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Sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on China National Lung Cancer Screening Program

BACKGROUND: Non-smokers account for a large proportion of lung cancer patients, especially in Asia, but the attention paid to them is limited compared with smokers. In non-smokers, males display a risk for lung cancer incidence distinct from the females—even after excluding the influence of smoking;...

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Autores principales: Wu, Zheng, Tan, Fengwei, Yang, Zhuoyu, Wang, Fei, Cao, Wei, Qin, Chao, Dong, Xuesi, Zheng, Yadi, Luo, Zilin, Zhao, Liang, Yu, Yiwen, Xu, Yongjie, Ren, Jiansong, Shi, Jufang, Chen, Hongda, Li, Jiang, Tang, Wei, Shen, Sipeng, Wu, Ning, Chen, Wanqing, Li, Ni, He, Jie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9433079/
https://www.ncbi.nlm.nih.gov/pubmed/35830209
http://dx.doi.org/10.1097/CM9.0000000000002161
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author Wu, Zheng
Tan, Fengwei
Yang, Zhuoyu
Wang, Fei
Cao, Wei
Qin, Chao
Dong, Xuesi
Zheng, Yadi
Luo, Zilin
Zhao, Liang
Yu, Yiwen
Xu, Yongjie
Ren, Jiansong
Shi, Jufang
Chen, Hongda
Li, Jiang
Tang, Wei
Shen, Sipeng
Wu, Ning
Chen, Wanqing
Li, Ni
He, Jie
author_facet Wu, Zheng
Tan, Fengwei
Yang, Zhuoyu
Wang, Fei
Cao, Wei
Qin, Chao
Dong, Xuesi
Zheng, Yadi
Luo, Zilin
Zhao, Liang
Yu, Yiwen
Xu, Yongjie
Ren, Jiansong
Shi, Jufang
Chen, Hongda
Li, Jiang
Tang, Wei
Shen, Sipeng
Wu, Ning
Chen, Wanqing
Li, Ni
He, Jie
author_sort Wu, Zheng
collection PubMed
description BACKGROUND: Non-smokers account for a large proportion of lung cancer patients, especially in Asia, but the attention paid to them is limited compared with smokers. In non-smokers, males display a risk for lung cancer incidence distinct from the females—even after excluding the influence of smoking; but the knowledge regarding the factors causing the difference is sparse. Based on a large multicenter prospective cancer screening cohort in China, we aimed to elucidate the interpretable sex differences caused by known factors and provide clues for primary and secondary prevention. METHODS: Risk factors including demographic characteristics, lifestyle factors, family history of cancer, and baseline comorbidity were obtained from 796,283 Chinese non-smoking participants by the baseline risk assessment completed in 2013 to 2018. Cox regression analysis was performed to assess the sex difference in the risk of lung cancer, and the hazard ratios (HRs) that were adjusted for different known factors were calculated and compared to determine the proportion of excess risk and to explain the existing risk factors. RESULTS: With a median follow-up of 4.80 years, 3351 subjects who were diagnosed with lung cancer were selected in the analysis. The lung cancer risk of males was significantly higher than that of females; the HRs in all male non-smokers were 1.29 (95% confidence interval [CI]: 1.20–1.38) after adjusting for the age and 1.38 (95% CI: 1.28–1.50) after adjusting for all factors, which suggested that known factors could not explain the sex difference in the risk of lung cancer in non-smokers. Known factors were 7% (|1.29–1.38|/1.29) more harmful in women than in men. For adenocarcinoma, women showed excess risk higher than men, contrary to squamous cell carcinoma; after adjusting for all factors, 47% ([1.30–1.16]/[1.30–1]) and 4% ([7.02–6.75]/[7.02–1])) of the excess risk was explainable in adenocarcinoma and squamous cell carcinoma. The main causes of gender differences in lung cancer risk were lifestyle factors, baseline comorbidity, and family history. CONCLUSIONS: Significant gender differences in the risk of lung cancer were discovered in China non-smokers. Existing risk factors did not explain the excess lung cancer risk of all non-smoking men, and the internal causes for the excess risk still need to be explored; most known risk factors were more harmful to non-smoking women; further exploring the causes of the sex difference would help to improve the prevention and screening programs and protect the non-smoking males from lung cancers.
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spelling pubmed-94330792022-09-01 Sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on China National Lung Cancer Screening Program Wu, Zheng Tan, Fengwei Yang, Zhuoyu Wang, Fei Cao, Wei Qin, Chao Dong, Xuesi Zheng, Yadi Luo, Zilin Zhao, Liang Yu, Yiwen Xu, Yongjie Ren, Jiansong Shi, Jufang Chen, Hongda Li, Jiang Tang, Wei Shen, Sipeng Wu, Ning Chen, Wanqing Li, Ni He, Jie Chin Med J (Engl) Original Articles BACKGROUND: Non-smokers account for a large proportion of lung cancer patients, especially in Asia, but the attention paid to them is limited compared with smokers. In non-smokers, males display a risk for lung cancer incidence distinct from the females—even after excluding the influence of smoking; but the knowledge regarding the factors causing the difference is sparse. Based on a large multicenter prospective cancer screening cohort in China, we aimed to elucidate the interpretable sex differences caused by known factors and provide clues for primary and secondary prevention. METHODS: Risk factors including demographic characteristics, lifestyle factors, family history of cancer, and baseline comorbidity were obtained from 796,283 Chinese non-smoking participants by the baseline risk assessment completed in 2013 to 2018. Cox regression analysis was performed to assess the sex difference in the risk of lung cancer, and the hazard ratios (HRs) that were adjusted for different known factors were calculated and compared to determine the proportion of excess risk and to explain the existing risk factors. RESULTS: With a median follow-up of 4.80 years, 3351 subjects who were diagnosed with lung cancer were selected in the analysis. The lung cancer risk of males was significantly higher than that of females; the HRs in all male non-smokers were 1.29 (95% confidence interval [CI]: 1.20–1.38) after adjusting for the age and 1.38 (95% CI: 1.28–1.50) after adjusting for all factors, which suggested that known factors could not explain the sex difference in the risk of lung cancer in non-smokers. Known factors were 7% (|1.29–1.38|/1.29) more harmful in women than in men. For adenocarcinoma, women showed excess risk higher than men, contrary to squamous cell carcinoma; after adjusting for all factors, 47% ([1.30–1.16]/[1.30–1]) and 4% ([7.02–6.75]/[7.02–1])) of the excess risk was explainable in adenocarcinoma and squamous cell carcinoma. The main causes of gender differences in lung cancer risk were lifestyle factors, baseline comorbidity, and family history. CONCLUSIONS: Significant gender differences in the risk of lung cancer were discovered in China non-smokers. Existing risk factors did not explain the excess lung cancer risk of all non-smoking men, and the internal causes for the excess risk still need to be explored; most known risk factors were more harmful to non-smoking women; further exploring the causes of the sex difference would help to improve the prevention and screening programs and protect the non-smoking males from lung cancers. Lippincott Williams & Wilkins 2022-06-05 2022-07-13 /pmc/articles/PMC9433079/ /pubmed/35830209 http://dx.doi.org/10.1097/CM9.0000000000002161 Text en Copyright © 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Original Articles
Wu, Zheng
Tan, Fengwei
Yang, Zhuoyu
Wang, Fei
Cao, Wei
Qin, Chao
Dong, Xuesi
Zheng, Yadi
Luo, Zilin
Zhao, Liang
Yu, Yiwen
Xu, Yongjie
Ren, Jiansong
Shi, Jufang
Chen, Hongda
Li, Jiang
Tang, Wei
Shen, Sipeng
Wu, Ning
Chen, Wanqing
Li, Ni
He, Jie
Sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on China National Lung Cancer Screening Program
title Sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on China National Lung Cancer Screening Program
title_full Sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on China National Lung Cancer Screening Program
title_fullStr Sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on China National Lung Cancer Screening Program
title_full_unstemmed Sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on China National Lung Cancer Screening Program
title_short Sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on China National Lung Cancer Screening Program
title_sort sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on china national lung cancer screening program
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9433079/
https://www.ncbi.nlm.nih.gov/pubmed/35830209
http://dx.doi.org/10.1097/CM9.0000000000002161
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