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. 2024 Mar 26;24(1):384.
doi: 10.1186/s12885-024-12133-9.

Reproductive factors and risk of lung cancer among 300,000 Chinese female never-smokers: evidence from the China Kadoorie Biobank study

Marwa M A Elbasheer  1 , Bastian Bohrmann  1 , Yiping Chen  1   2 , Jun Lv  3   4   5 , Dianjianyi Sun  3   4   5 , Xia Wu  6 , Xiaoming Yang  1 , Daniel Avery  1 , Liming Li  3   4   5 , Zhengming Chen  1   2 , Christiana Kartsonaki #  1   2 , Ka Hung Chan #  1   7 , Ling Yang #  8   9
Affiliations

Reproductive factors and risk of lung cancer among 300,000 Chinese female never-smokers: evidence from the China Kadoorie Biobank study

Marwa M A Elbasheer et al. BMC Cancer. .

Abstract

Background: Lung cancer is the leading cause of cancer mortality among Chinese females despite the low smoking prevalence among this population. This study assessed the roles of reproductive factors in lung cancer development among Chinese female never-smokers.

Methods: The prospective China Kadoorie Biobank (CKB) recruited over 0.5 million Chinese adults (0.3 million females) from 10 geographical areas in China in 2004-2008 when information on socio-demographic/lifestyle/environmental factors, physical measurements, medical history, and reproductive history collected through interviewer-administered questionnaires. Cox proportional hazard regression was used to estimate adjusted hazard ratios (HRs) of lung cancer by reproductive factors. Subgroup analyses by menopausal status, birth year, and geographical region were performed.

Results: During a median follow-up of 11 years, 2,284 incident lung cancers occurred among 282,558 female never-smokers. Ever oral contraceptive use was associated with a higher risk of lung cancer (HR = 1.16, 95% CI: 1.02-1.33) with a significant increasing trend associated with longer duration of use (p-trend = 0.03). Longer average breastfeeding duration per child was associated with a decreased risk (0.86, 0.78-0.95) for > 12 months compared with those who breastfed for 7-12 months. No statistically significant association was detected between other reproductive factors and lung cancer risk.

Conclusion: Oral contraceptive use was associated with an increased risk of lung cancer in Chinese female never-smokers. Further studies are needed to assess lung cancer risk related to different types of oral contraceptives in similar populations.

Keywords: Chinese females; Lung cancer; Never-smokers; Reproductive factors.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Relative risks of lung cancer associated with reproductive factors. Models were adjusted for age, study area, occupation, education, log-height, log-weight, physical activity, family history of any cancer, personal history of lung disease, alcohol drinking, frequency of environmental tobacco smoke exposure, heating fuel during winter and cooking fuel. *Relevent to never users
Fig. 2
Fig. 2
Adjusted hazard ratios of lung cancer according to childbearing factors by menopausal status. Models adjusted for age, region, occupation, education, log-height, log-weight, physical activity, family history of cancer, personal history of lung disease, alcohol drinking, frequency of environmental tobacco smoke exposure, heating fuel during winter, cooking fuel and oral contraceptive use
Fig. 3
Fig. 3
Adjusted hazard ratios of lung cancer according to childbearing factors by year of birth. Models adjusted for age, region, occupation, education, log-height, log-weight, physical activity, family history of cancer, personal history of lung disease, alcohol drinking, frequency of environmental tobacco smoke exposure, heating fuel during winter, cooking fuel and oral contraceptive use
Fig. 4
Fig. 4
Adjusted hazard ratios of lung cancer according to childbearing factors by geographical regions. Models adjusted for age, region, occupation, education, log-height, log-weight, physical activity, family history of cancer, personal history of lung disease, alcohol drinking, frequency of environmental tobacco smoke exposure, heating fuel during winter, cooking fuel and oral contraceptive use
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