Originally published as JCO Early Release 10.1200/JCO.2008.17.0498 on October 6 2008

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Reduction and Cessation of Cigarette Smoking and Risk of Cancer: A Cohort Study of Korean Men

Yun-Mi Song, Joohon Sung, Hong-Jun Cho

From the Department of Family Medicine, Samsung Medical Center, and Center for Clinical Research, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine; Department of Epidemiology, School of Public Health, Seoul National University; Department of Cancer Epidemiology and Cancer Prevention, National Cancer Center; and the Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding author: Hong-Jun Cho, MD, MPH, PhD, Department of Family Medicine, Asan Medical Center, 388-1 Poongnap-dong Songpa-gu, Seoul 138-736 Korea; e-mail: hjcho{at}amc.seoul.kr

Purpose Reducing cigarette smoking has been proposed as a method of harm reduction. The effect of smoking reduction on cancer risk has not been studied in Asian populations.

Patients and Methods A total of 479,156 Korean men, age 30 to 58 years, were stratified into nine groups based on smoking status in 1990 and 1992. From 1992 to 2003, patients were observed and tested for the occurrence of cancer.

Results There was no association between smoking reduction and risk of all cancers. However, the risk of smoking-related cancers tended to decrease, though not significantly, when heavy smokers ( 20 cigarettes/d) became moderate smokers (10 to 19 cigarettes/d), with a hazard ratio (HR) of 0.91 (95% CI, 0.82 to 1.02). For lung cancer, patients who reduced from heavy to moderate smoking and from heavy to light smoking (< 10 cigarettes/d) had significantly decreased risks based on multivariable-adjusted HRs (HR = 0.72, 95% CI, 0.49 to 0.89; HR = 0.63, 95% CI, 0.46 to 0.84, respectively). Study participants who never smoked, sustained ex-smokers, and quitters had lower risks for all cancers, smoking-related cancers, and lung cancer in a dose-response manner as compared with heavy smokers.

Conclusion Smoking reduction was associated with a significant decrease in the risk of lung cancer, but the size of risk reduction was disproportionately smaller than that expected from the reduced amount of cigarette consumption. Although smoking cessation should be the cornerstone of preventing smoking-related cancers, smoking reduction could be considered as a strategy to supplement smoking cessation for those who are unable to quit smoking immediately.

published online ahead of print at www.jco.org on October 6, 2008.

Supported by Grant No. SBRI C-A7-416-1 from the Samsung Biomedical Research Institute, Grant No. 0610552-2 from the National Cancer Center, and Grant No. 01-PJ1-PG1-01CH10-0007 Ministry of Health and Welfare, Korea. The sponsors had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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