

Figure 1.
Figure 1.
Associations of current vs never cigarette smoking with 20 smoking-related cancer sites in women and men. Relative risks on the log scale are on the x-axis, with each cancer site listed on the y-axis. Plotted circles represent the point estimate and whiskers reflect the 95% confidence intervals. Horizontal line represents a relative risk of 1. Relative risks are adjusted for age, education, alcohol intake, self-reported ethnicity and smoking pipes or cigars. Never smokers are participants who did not smoke cigarettes, pipes or cigars. Attributable fractions and associated 95% confidence intervals for ever smoking are also included.
Figure 2.
Figure 2.
Current cigarette use and lung and head and neck cancer by study year, in women. Relative risks for current vs never smoking are plotted on the y-axis, using a log scale. Year is on the x-axis. Plotted circles represent the point estimate and whiskers reflect the 95% confidence intervals. Each study is plotted by the mid point of when it was conducted, and labelled with the first author of the associated publication. Horizontal line represents a relative risk of 1. (a) Lung adenocarcinoma; (b) lung squamous cell carcinoma; (c) larynx; (d) oral cavity and pharynx.
Figure 3.
Figure 3.
Current cigarette use and lung and head and neck cancer by study year, in men. Relative risks for current vs never smoking are plotted on the y-axis, using a log scale. Year is on the x-axis. Plotted circles represent the point estimate and whiskers reflect the 95% confidence intervals. Each study is plotted by the mid point of when it wasconducted, and labelled with the first author of the associated publication. Horizontal line represents a relative risk of 1. (a) lung adenocarcinoma; (b) lung squamous cell carcinoma; (c) larynx; (d) oral cavity and pharynx.
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