title: Cigarette smoking and lung cancer in women: results of the French ICARE case-control study.
abstract: BACKGROUND
  The incidence of female lung cancer in developed countries has been increasing since 1950. In order to have recent and reliable data on the association between cigarette smoking and the risk of lung cancer in women, we analysed cases from a French population-based case-control study.
  
  
  METHODS
  The ICARE study is a multicenter case-control study on respiratory cancers (lung and UADT cancers), set up in 10 départements that include a general cancer registry. We included 648 women lung cancer cases up to 76 years of age, with a histologically confirmed primary lung cancer. The 775 controls were randomly selected from the general population and frequency-matched with cases by age and département.
  
  
  RESULTS
  Overall, smoking cigarettes at some time was associated with a 8-fold increase in lung cancer risk (OR=8.2, 95% CI 6.0-11.4). A dose-response relationship was observed as a function of duration, intensity and pack-years. Using restricted splines cubic models, we have shown that intensity dose-response departed significantly from linearity while the risk increased linearly with duration and decreased linearly with time since cessation. The following characteristics were associated with a higher relative risk: smoke inhalation, smoking non-filter cigarettes, smoking dark tobacco cigarettes and starting at a young age. In addition, duration, intensity and time since cessation was significantly related with histological type. This was not the case for characteristics such as the use of a filter or not, the inhalation pattern, or the type of tobacco smoked. The proportion of lung cancer cases attributable to cigarette smoking was 55% (95% CI: [47-63%]).
  
  
  CONCLUSIONS
  Our results confirm that cigarette smoking is by far the most important cause of the current epidemic of lung cancer among French women and that the most important smoking-related variables for varying the risk of lung cancer are the duration, the intensity and the time since cessation.
authors.affiliation: Environmental Epidemiology of Cancer, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papadopoulos
authors.forename: Florence
authors.initials: F
authors.lastname: Guida
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cénée
authors.forename: Diane
authors.initials: D
authors.lastname: Cyr
authors.forename: Annie
authors.initials: A
authors.lastname: Schmaus
authors.forename: Loredana
authors.initials: L
authors.lastname: Radoï
authors.forename: Sophie
authors.initials: S
authors.lastname: Paget-Bailly
authors.forename: Matthieu
authors.initials: M
authors.lastname: Carton
authors.forename: Chloé
authors.initials: C
authors.lastname: Tarnaud
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.forename: Patricia
authors.initials: P
authors.lastname: Delafosse
authors.forename: Florence
authors.initials: F
authors.lastname: Molinié
authors.forename: Danièle
authors.initials: D
authors.lastname: Luce
authors.forename: Isabelle
authors.initials: I
authors.lastname: Stücker
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D005260:Female; D005602:France; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking; D016540:Smoking Cessation