Tobacco smoking and lung cancer risk: An evaluation based on a systematic review of epidemiological evidence among the Japanese population

Kenji Wakai, Manami Inoue, Tetsuya Mizoue, Keitaro Tanaka, Ichiro Tsuji, Chisato Nagata, Shoichiro Tsugane, Shizuka Sasazuki, Motoki Iwasaki, Tetsuya Otani, Yoshitaka Tsubono, Taichi Shimazu

Research output: Contribution to journalReview articlepeer-review

75 Citations (Scopus)


Background: Although tobacco smoking is the best established risk factor for lung cancer, the association is not as strong among Japanese as among Western populations. It would be of value, therefore, to quantify that association in Japan based on a systematic review of epidemiological evidence for the primary prevention of lung cancer. Methods: Original data were obtained from MEDLINE searches using PubMed, supplemented with manual searches. The evaluation of associations was based on the strength of evidence and the magnitude of the association, together with biological plausibility as previously evaluated by the International Agency for Research on Cancer. A meta-analysis was also conducted to estimate the summary measure of those associations. Results: A total of 8 cohort studies and 14 case-control studies were identified, almost all of which consistently showed a strong association of current smoking with the risk of lung cancer. The summary relative risk for current smokers versus never smokers was estimated as 4.39 (95% confidence interval 3.92-4.92) for men and 2.79 (95% confidence interval 2.44-3.20) for women. Cohort studies and case-control studies gave reasonably consistent summary measures. The summary relative risks were 11.7 and 2.30 for squamous cell carcinoma and adenocarcinoma, respectively, in men, and were 11.3 and 1.37 correspondingly in women. Conclusion: There is convincing evidence that tobacco smoking strongly increases the risk of lung cancer in the Japanese population, with the relative risk for current smokers compared with never smokers measuring around 4.4 for men and 2.8 for women.

Original languageEnglish
Pages (from-to)309-324
Number of pages16
JournalJapanese journal of clinical oncology
Issue number5
Publication statusPublished - 2006 May


  • Epidemiology
  • Japanese
  • Lung neoplasms
  • Smoking
  • Systematic review

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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