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Am J Epidemiol. 2017 Jun 15;185(12):1272-1280. doi: 10.1093/aje/kwx018.

Active and Passive Smoking and Risk of Nasopharyngeal Carcinoma: A Population-Based Case-Control Study in Southern China.

Chang ET1,2, Liu Z3, Hildesheim A4, Liu Q5,6, Cai Y7,8, Zhang Z9,10, Chen G11, Xie SH5,6, Cao SM5,6, Shao JY6, Jia WH6, Zheng Y7,8, Liao J12, Chen Y10, Lin L10, Ernberg I13, Vaughan TL14,15, Adami HO3,16, Huang G9,10, Zeng Y11, Zeng YX6,17, Ye W3.

Author information

Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California.
Center for Health Sciences, Exponent, Inc., Menlo Park, California.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
Department of Cancer Prevention, Sun Yat-sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Clinical Laboratory, Wuzhou Red Cross Hospital, Wuzhou, China.
Wuzhou Health System Key Laboratory for Nasopharyngeal Carcinoma Etiology and Molecular Mechanism, Wuzhou, China.
Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Key Laboratory of High-Incidence-Tumor Prevention and Treatment, Guangxi Medical University, Ministry of Education, Nanning, China.
State Key Laboratory for Infectious Diseases Prevention and Control, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Cangwu Institute for Nasopharyngeal Carcinoma Control and Prevention, Wuzhou, China.
Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Beijing Hospital, Beijing, China.


The magnitude and patterns of associations between smoking and risk of nasopharyngeal carcinoma (NPC) in high-incidence regions remain uncertain. Associations with active and passive tobacco smoking were estimated using multivariate logistic regression in a population-based case-control study of 2,530 NPC cases and 2,595 controls in Guangdong and Guangxi, southern China, in 2010-2014. Among men, risk of NPC was significantly higher in current smokers compared with never smokers (odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.14, 1.53) but not in former smokers (OR = 0.92, 95% CI: 0.73, 1.17). Risk increased with smoking intensity (per 10 cigarettes/day, OR = 1.09, 95% CI: 1.03, 1.16), smoking duration (per 10 years, OR = 1.11, 95% CI: 1.06, 1.16), and cumulative smoking (per 10 pack-years, OR = 1.08, 95% CI: 1.04, 1.12). Risk decreased with later age at smoking initiation (per year, OR = 0.97, 95% CI: 0.96, 0.98) but not greater time since smoking cessation. Exposures to passive smoking during childhood (OR = 1.24, 95% CI: 1.03, 1.48) and from a spouse during adulthood (OR = 1.30, 95% CI: 1.03, 1.63) were independently associated with increased NPC risk in never-smoking men and women, but exposure-response trends were not observed. In conclusion, active and passive tobacco smoking are associated with modestly increased risk of NPC in southern China; risk is highest among long-term smokers.


China; case-control studies; nasopharyngeal carcinoma; passive smoking; smoking; tobacco smoking

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