© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 8, 659,
April 21, 1999
© 1999 Oxford University Press
IN THIS ISSUE |
For the second consecutive year, the American Cancer Society, the National Cancer Institute, and the Centers for Disease Control and Prevention (including the National Center for Health Statistics) have prepared an annual report to the nation on the status of cancer. This year's report, which is published as a Special Article in this issue, contains a special section on lung cancer and tobacco smoking. In the report, Wingo et al. (p. 675) write that cancer incidence rates and cancer mortality rates for all sites (i.e., cancer types) combined decreased during the period from 1990 through 1996. For some sites, the decreases were statistically significant. The authors caution, however, that lung cancer rates, which appear to be declining in recent years in the United States, may rise again if upward trends in smoking among adolescents cannot be reversed.
". . .[L]ung cancer accounts for approximately 14% of new cancer cases and 28% of cancer deaths each year [in the United States]. . . ."—Wingo et al.
In an accompanying editorial, Koh (p. 660) draws on the findings by Wingo et al. and Boffetta et al. (see below) to argue for intensified efforts to decrease the use of tobacco products in the United States, particularly among youth. In particular, he calls for an emphasis on smoking prevention in populations to complement smoking cessation efforts aimed at individuals.
"Future medical historians will undoubtedly recall the 1900s as the ‘tobacco and cancer' century."—Koh
Cigars, Pipes, and Lung Cancer Risk
How does smoking cigars or a pipe, as opposed to cigarettes, affect the risk of developing lung cancer? Boffetta et al. (p. 697) asked that question in a case-control study conducted in seven European areas. The authors find that the odds ratio for lung cancer among smokers of cigars and cigarillos only compared with nonsmokers is 9.0 (95% confidence interval [CI] = 5.8-14.1) and among smokers of pipe tobacco only is 7.9 (95% CI = 5.3-11.8); in comparison, among smokers of cigarettes only, the odds ratio is 14.9 (95% CI = 12.3-18.1). Boffetta et al. conclude that, for the prevention of lung cancer, control of cigar and pipe smoking may be as important as control of cigarette smoking.
"Our study suggests that the lower overall risk of lung cancer among smokers of cigars and pipes as compared with cigarette smokers might be due to lower consumption of tobacco in the former group...."—Boffetta et al.
Smoking Effects and Gender
Lung cancer is now the most common cause of cancer death in North American women, but smoking-related changes in the lung have not been studied in detail in women. To address this deficiency, Lam et al. (p. 691) determined lung function and the prevalence of high-grade preinvasive lesions in the lungs of current and former smokers of both sexes. They report that, compared with men, women had a lower prevalence of these lesions in the airways examined and that the prevalence did not change for more than 10 years after the women stopped smoking. They also report that lung function was associated with the prevalence of prevasive lesions, but the association was weaker in women than in men. The authors conclude that, in developing strategies for chemoprevention or early detection of lung cancer in high-risk populations, it is important to consider the effect of gender and arbitrarily chosen lung function values.
". . . [T]here has been a change in the demographics of lung cancer. Instead of its predominance in men and current smokers, lung cancer is becoming more predominant in women and former smokers."—Lam et al.
Personal Costs of Breast Disease
The personal costs incurred by women diagnosed with either breast cancer or benign breast disease has been explored by Secker-Walker et al. (p. 702). The authors analyzed data from personal interviews with women diagnosed with either condition in the preceding 6-8 months. They found that costs in terms of time and distance traveled for treatment and follow-up were statistically significantly higher for women with breast cancer than for women with benign breast disease, as were personal financial costs. They also found that personal financial costs for detection, diagnosis, and treatment were statistically significantly lower for women whose breast problems were detected by screening rather than because of symptoms. They conclude that there are substantial personal costs for women who have a breast problem, whether the problems are detected through screening or because of symptoms.
Tobacco Smoking and Risk of Anal Cancer
Most cases of anal cancer are caused by certain types of human papilloma-viruses. The viral infection alone, however, is not enough to cause malignant transformation in this tissue; poorly defined cofactors are also required. Frisch et al. (p. 708) report a strong association between smoking and the risk of anal cancer that is confined to premenopausal women, suggesting that smoking may be such a cofactor in this group. The investigators also note that the risk of anal cancer among these women increased linearly with the number of cigarettes smoked. Because the higher risk also was associated with late menarche and a lean body composition and because anal tissue is an estrogen-sensitive area, the authors suggest that smoking may act through an antiestrogen mechanism in premenopausal women.
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