Steven Stellman - Smoking and lung cancer risk in American and Japanese men: an international case-control study

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      Stellman, S. D., Takezaki, T., Wang, L., Chen, Y., Citron, M. L.,   Djordjevic, M. V., Harlap, S., Muscat, J. E., Neugut, A. I.,   Wynder, E. L., Ogawa, H., Tajima, K., Aoki, K. 10 (11)   1193-9-

      Abstract: Rates of lung cancer in American men   have greatly exceeded those in Japanese men for several decades   despite the higher smoking prevalence in Japanese men. It is not   known whether the relative risk of lung cancer associated with   cigarette smoking is lower in Japanese men than American men and   whether these risks vary by the amount and duration of smoking.   To estimate smoking-specific relative risks for lung cancer in   men, a multicentric case-control study was carried out in New   York City, Washington, DC, and Nagoya, Japan from 1992 to 1998. A   total of 371 cases and 373 age-matched controls were interviewed   in United States hospitals and 410 cases and 252 hospital   controls in Japanese hospitals; 411 Japanese age-matched healthy   controls were also randomly selected from electoral rolls. The   odds ratio (OR) for lung cancer in current United States smokers   relative to nonsmokers was 40.4 [95% confidence interval (CI) =   21.8-79.6], which was >10 times higher than the OR of 3.5 for   current smokers in Japanese relative to hospital controls (95% CI   = 1.6-7.5) and six times higher than in Japanese relative to   community controls (OR = 6.3; 95% CI = 3.7-10.9). There were no   substantial differences in the mean number of years of smoking or   average daily number of cigarettes smoked between United States   and Japanese cases or between United States and Japanese   controls, but American cases began smoking on average 2.5 years   earlier than Japanese cases. The risk of lung cancer associated   with cigarette smoking was substantially higher in United States   than in Japanese males, consistent with population-based   statistics on smoking prevalence and lung cancer incidence.   Possible explanations for this difference in risk include a more   toxic cigarette formulation of American manufactured cigarettes   as evidenced by higher concentrations of tobacco-specific   nitrosamines in both tobacco and mainstream smoke, the much wider   use of activated charcoal in the filters of Japanese than in   American cigarettes, as well as documented differences in genetic   susceptibility and lifestyle factors other than smoking.

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