Cigarette Smoking and Histologic Type of Lung Cancer in Men

doi:10.1378/chest.112.6.1474

Chest

Volume 112, Issue 6, December 1997, Pages 1474-1479

https://doi.org/10.1378/chest.112.6.1474 Get rights and content

Study objectives

To determine whether intensity, duration, age at initiation, and cessation of cigarette smoking act differently in the development of various histologic types of lung cancer. Design: A case-control study among deceased men who underwent autopsy, a procedure that involves approximately 73% of all local deaths.

Setting

The Province of Trieste in northeastern Italy

Participants

Seven hundred fifty-five patients with lung cancer, including 267 with squamous cell carcinoma, 218 with small cell carcinoma, 90 with large cell carcinoma, 158 with adenocarcinoma, and 22 with other histologic types, and 755 control subjects who had died of causes other than chronic lung diseases and certain tumors. Information on smoking habits, residential history, and occupational exposure was obtained from each subject's next of kin.

Results

Compared with nonsmokers, the odds ratio (OR) for current smokers was 13.4 for all types combined, 18.8 for squamous cell carcinoma, 14.3 for small cell carcinoma, 34.3 for large cell carcinoma, and 7.9 for adenocarcinoma. Intensity of smoking, duration, age at starting, and dose were all directly associated with all histologic types of lung cancer, although the OR was lower for adenocarcinoma than for other cell types. When results were restricted to ever smokers, exposure-response curves were similar across histologic types. The risk of lung cancer attributable to smoking was 88% for all types combined, 91% for squamous cell carcinoma, 89% for small cell carcinoma, 95% for large cell carcinoma, and 82% for adenocarcinoma.

Conclusions

This study confirms that cigarette smoking causes all types of lung cancer, but the proportion of cases attributable to smoking is lower for adenocarcinoma than for other types, due to a higher proportion of nonsmokers.

Section snippets

Materials and Methods

The case, and control subjects were identified among the male residents of the province of Trieste who had died and received autopsies at the Department of Pathology of the University from 1979 to 1981 and from 1985 to 1986. The study was restricted to male subjects because the original interest of the study was in occupational exposures to carcinogens, especially asbestos, which occurred in Trieste almost exclusively among men. A unique characteristic of Trieste province is that since the

Results

The mean age of the cases was 69 years (range, 37 to 93 years) and did not vary markedly by histologic type. The mean age of the control subjects was 70 years (range, 36 to 98 years). The distribution of cases and control subjects by pattern of smoking is displayed in Table 1 for all histologic types combined. Compared with nonsmokers, all categories of smokers were strongly associated with lung cancer. Subjects who smoked between 1 and 10 cigarettes per day, or for <30 years or who had quit

Discussion

The main objective of the study was to evaluate whether the pattern of smoking-related risk of lung cancer varied by type. Our findings show that all histologic types of lung cancer were strongly associated with cigarette smoking and that the risk increased with increasing dose, intensity, and duration, and with decreasing age at starting. Conversely, the risk decreased with quitting.

The risk of smoking, as compared to never smoking, was similar between SQCC and SMCC. The relation was not as

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: This study was supported in part by the Consiglio Nazionale delle Ricerche under grant No. 8400604.44 and by the Associaziane Italiana per la Ricerca sul Cancro.

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Chest

Clinical Investigations: CancerCigarette Smoking and Histologic Type of Lung Cancer in Men

Study objectives

Setting

Participants

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Lung cancer and cigarette smoking

The effect of low-yield cigarette smoking on lung cancer risk

Cancer

Assessment of lung cancer risk factors by histologic category

J Natl Cancer Inst

Variation in smoking-related lung cancer risk among New Jersey women

Am J Epidemiol

Smoking, air pollution and high rates of lung cancer in Shenyang, China

J Natl Cancer Inst

Histological lung cancer types: a morphological and biological correlation

Acta Pathol Microbiol Immunol Scand

Air pollution and lung cancer in Trieste, Italy

Am J Epidemiol

Comparison of epidemiologic methods in a case-control study of lung cancer and air pollution in Trieste, Italy

Epidemiol Prev

Occupational exposure and lung cancer risk in a coastal area of north-eastern Italy

Int Arch Occup Environ Health

Tobacco smoking: monographs on the evaluation of the carcinogenic risk to humans (vol 38)

Clinical Investigations: Cancer
Cigarette Smoking and Histologic Type of Lung Cancer in Men