Lung Cancer Risk in White and Black AmericansWord格式.docx
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Lung Cancer Risk in White and Black AmericansWord格式.docx
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13:
294–302(C)2003ElsevierScienceInc.Allrightsreserved.
KEYWORDS:
LungCancer,Cigarettes,Smoking,Risk,RacialDifferences,Dosage,Menthol.
LungcancerratesintheUSshowsubstantialunexplainedracialvariability.SEERincidencerateshavebeenreportedhigherforblacksthanwhitesineveryyearsince1973,withratedifferentialsbetween34%and67%.(1,2).Thepreva-lenceofcigarettesmokinghasbeenconsiderablyhigherinblackthaninwhitemalessince1950.Itwasslightlyhigherinblackthaninwhitefemalesfrom1962until1992,afterwhichtherateshavebeennearlyequal(3–6).Theseeming
FromtheAmericanHealthFoundation,OneDanaRoad,Valhalla,NY
10595(S.D.S.);
DepartmentofEpidemiology,MailmanSchoolofPublic
Health,ColumbiaUniversity,630West168thStreet,PH-18,NewYork,
NY10032(S.D.S.,Y.C.,A.I.N.);
DivisionofEpidemiology,American
HealthFoundation,OneDanaRoad,Valhalla,NY10595(J.E.M.);
To-
baccoControlResearchBranch,DivisionofCancerControlandPopula-
tionSciences,NationalCancerInstitute,6130ExecutiveBoulevard,EPN
4039,Rockville,MD20852(M.V.D.);
DivisionofNutritionalCarcinogen-
esis,AmericanHealthFoundation,OneDanaRoad,Valhalla,NY10595
(J.P.R.);
DivisionsofCancerControlandMol.Oncology,H.LeeMoffitt
CancerCenter,MRC-2E,12902MagnoliaDrive,Tampa,FL33612(P.L.);
Bristol-MeyersSquibb,5ResearchParkway,Wallingford,CT06492(S.T.);
DivisionofThoracicSurgery,NewYorkPresbyterianHospital,525East
68thStreet,NewYork,NY10021(N.A.);
DepartmentofEpidemiology&
Biostatistics,MemorialSloan-KetteringCancerCenter,1275YorkAvenue,
NewYork,NY10021(M.B.,S.O.);
ProHealth,Inc.,2800MarcusAvenue,
LakeSuccess,NY11042(M.L.C.);
Dept.ofObstetricsandGynecologyan
KaplanCancerCenter,NYUMedicalCenter—RoomNBV-9E-2,550Firs
Avenue,NewYork,NY10016(S.H.);
Dept.ofObstetricsandGynecology
TempleUniversityHospital,3401N.BroadStreet,Philadelphia,PA1914
(T.B.K.);
PulmonaryDivision,TempleUniversitySchoolofMedicine
3400N.BroadStreet,Philadelphia,PA19140(J.M.T.);
DivisionofClini
calPharmacology,DepartmentsofMedicineandPharmacology,George
townUniversityMedicalCenter,3900ReservoirRoadNW,Washington
DC20007(P.W.);
DepartmentofEpidemiology,UCLASchoolofPubli
Health,71-225CHS,Box951772,10833LeConteAvenue,LosAngeles
CA90095-1772.(Z-F.Z.).
Addresscorrespondencesto:
StevenD.Stellman,Ph.D.M.P.H.,Dept
ofEpidemiology,MailmanSchoolofPublicHealth,630West168t
Street–PH-18,NewYork,NY10032,USA.Tel.:
212-305-4911.E-mail
sds91@columbia.edu
ReceivedMay9,2001;
revisedMay9,2002;
acceptedMay22,2002.
consistencybetweensmokingandlungcancerratesis
weakened,however,bysubstantialdifferencesinthenum-
berofcigarettessmokedperday(CPD).In1991,29.2%of
adultblackscurrentlysmokedcigarettescomparedwith
25.5%ofwhites,butblackssmokedonaverage15.0CPD
whilewhitessmoked21.0CPD.(7).Comparablediffer-
enceshavebeenreportedinmanyotherstudies(5,8–10).
Fewanalyticstudieshaveaddressedthisanomaly.Schwartz
andSwanson(11)concludedthatracialdifferencesininci-
dencecouldbe“entirelyexplained”bysmokinghabits,
basedonanepidemiologicalstudyofover5500casesdiag-
nosedinDetroitareahospitalsin1984to1987.Neverthe-
less,theirconclusiondidnotapplytopersonsunder55yearsof
age,andwasbasedonlargenumbersofproxyinterviews,
whichmighthaveaffectedtheprecisionofreportedORs.
Althoughsmokingistheoverwhelmingcauseoflung
cancer,otherhostandenvironmentalfactorsmayalsomod-
ifyrisk.Modifyingfactorsthathavebeenstudiedinclude
diet(12,13),geneticpolymorphismsinmetabolizinggenes
(14–18)aswellasmoregeneralfamilialfactors(19,20),
metabolismdifferences(21,22),occupation(23),andnon-
biologicalfactorssuchassocialclass(24)andeducation
(25).Thehypothesisthatthestrongpreferenceformen-
tholflavoredcigarettesamongblacksmokersmayalso
partlyexplainriskdifferenceshasledtoconflictingresults
amonginvestigators,withnoassociationreportedbyour
group(26),andapositiveassociationreportedformenbut
notwomenbySidneyetal.(27).
Tobetterdelineatesmoking-relatedrisksforlungcancer
betweenracialgroups,itisimportanttomakedirectassess-
mentsofriskinrelationtosmokinghabitsasanessential
backdropforinterpretingtheimpactofotherriskfactors,
includingthoseobservedinmetabolicandmolecularstud-
ies.Toaddresstheseissuesweexaminedsmokinghabits
andlungcancerriskinblackandwhiteAmericans.
METHODS
Between1984and1998theAmericanHealthFoundation
performedahospital-basedcase-controlstudyinthethree
majorNewYorkCitycancercentersplusotherhospitalsin
NewYork,Philadelphia,WashingtonDC,andotherUS
cities(seeAcknowledgments).Onlyincidentcaseswerese-
lected,definedaspersonsdiagnosedwithlungcancerfor
thefirsttimeduringthe12monthsprecedinginterview
(mostwithin2months).Allcaseswereconfirmedbyhisto-
pathology.Adenocarcinomasweremorecommoninwomen
(46%ofcases)thaninmen(37%),butdifferedlittleby
race.Controlswereselectedfromthedailyadmissionros-
tersandfrequencymatchedtocasesonthebasisofsex,age
(5y),hospital,andyearofinterview.Eligiblecontroldi-
agnosesexcludedtobacco-relateddiseasessuchascoronary
heartdisease,stroke,peripheralvasculardisease,chronic
obstructivepulmonarydisease,gastriculcer,cirrhosisofthe
liver,andcancersofthemouth,larynx,esophagus,bladder,
kidney,pancreas,orliver(28).Controlpatientsforstudies
ofothertobacco-relatedcancersbesideslungwerebeingin-
terviewedatthesametimeascases,sothatalargecontrol
poolofpatientswithnon-tobacco-relateddiseaseswas
available.Approximatelyhalfofmalecontrolshadbenign
ormalignantdiseasesincludingbenignprostatichypertro-
phy(9%),prostatecancer(8%),colon-rectumcancer
(11%);
boneandjointdiseases(5%);
kidneystones,ne-
phritis,andotherkidneydiseases(8%);
abscesses(2%);
sprains,strains,andfracturesincludinghip,andawidevari-
etyofothernon-malignantconditionsrequiringhospital-
ization.Fortypercentoffemalecontrolshadcancerswhich
includedbreast(15%),colon-rectum(7%),ovary(4%),
connectivetissue(2%),andmelanoma(2%);
otherfemale
controlswerehospitalizedforosteoarthritis(5%),fractures
includinghip(5%),genitalprolapse(2%),abscesses(2%)
andawidevarietyofothernon-malignantconditions.Af-
terprovidingwritteninformedconsentusingaformap-
provedbytheInstitutionalReviewBoardofeachhospital,
everysubjectwasinterviewedbyanAHF-trainedinter-
viewerusingastructuredquestionnairethatelicitedinfor-
mationondemographicvariables,smokinghistory,and
otherpossibleriskfactors.Approximately85%ofeligible
patientswhowereapproachedagreedtobeinterviewed.
The15-yearaccrualintervalwaschosenbecauseitin-
cludedlargenumbersofblackandwhitepatientswhowere
recruitedwithauniformprotocolandinterviewedunder
similarcircumstances.Thepresentanalysisoverlapsand
extendsearlierreports(26,29)thatincludedpatientsinter-
viewedbetween1977and1991.Thisisasignificantexten-
sion,sinceitmakesuseofdataobtainedviafacetoface
interviewswith11,599patients(4192interviewedafter
1991),ofwhom3448werecasesand8151werecontrols.It
includes417blackcases,254ofwhom
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