Lung cancer risk in white and black Americans.
OBJECTIVE
To test whether differences in smoking-related lung cancer risks in blacks and whites can explain why lung cancer incidence is greater in black males than in white males but about equal in black and white females, given that a greater proportion of blacks are smokers, but smoke far fewer cigarettes per day than do whites.


METHODS
A hospital-based case-control study was conducted between 1984 and 1998 that included interviews with 1,710 white male and 1,321 white female cases of histologically confirmed lung cancer, 254 black male and 163 black female cases, and 8,151 controls. Relative risks were estimated via odds ratios using logistic regression, adjusted for age, education, and body mass index.


RESULTS
We confirmed prior reports that smoking prevalence is higher but overall dosage is lower among blacks. Overall ORs were similar for blacks and whites, except among the heaviest smoking males (21+ cigarettes per day or 37.5 pack-years), in whom ORs for blacks were considerably greater than for whites. Long-term benefits of cessation were similar for white and black ex-smokers. Smokers of menthol flavored cigarettes were at no greater risk for lung cancer than were smokers of unflavored brands.


CONCLUSIONS
Lung cancer risks were similar for whites and blacks with similar smoking habits, except possibly for blacks who were very heavy smokers; this sub-group is unusual in the general population of African American smokers. Explanations of racial disparities in lung cancer risk may need to account for modifying factors including type of cigarette (yield, mentholation), diet, occupation, and host factors such as ability to metabolize mainstream smoke carcinogens.
Stellman
Steven D
SD
American Health Foundation, One Dana Road, Valhalla, NY 10595, USA. sds91@columbia.edu
Chen
Yu
Y
Muscat
Joshua E
JE
Djordjevic
Mirjana V
MV
Richie
John P
JP
Lazarus
Philip
P
Thompson
Seth
S
Altorki
Nasser
N
Berwick
Marianne
M
Citron
Marc L
ML
Harlap
Susan
S
Kaur
Tajinder B
TB
Neugut
Alfred I
AI
Olson
Sara
S
Travaline
John M
JM
Witorsch
Philip
P
Zhang
Zuo-Feng
ZF
D001741:Black or African American; D015992:Body Mass Index; D004522:Educational Status; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D012737:Sex Factors; D012907:Smoking; D012923:Social Class; D014481:United States / Q000453:epidemiology; D044465:White People