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Cancer. 2015 Sep 1;121 Suppl 17:3097-106. doi: 10.1002/cncr.29560.

Emerging tobacco-related cancer risks in China: A nationwide, prospective study of 0.5 million adults.

Author information

1
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
2
Chinese Academy of Medical Sciences, Beijing, China.
3
Liuzhou Center for Disease Control and Prevention, Liuzhou, China.
4
Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
5
China National Center for Food Safety Risk Assessment, Beijing, China.
6
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.

Abstract

BACKGROUND:

In China, cigarette consumption has increased substantially since the 1980s, almost exclusively in men. This study was aimed at assessing the emerging cancer risks.

METHODS:

A nationwide, prospective study recruited 210,259 men and 302,632 women aged 30 to 79 years from 10 areas of China from 2004 to 2008; approximately 18,000 incident cancers were recorded during 7 years of follow-up. Cox regression yielded adjusted risk ratios (RRs) comparing smokers (including those who had stopped because of illness but not those who had stopped by choice) with never-smokers.

RESULTS:

Among men, 68% were smokers; their overall cancer risk was significantly increased (RR, 1.44; 95% confidence interval [CI], 1.37-1.53), and it was greater in urban (RR, 1.55; 95% CI, 1.41-1.70) than in rural areas (RR, 1.39; 95% CI, 1.30-1.49). This excess accounted for 23% of all cancers between the ages of 40 and 79 years, with significantly elevated risks of lung cancer (RR, 2.51; 95% CI, 2.18-2.90), liver cancer (RR, 1.32; 95% CI, 1.12-1.54), stomach cancer (RR, 1.34; 95% CI, 1.16-1.55), esophageal cancer (RR, 1.47; 95% CI, 1.24-1.73), and an aggregate of 5 other minor sites (RR, 1.52; 95% CI, 1.25-1.86). For lung cancer, the RRs were much greater for nonadenocarcinoma (RR, 5.83; 95% CI, 5.02-6.77) than for adenocarcinoma (RR, 1.78; 95% CI, 1.36-2.34). Among exsmokers (6.7%) who had stopped by choice, there was little excess cancer risk approximately 15 years after quitting. Among the few female smokers (3%), the overall cancer risk was also significantly increased (RR, 1.42; 95% CI, 1.28-1.57). Smoking was estimated to cause approximately 435,000 new cancers per year in China (approximately 360,000 in men and approximately 75,000 in women).

CONCLUSIONS:

In China, smoking now causes a quarter of all adult male cancers. High male uptake rates before the age of 20 years and nearly universal use of cigarettes foreshadow substantial tobacco-attributed risks in China unless there is widespread cessation.

KEYWORDS:

China; cancer; cessation; cohort study; smoking

PMID:
26331816
PMCID:
PMC4584499
DOI:
10.1002/cncr.29560
[Indexed for MEDLINE]
Free PMC Article

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