在整个接触史期间,评估吸烟强度和职业接触石棉对肺癌风险的影响。
2026例男性病例和2610例男性对照的数据来自法国ICARE(呼吸道癌症的职业和环境原因调查)人群,病例对照研究。从标准化问卷和面对面访谈中收集了终身吸烟史和职业史。使用工作暴露矩阵评估了对石棉的职业暴露。在逻辑回归模型中,使用灵活的加权累积暴露指数估算了年平均每日吸烟强度(每天报告的平均吸烟数量)和石棉暴露(工作中石棉纤维的平均每日空气浓度估计)的影响。
诊断前10年的吸烟强度与肺癌风险的相关性比远处的吸烟强度更强。相比之下,与最近的强度相比,在诊断前40多年发生的石棉暴露强度与肺癌的风险有更强的关联。即使诊断前10年的强度也有显著影响。
我们的结果说明了吸烟强度和职业接触石棉对肺癌风险的影响的动态。他们确认暴露的时间起着重要的作用,并建议标准分析方法假设在整个暴露历史上具有相同的强度权重可能是有问题的。
To estimate the impact of intensity of both smoking and occupational exposure to asbestos on the risk of lung cancer throughout the whole exposure history.
Data on 2026 male cases and 2610 male controls came from the French ICARE (Investigation of occupational and environmental causes of respiratory cancers) population-based,
case-control study. Lifetime smoking history and occupational history were collected from standardised questionnaires and face-to-face interviews. Occupational exposure to asbestos was assessed using a job exposure matrix. The effects of annual average daily intensity of smoking (reported average number of cigarettes smoked per day) and asbestos exposure (estimated average daily air concentration of asbestos fibres at work) were estimated using a flexible weighted cumulative index of exposure in logistic regression models.
Intensity of smoking in the 10 years preceding diagnosis had a much stronger association with the risk of lung cancer than more distant intensity. By contrast, intensity of asbestos exposure that occurred more than 40 years before diagnosis had a stronger association with the risk of lung cancer than more recent intensity, even if intensity in the 10 years preceding diagnosis also had a significant effect.
Our results illustrate the dynamic of the effect of intensity of both smoking and occupational exposure to asbestos on the risk of lung cancer. They confirm that the timing of exposure plays an important role, and suggest that standard analytical methods assuming equal weights of intensity over the whole exposure history may be questionable.