© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 8, 697-701,
April 21, 1999
© 1999 Oxford University Press
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Cigar and Pipe Smoking and Lung Cancer Risk: a Multicenter Study From Europe
Affiliations of authors: P. Boffetta, V. Gaborieau, International Agency for Research on Cancer, Lyon, France; G. Pershagen, F. Nyberg, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; K.-H. Jöckel, Institute for Medical Informatics, Biometry and Epidemiology, Essen, Germany; F. Forastiere, Epidemiology Unit Latium Region, Rome, Italy; J. Heinrich, M. Kreuzer, National Research Center for Environment and Health (GSF) Institute for Epidemiology, Munich, Germany; I. Jahn, Bremen Institute for Prevention Research, Germany; F. Merletti, Unit of Cancer Epidemiology, University of Turin, Italy; F. Rösch, International Agency for Research on Cancer, Lyon, and GSF Institute for Epidemiology; L. Simonato, Venetian Cancer Registry, Padua, Italy.
Correspondence to: Paolo Boffetta, M.D., International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon cedex 08, France (e-mail: boffetta{at}iarc.fr).
BACKGROUND: Because limited information is available on the quantitative association between consumption of tobacco products other than cigarettes and lung cancer risk, we undertook a case-control study of this relationship. METHODS: We investigated lung cancer risk among smokers of cigars and/or cigarillos only and of pipes only and compared these risks with the risk of smokers of cigarettes only in a case-control study conducted in seven European areas. Our study population consisted of 5621 male case patients with lung cancer and 7255 male control subjects. Each subject or his proxy was interviewed with respect to the subject's smoking history and other risk factors for lung cancer. RESULTS: The odds ratio (OR) for smoking cigars and cigarillos only was 9.0 (95% confidence interval [CI] = 5.8-14.1), based on 43 exposed case patients and 77 exposed control subjects, and the OR for smoking a pipe only was 7.9 (95% CI = 5.3-11.8), representing 61 case patients and 129 control subjects. The OR for smoking cigarettes only was 14.9 (95% CI = 12.3-18.1), based on 4204 case patients and 3930 control subjects. A dose-response relationship was present for duration of use and cumulative consumption both for cigars and cigarillos and for pipe tobacco. An effect was also suggested for inhalation of cigar and cigarillo smoke. The dose-response relationships between lung cancer risk and either duration of smoking or average and cumulative consumption were similar for cigar and cigarillo smoking, pipe smoking, and cigarette smoking. CONCLUSION: Our results suggest that smoking of European cigars, cigarillos, and pipe tobacco might exert a carcinogenic effect on the lung comparable to that of cigarettes.
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