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. 2018 Dec 19;18(1):1275.
doi: 10.1186/s12885-018-5144-5.

Risk of lung cancer in relation to various metrics of smoking history: a case-control study in Montreal

T Remen  1 , J Pintos  2 , M Abrahamowicz  3 , J Siemiatycki  2
Affiliations

Risk of lung cancer in relation to various metrics of smoking history: a case-control study in Montreal

T Remen et al. BMC Cancer. .

Abstract

Background: Few 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.

Methods: Based 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.

Results: Odds 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.

Conclusions: This 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.

Keywords: Cigarette; Pack-years; Risk assessment; Tobacco.

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Conflict of interest statement

Ethics approval and consent to participate

This research was approved by the ethics committees of the Institut national de recherche scientifique-Institut Armand-Frappier (INRS-IAF) and McGill University. Ethics approval was also received from the following Montreal-area hospitals in which subjects were recruited: Montreal Chest Hospital Centre, Centre Hospitalier de Verdun, Cité de la santé, Hôpital Général Fleury, Hôtel Dieu de Montréal, Hôpital Jean-Talon, Hôpital Maisonneuve-Rosemont, Hôpital Notre Dame, Hôpital Sacré-Coeur, Hôpital St-Luc, Jewish General Hospital, Lakeshore Hospital, Montreal General Hospital, Queen Elizabeth Hospital, Reddy Memorial Hospital, Royal Victoria Hospital, Hôpital Santa Cabrini, Hôpital Ste. Jeanne-d’Arc and St Mary’s Hospital. All participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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