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Active and passive smoking in relation to lung cancer incidence in the Women's Health Initiative Observational Study prospective cohort.

ABSTRACT: Lung cancer is the leading cause of worldwide cancer deaths. While smoking is its leading risk factor, few prospective cohort studies have reported on the association of lung cancer with both active and passive smoking. This study aimed to determine the relationship between lung cancer incidence with both active and passive smoking (childhood, adult at home, and at work).The Women's Health Initiative Observational Study (WHI-OS) was a prospective cohort study conducted at 40 US centers that enrolled postmenopausal women from 1993 to 1999. Among 93 676 multiethnic participants aged 50-79, 76 304 women with complete smoking and covariate data comprised the analytic cohort. Lung cancer incidence was calculated by Cox proportional hazards models, stratified by smoking status.Over 10.5 mean follow-up years, 901 lung cancer cases were identified. Compared with never smokers (NS), lung cancer incidence was much higher in current [hazard ratio (HR) 13.44, 95% confidence interval (CI) 10.80-16.75] and former smokers (FS; HR 4.20, 95% CI 3.48-5.08) in a dose-dependent manner. Current and FS had significantly increased risk for all lung cancer subtypes, particularly small-cell and squamous cell carcinoma. Among NS, any passive smoking exposure did not significantly increase lung cancer risk (HR 0.88, 95% CI 0.52-1.49). However, risk tended to be increased in NS with adult home passive smoking exposure ?30 years, compared with NS with no adult home exposure (HR 1.61, 95% CI 1.00-2.58).In this prospective cohort of postmenopausal women, active smoking significantly increased risk of all lung cancer subtypes; current smokers had significantly increased risk compared with FS. Among NS, prolonged passive adult home exposure tended to increase lung cancer risk. These data support continued need for smoking prevention and cessation interventions, passive smoking research, and further study of lung cancer risk factors in addition to smoking. CLINICALTRIALS.GOV: NCT00000611.

SUBMITTER: Wang A

PROVIDER: S-EPMC4326306 | biostudies-other | 2015 Jan

REPOSITORIES: biostudies-other

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Active and passive smoking in relation to lung cancer incidence in the Women's Health Initiative Observational Study prospective cohort.

Wang A A Kubo J J Luo J J Desai M M Hedlin H H Henderson M M Chlebowski R R Tindle H H Chen C C Gomez S S Manson J E JE Schwartz A G AG Wactawski-Wende J J Cote M M Patel M I MI Stefanick M L ML Wakelee H A HA

Annals of oncology : official journal of the European Society for Medical Oncology 20141014 1

<h4>Background</h4>Lung cancer is the leading cause of worldwide cancer deaths. While smoking is its leading risk factor, few prospective cohort studies have reported on the association of lung cancer with both active and passive smoking. This study aimed to determine the relationship between lung cancer incidence with both active and passive smoking (childhood, adult at home, and at work).<h4>Patients and methods</h4>The Women's Health Initiative Observational Study (WHI-OS) was a prospective c ...[more]

PMID: 25316260

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Project description:ObjectiveTo examine the association between smoking and risk of invasive breast cancer using quantitative measures of lifetime passive and active smoking exposure among postmenopausal women.DesignProspective cohort study.Setting40 clinical centres in the United States.Participants79,990 women aged 50-79 enrolled in the Women's Health Initiative Observational Study during 1993-8.Main outcome measuresSelf reported active and passive smoking, pathologically confirmed invasive breast cancer.ResultsIn total, 3520 incident cases of invasive breast cancer were identified during an average of 10.3 years of follow-up. Compared with women who had never smoked, breast cancer risk was elevated by 9% among former smokers (hazard ratio 1.09 (95% CI 1.02 to 1.17)) and by 16% among current smokers (hazard ratio 1.16 (1.00 to 1.34)). Significantly higher breast cancer risk was observed in active smokers with high intensity and duration of smoking, as well as with initiation of smoking in the teenage years. The highest breast cancer risk was found among women who had smoked for ≥ 50 years or more (hazard ratio 1.35 (1.03 to 1.77) compared with all lifetime non-smokers, hazard ratio 1.45 (1.06 to 1.98) compared with lifetime non-smokers with no exposure to passive smoking). An increased risk of breast cancer persisted for up to 20 years after smoking cessation. Among women who had never smoked, after adjustment for potential confounders, those with the most extensive exposure to passive smoking (≥ 10 years' exposure in childhood, ≥ 20 years' exposure as an adult at home, and ≥ 10 years' exposure as an adult at work) had a 32% excess risk of breast cancer compared with those who had never been exposed to passive smoking (hazard ratio 1.32 (1.04 to 1.67)). However, there was no significant association in the other groups with lower exposure and no clear dose response to cumulative passive smoking exposure.ConclusionsActive smoking was associated with an increase in breast cancer risk among postmenopausal women. There was also a suggestion of an association between passive smoking and increased risk of breast cancer.

Project description:ObjectivesTo determine associations between postmenopausal change in body weight and incidence of fracture and associations between voluntary and involuntary weight loss and risk of fracture.DesignPost hoc analysis of data from the Women's Health Initiative Observational Study and Clinical Trials.Setting40 clinical centers in the United States.Participants120,566 postmenopausal women, aged 50-79 at baseline (1993-98), followed through 2013 (mean fracture follow-up duration 11 years from baseline).ExposuresAnnualized percentage change in measured body weight from baseline to year 3, classified as stable (<5% change), weight loss (≥ 5%), or weight gain (≥ 5%). Self assessment of whether weight loss was intentional or unintentional. Cox proportional hazards regression models were adjusted for age, race/ethnicity, baseline body mass index (BMI), smoking, alcohol intake, level of physical activity, energy expenditure, calcium and vitamin D intake, physical function score, oophorectomy, hysterectomy, previous fracture, comorbidity score, and drug use.Main outcomesIncident self reported fractures of the upper limbs, lower limbs, and central body; hip fractures confirmed by medical records.ResultsMean participant age was 63.3. Mean annualized percent weight change was 0.30% (95% confidence interval 0.28 to 0.32). Overall, 79,279 (65.6%) had stable weight; 18,266 (15.2%) lost weight; and 23,021 (19.0%) gained weight. Compared with stable weight, weight loss was associated with a 65% higher incidence rates of fracture in hip (adjusted hazard ratio 1.65, 95% confidence interval 1.49 to 1.82), upper limb (1.09, 1.03 to 1.16), and central body (1.30, 1.20 to 1.39); weight gain was associated with higher incidence rates of fracture in upper limb (1.10, 1.05 to 1.18) and lower limb (1.18, 1.12 to 1.25). Compared with stable weight, unintentional weight loss was associated with a 33% higher incidence rates of hip fracture (1.33, 1.19 to 1.47) and increased incidence rates of vertebral fracture (1.16, 1.06 to 1.26); intentional weight loss was associated with increased incidence rates of lower limb fracture (1.11, 1.05 to 1.17) and decreased incidence of hip fracture (0.85, 0.76 to 0.95).ConclusionsWeight gain, weight loss, and intentional weight loss are associated with increased incidence of fracture, but associations differ by fracture location. Clinicians should be aware of fracture patterns after weight gain and weight loss.

Project description:Cigarette smoking remains the leading avoidable cause of disease burden worldwide, and observational studies have linked various smoking behaviours (active smoking, passive smoking, and smoking cessation) with risk of type 2 diabetes. We did a meta-analysis of prospective studies to investigate the associations between various smoking behaviours and diabetes risk.We systematically searched MEDLINE (up to May 3, 2015) and Embase (up to April 16, 2014) for reports of prospective studies, using search terms related to smoking, diabetes mellitus, and studies with a prospective design. We supplemented this strategy with manual searches of the reference lists of retrieved publications and relevant reviews. We included prospective studies that reported risk of type 2 diabetes by baseline smoking status. We calculated pooled relative risks (RRs) with 95% CIs using random-effects models, and did subgroup analyses by participant and study characteristics.We identified 88 eligible prospective studies with 5?898?795 participants and 295?446 incident cases of type 2 diabetes. The pooled RR of type 2 diabetes was 1·37 (95% CI 1·33-1·42) for comparing current smoking with non-smoking (84 studies with 5?853?952 participants), 1·14 (1·10-1·18) for comparing former smoking with never smoking (47 studies with 2?930?391 participants), and 1·22 (1·10-1·35) for comparing never smokers with and without exposure to passive smoke (seven studies with 156?439 participants). The associations persisted in all subgroups, and we identified a dose-response relation for current smoking and diabetes risk: compared with never smokers, the RRs were 1·21 (1·10-1·33) for light smokers, 1·34 (1·27-1·41) for moderate smokers, and 1·57 (1·47-1·66) for heavy smokers. Based on the assumption that the association between smoking and diabetes risk is causal, we estimated that 11·7% of cases of type 2 diabetes in men and 2·4% in women (ie, about 27·8 million cases in total worldwide) were attributable to active smoking. Compared with never smokers, the pooled RR from ten studies with 1?086?608 participants was 1·54 (95% CI 1·36-1·74) for new quitters (<5 years), 1·18 (1·07-1·29) for middle-term quitters (5-9 years), and 1·11 (1·02-1·20) for long-term quitters (?10 years).Active and passive smoking are associated with significantly increased risks of type 2 diabetes. The risk of diabetes is increased in new quitters, but decreases substantially as the time since quitting increases. If the association between smoking and risk of type 2 diabetes is causal, public health efforts to reduce smoking could have a substantial effect on the worldwide burden of type 2 diabetes.Chinese National Thousand Talents Program for Distinguished Young Scholars, US National Institutes of Health, the Chinese National 111 Project, and the Program for Changjiang Scholars and Innovative Research Team in University from the Chinese Ministry of Education.

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Active and passive smoking in relation to lung cancer incidence in the Women's Health Initiative Observational Study prospective cohort.

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Active and passive smoking in relation to lung cancer incidence in the Women's Health Initiative Observational Study prospective cohort.

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