Cigarette smoking, educational level and total and site-specific cancer

Abstract

Smoking is an established risk factor for cancer. However, most studies have been carried out on western populations, and less is known about the impact in central and eastern Europe. Our objective was to investigate the association between cigarette smoking, educational level and risk of cancer in a Lithuanian population-based cohort study. The study included 6976 men initially free from cancer. During the follow-up (1978-2008), 1780 cancer cases were identified. Cox proportional hazards models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs). In addition, the burden of cancer attributable to smoking was assessed by the population attributable fraction. Following adjustment for age, education, alcohol consumption and BMI, for current compared with never smokers, highly significant and strongly elevated estimates were found for total (HR=1.79, 95% CI 1.59-2.02), tobacco-related (HR=2.52, 95% CI 2.16-2.95), upper aerodigestive tract (UADT) (HR=5.77, 95% CI 2.73-12.21), lung (HR=10.47, 95% CI 6.74-16.25), bladder (HR=3.31, 95% CI 1.71-6.41) and liver (HR=4.64, 95% CI 1.53-14.08) cancer. Findings suggest a lower risk of prostate cancer in current smokers. In addition, the occurrence of lung and UADT cancer was significantly elevated in men in the lowest educational attainment category. If smoking had not occurred, ∼23% of total cancer, 37% of tobacco-related, 77% of lung, 58% of UADT, 43% of liver and 45% of bladder cancer cases could have been prevented in this cohort of men. Cancer-control strategies focused on reducing smoking should be a public health priority.

Non-pulmonary cancer risk following tuberculosis: a nationwide retrospective cohort study in Lithuania

“…It is possible, that patients with tuberculosis differ from the general population with respect to lifestyle factors, like use of tobacco or alcohol. As these factors have been found to be risk factors for various cancer types, confounding by them is likely [27, 28, 34]. In addition, it is possible that the study cohort included individuals with cancer, because tumours may have been interpreted as tuberculosis lesion prior to cancer diagnosis.…”

Body mass index, cholesterol level and risk of lung cancer in Lithuanian men

“…Our study, described in detail elsewhere [3,17], included two cohorts-the Kaunas-Rotterdam Intervention Study (KRIS) and Multifactorial ischemic heart disease prevention study (MIHDPS). Briefly, a random sample of men aged 45-59 (KRIS) or 40-59 (MIHDPS), living in the city of Kaunas (Lithuania) were recruited during the years 1972-1974 (KRIS) and 1976-1980.…”

“…Lung cancer rates in Lithuanian men remain among the highest in the world [1], and this is closely related to the high prevalence of tobacco smoking in this population [2,3].…”

The future burden of kidney and bladder cancers preventable by behavior modification in Australia: A pooled cohort study

“…Several studies have estimated population attributable fractions (PAFs) for the burden of kidney and bladder cancers attributable to behavioral exposures . However, these estimates are based on noncontemporary exposure distributions, and thus do not represent the currently preventable burden and priorities for prevention.…”

“…4,5 Several studies have estimated population attributable fractions (PAFs) for the burden of kidney and bladder cancers attributable to behavioral exposures. [6][7][8][9][10][11][12][13][14][15][16][17] However, these estimates are based on noncontemporary exposure distributions, and thus do not represent the currently preventable burden and priorities for prevention. For example, the prevalence of smoking has continuously decreased over time, while body fatness has increased, both in Australia 15,18 and in other industrialized countries.…”