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BMC Cancer. 2019 Apr 11;19(1):348. doi: 10.1186/s12885-019-5484-9.

Is exposure to tobacco associated with extrahepatic cholangiocarcinoma epidemics? A retrospective proportional mortality study in China.

Author information

1
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences / School of Basic Medicine Peking Union Medical College, A505 Room Mingri Building, 5 Dongdansantiao Street, Dongcheng District, Beijing, 100005, China.
2
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
3
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences / School of Basic Medicine Peking Union Medical College, A505 Room Mingri Building, 5 Dongdansantiao Street, Dongcheng District, Beijing, 100005, China. jingmeijiang@ibms.pumc.edu.cn.
4
Cancer Institute & Hospital, Chinese Academy of Medical Sciences / Peking Union Medical College, Beijing, China. boqiliu@163.com.
5
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. boqiliu@163.com.
6
Cancer Institute & Hospital, Chinese Academy of Medical Sciences / Peking Union Medical College, Beijing, China.

Abstract

BACKGROUND:

Extrahepatic cholangiocarcinoma (ECC) has become one of the most rapidly increasing malignancies in China during recent decades. The relationship between tobacco exposure and ECC epidemics is unclear; this study aimed to explore this relationship.

METHODS:

We included 55,806 participants aged 30 years or older from the National Mortality and Smoking Survey of China. Smoking in participants and spouses was defined as 1 cigarette or more per day for up to 1 year. Spouses' smoking was taken as a measure of exposure to passive smoking. Smoking information in 1980 was ascertained and outcomes were defined as ECC mortality during 1986-1988.

RESULTS:

We found that either passive or active smoking increased the risk of death from ECC by 20% (risk ratio [RR], 1.20; 95% confidence interval [CI], 0.99-1.47), compared with no exposure to any tobacco. This risk was a notable 98% (RR, 1.98; 95% CI, 1.49-2.64) for individuals exposed to passive plus active smoking. These findings were highly consistent among men and women. Pathology-based analyses showed dose-response relationships of ECC with pack-years for all types of smoking exposure (Ps for trend < 0.05); the RR reached 2.75 (95% CI, 1.20-6.30) in individuals exposed to combined smoking with the highest exposure dose. The findings were similar for non-pathology-based analysis.

CONCLUSIONS:

This study indicates that tobacco exposure increases ECC risk. Given the dramatic increase of exposure to secondhand smoke and patients with ECC, an inadequate provision of smoke-free environments could be contributing to ECC epidemics and could further challenge public health and medical services, based on the current disease spectrum.

KEYWORDS:

Cholangiocarcinoma; Mortality; Population; Smoking

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