title: Smoking and subsequent risk of leukemia in Japan: The Japan Public Health Center-based Prospective Study.
abstract: BACKGROUND
  Cigarette smoking has been reported to be associated with an increased risk of leukemia. Most epidemiological evidence on the association between cigarette smoking and leukemia risk is from studies conducted in Western populations, however, and evidence from Asian populations is scarce.
  
  
  METHODS
  We conducted a large-scale population-based cohort study of 96,992 Japanese subjects (46,493 men and 50,499 women; age 40-69 years at baseline) with an average 18.3 years of follow-up, during which we identified 90 cases of acute myeloid leukemia (AML), 19 of acute lymphoblastic leukemia (ALL), and 28 of chronic myeloid leukemia (CML). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a Cox regression model adjusted for potential confounders.
  
  
  RESULTS
  When we adjusted for age, sex, and study area, our findings showed no significant association or increasing dose-response relationship between risk of AML and cigarette smoking overall. However, after further adjustment for body mass index and occupation, current smokers with more than 30 pack-years of cigarette smoking had a significantly increased risk of AML compared to never smokers among men (HR 2.21; 95% CI, 1.01-4.83). This increased risk was not clear among women.
  
  
  CONCLUSIONS
  Our results suggest that cigarette smoking increases the risk of AML in Japanese men. The associations of smoking with AML among women, and with CML and ALL among men and women, should be assessed in future studies.
authors.affiliation: Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan; Division of Hematology, Saitama Medical Center, Jichi Medical University, Omiya, Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ugai
authors.affiliation: Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan; Department of Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: kmatsuo@aichi-cc.jp.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
authors.forename: Norie
authors.initials: N
authors.lastname: Sawada
authors.affiliation: Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
authors.forename: Taiki
authors.initials: T
authors.lastname: Yamaji
authors.affiliation: Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Shimazu
authors.affiliation: Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
authors.forename: Shizuka
authors.initials: S
authors.lastname: Sasazuki
authors.affiliation: Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Manami
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007938:Leukemia / Q000453:epidemiology*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000453:epidemiology; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology; D011446:Prospective Studies; D011634:Public Health; D018570:Risk Assessment; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology
keywords: JPHC study; Leukemia; Prospective cohort study; Smoking