title: Time to smoke first morning cigarette and lung cancer in a case-control study.
abstract: BACKGROUND
  Targeting smokers at higher lung cancer risk can improve efficiency and reduce false-positive detection in lung cancer screening. We evaluated whether time to first cigarette after waking (TTFC), a single-item measure of nicotine dependency, could improve stratification of lung cancer risk beyond standard smoking metrics (intensity, duration, and pack-years).
  
  
  METHODS
  In 3249 ever-smokers (n = 1812 case subjects; n = 1437 control subjects) from a population-based case-control study in Italy, we examined the association between TTFC and lung cancer using logistic regression and estimated lung cancer incidence by levels of TTFC, and intensity, duration, and pack-years using absolute risk regression. Significance tests were two-sided.
  
  
  RESULTS
  Compared with smokers with TTFC greater than 60 minutes, the lung cancer odds ratios for TTFC of 31 to 60 minutes, 6 to 30 minutes, and 5 or fewer minutes (by increasing dependency) were 2.57 (95% confidence interval [CI] = 2.03 to 3.26), 2.27 (95% CI = 1.79 to 2.88), and 3.50 (95% CI = 2.64 to 4.64), respectively (P trend < .0001). The average lung cancer incidence rates for smokers of 1 to 10, 11 to 20, 21 to 30 and more than 30 cigarettes per day were consistently higher among smokers with TTFC of 60 or fewer minutes vs more than 60 minutes (64.1 vs 11.7; 125.6 vs 28.6; 130.1 vs 40.7; and 260.8 vs 108.9 per 100000 person-years, respectively). The slopes of increase in lung cancer rates with smoking duration and pack-years were statistically significantly greater among smokers with higher dependency (P interaction < .001).
  
  
  CONCLUSIONS
  Lung cancer risk increases with shorter TTFC; this simple nicotine dependency measure increases lung cancer risk stratification beyond standard smoking measures. Assessing TTFC may improve lung cancer risk prediction and could be useful in lung cancer screening and smoking cessation programs.
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Fangyi
authors.initials: F
authors.lastname: Gu
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Sholom
authors.initials: S
authors.lastname: Wacholder
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kovalchik
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Orestis A
authors.initials: OA
authors.lastname: Panagiotou
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Carolyn
authors.initials: C
authors.lastname: Reyes-Guzman
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Neal D
authors.initials: ND
authors.lastname: Freedman
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Sara
authors.initials: S
authors.lastname: De Matteis
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Bertazzi
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Bergen
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB).
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Landi
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD (FG, SW, SK, OAP, CR-G, NDF, SDM, MTL, NEC); Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart & Lung Institute, Imperial College London, London, UK (SDM); Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (SDM, DC, PAB); Center for Health Sciences, SRI International, Menlo Park, CA (AWB). caporaso@nih.gov fangyigu@gmail.com.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Caporaso
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013997:Time Factors