Tobacco Smoking and Risk of Second Primary Lung Cancer
Aredo, J.V.; Luo, S.J.; Gardner, R.M.; Sanyal, N.; Choi, E.; Hickey, T.P.; Riley, T.L.; Huang, W.-Y.; Kurian, A.W.; Leung, A.N.; Wilkens, L.R.; Robbins, H.A.; Riboli, E.; Kaaks, R.; Tjønneland, A.; Vermeulen, R.C.H.; Panico, S.; Le Marchand, L.; Amos, C.I.; Hung, R.J.; Freedman, N.D.; Johansson, M.; Cheng, I.; Wakelee, H.A.; Han, S.S.
(2021) Journal of Thoracic Oncology, volume 16, issue 6, pp. 968 - 979
(Article)
Abstract
Introduction: Lung cancer survivors are at high risk of developing a second primary lung cancer (SPLC). However, SPLC risk factors have not been established and the impact of tobacco smoking remains controversial. We examined the risk factors for SPLC across multiple epidemiologic cohorts and evaluated the impact of smoking cessation
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on reducing SPLC risk. Methods: We analyzed data from 7059 participants in the Multiethnic Cohort (MEC) diagnosed with an initial primary lung cancer (IPLC) between 1993 and 2017. Cause-specific proportional hazards models estimated SPLC risk. We conducted validation studies using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (N = 3423 IPLC cases) and European Prospective Investigation into Cancer and Nutrition (N = 4731 IPLC cases) cohorts and pooled the SPLC risk estimates using random effects meta-analysis. Results: Overall, 163 MEC cases (2.3%) developed SPLC. Smoking pack-years (hazard ratio [HR] = 1.18 per 10 pack-years, p < 0.001) and smoking intensity (HR = 1.30 per 10 cigarettes per day, p < 0.001) were significantly associated with increased SPLC risk. Individuals who met the 2013 U.S. Preventive Services Task Force's screening criteria at IPLC diagnosis also had an increased SPLC risk (HR = 1.92; p < 0.001). Validation studies with the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and European Prospective Investigation into Cancer and Nutrition revealed consistent results. Meta-analysis yielded pooled HRs of 1.16 per 10 pack-years (pmeta < 0.001), 1.25 per 10 cigarettes per day (pmeta < 0.001), and 1.99 (pmeta < 0.001) for meeting the U.S. Preventive Services Task Force's criteria. In MEC, smoking cessation after IPLC diagnosis was associated with an 83% reduction in SPLC risk (HR = 0.17; p < 0.001). Conclusions: Tobacco smoking is a risk factor for SPLC. Smoking cessation may reduce the risk of SPLC. Additional strategies for SPLC surveillance and screening are warranted.
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Keywords: Screening, Second primary lung cancer, Smoking cessation, Surveillance, Tobacco smoking, Oncology, Pulmonary and Respiratory Medicine
ISSN: 1556-0864
Publisher: International Association for the Study of Lung Cancer
Note: Funding Information: This work was supported by the National Institutes of Health (1R37CA226081, U01 CA164973) and a Stanford Medical Scholars research grant. The funders had no role in the design and conduct of the study; management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Where authors are identified as personnel of the International Agency for Research on Cancer/WHO, the authors alone are responsible for the views expressed in this article and do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/WHO. Cancer incidence data have been provided by the Alabama Statewide Cancer Registry, Arizona Cancer Registry, Colorado Central Cancer Registry, District of Columbia Cancer Registry, Georgia Cancer Registry, Hawaii Cancer Registry, Cancer Data Registry of Idaho, Maryland Cancer Registry, Michigan Cancer Surveillance Program, Minnesota Cancer Surveillance System, Missouri Cancer Registry, Nevada Central Cancer Registry, Ohio Cancer Incidence Surveillance System, Pennsylvania Cancer Registry, Texas Cancer Registry, Utah Cancer Registry, Virginia Cancer Registry, and Wisconsin Cancer Reporting System. All are supported in part by funds from the Center for Disease Control and Prevention, National Program for Central Registries, local states or by the National Cancer Institute, Surveillance, Epidemiology, and End Results program. The results reported here and the conclusions derived are the sole responsibility of the authors. Funding Information: Disclosure: Dr. Kurian reports receiving research funding to the institution from Myriad Genetics outside of the submitted work. Dr. Wakelee reports receiving personal consulting fees from Janssen, Daiichi Sankyo, Helsinn, Mirati, AstraZeneca, and Blueprint and grants to institution for clinical trial conduct from ACEA Biosciences, Arrys Therapeutics, AstraZeneca/MedImmune, Bristol-Myers Squibb, Celgene, Clovis Oncology, Exelixis, Eli Lilly, Pfizer, and Pharmacyclics all outside of the submitted work. The remaining authors declare no conflict of interest. Publisher Copyright: © 2021 International Association for the Study of Lung Cancer
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