Tobacco And Cancer: The Science And The Story by Stephen S Hecht;Dorothy K Hatsukami;

Author:Stephen S Hecht;Dorothy K Hatsukami;
Language: eng
Format: epub
ISBN: 9789811239540
Publisher: World Scientific Publishing Company
Published: 2022-08-15T00:00:00+00:00

2.Epidemiological Studies

The existence of ethnic/racial differences in lung cancer risk in relation to smoking was first suggested by descriptive studies and case-control studies conducted in the US and Asia. It was recognized that the rise in lung cancer mortality that followed the introduction of manufactured cigarettes in the early 20th century in the US occurred a decade earlier and with a steeper slope in Native Hawaiians compared to Whites and Asian Americans in Hawaii.2 A similarly high incidence of lung cancer was reported for Maoris in New Zealand,3,4 suggesting that Polynesians, as a group, may be particularly susceptible to the lung carcinogenic effect of tobacco smoking. An ecological study among a random sample of 8,636 Hawaii residents also supported a greater lung cancer risk in Native Hawaiians due to smoking, since their lifetime use of cigarettes was found to be similar to that of Japanese American smokers, despite the two-fold greater incidence rate in the Native Hawaiian population.5 As a result, a population-based case-control study was conducted in Hawaii to formally test these ethnic differences in lung cancer risk. After adjusting for lifetime smoking, education and occupation, Native Hawaiian, Filipino and White male smokers were at 121%, 53% and 46% greater risk of lung cancer, respectively, compared to their Japanese counterparts.6 Chinese smokers had a risk similar to that of Japanese smokers. These risk patterns were consistent between sexes and across tumor histological types, and were apparently not explained by the type of cigarettes smoked, level of inhalation or diet. The lower lung cancer risk of Hawaii East Asian American smokers, compared to Whites, was consistent with the results of case-control studies conducted in Japan, China and Korea that all reported 4–10-fold smaller odds ratios for the smoking and lung cancer association, compared to studies conducted in the West.7–9

Evidence for a greater lung cancer risk due to cigarette smoking among African Americans compared to Whites was first provided by several case-control studies conducted in the US. An analysis of a hospital-based case-control study conducted by the American Health Foundation (AHF) in the 1970s and 1980s showed an 80% increased risk of lung cancer among African Americans compared to Whites for a given level of smoking.10 A subsequent analysis of more recent data from the AHF study suggested that this difference only existed at a high smoking intensity (21+ cigarettes per day or 37.5 pack-years).11 A population-based case-control study in Detroit also showed that African Americans aged 40–54 years were 2–4 times more likely to develop lung carcinoma than Whites after adjustment for self-reported lifetime smoking exposure.12 However, no significant risk difference was observed among older participants. With regard to other ethnic/racial populations in the US, only a case-control study in New Mexico reported on Hispanics. This study did not show any significant difference in lung cancer risk between Hispanics and Whites after accounting for differences in smoking.13 A recognized limitation of case-control studies is that they are often subject to biases (e.g., recall and selection biases). Prospective studies that collect

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