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Article ; Online: Smoking Cessation and Short- and Longer-Term Mortality.

Cho, Eo Rin / Brill, Ilene K / Gram, Inger T / Brown, Patrick E / Jha, Prabhat

NEJM evidence

2024 Volume 3, Issue 3, Page(s) EVIDoa2300272

Abstract: Smoking Cessation and MortalityIn this meta-analysis of four national cohorts (total of 1.48 million adults followed for 15 years, in whom 122,697 deaths occurred), current smokers had higher hazard ratios for death compared with never smokers (2.8 for ... ...

Abstract	Smoking Cessation and MortalityIn this meta-analysis of four national cohorts (total of 1.48 million adults followed for 15 years, in whom 122,697 deaths occurred), current smokers had higher hazard ratios for death compared with never smokers (2.8 for women, 2.7 for men). Survival between 40 and 79 years of age was 13 years less in people who smoked compared with never smokers. Former smokers showed lower hazard ratios (1.3 in both women and men). Cessation at every age was associated with longer survival, with benefits evident as early as 3 years after cessation.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Smokers ; Smoking/epidemiology ; Smoking Cessation ; Middle Aged ; Aged ; Mortality
Language	English
Publishing date	2024-02-08
Publishing country	United States
Document type	Meta-Analysis ; Journal Article
ISSN	2766-5526
ISSN (online)	2766-5526
DOI	10.1056/EVIDoa2300272
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Article ; Online: Factors associated with predictors of smoking cessation from a Norwegian internet-based smoking cessation intervention study.

Gram, Inger T / Antypas, Konstantinos / Wangberg, Silje C / Løchen, Maja-Lisa / Larbi, Dillys

Tobacco prevention & cessation

2022 Volume 8, Page(s) 38

Abstract: Introduction: We examined if we could identify predictors for smoking cessation at six months post cessation, among smokers enrolled in a large Norwegian population-based intervention study.: Methods: We followed 4333 (72.1% women) smokers who ... ...

Abstract	Introduction: We examined if we could identify predictors for smoking cessation at six months post cessation, among smokers enrolled in a large Norwegian population-based intervention study. Methods: We followed 4333 (72.1% women) smokers who enrolled in an internet-based smoking cessation intervention during 2010-2012. The baseline questionnaire collected information on sociodemographic and lifestyle factors, including current snus use. The cessation outcome was self-reported no smoking past seven days, at six months. We used logistic regression to estimate odds ratios (ORs) with 95% confidence intervals, to identify predictors of smoking cessation, adjusting for potential confounders. Results: Women (OR=1.30; 95% CI: 1.01-1.69) compared with men, and those with medium (OR=1.31; 95% CI: 1.02-1.68) and longer (OR=1.42; 95% CI: 1.06-1.90) education compared with those with shorter education, were more likely to be successful quitters.Overall, being a student (OR=0.56; 95% CI: 0.37-0.85) compared with having full-time work, and a moderate to high Fagerström test for nicotine dependence (FTND) score (OR=0.69; 95% CI: 0.55-0.87) compared with a low score, were predictors for unsuccessful cessation. Current snus use was a predictor for unsuccessful cessation compared to no snus use for both men (OR=0.49; 95% CI: 0.28-0.88) and women (OR=0.49; 95% CI: 0.32-0.75). Conclusions: Our study identifies female sex and longer education as predictors for successful smoking cessation, while a medium or high FTND score, being a student, and current snus use, were predictors for unsuccessful smoking cessation. Only current snus use was a predictor for unsuccessful cessation for both sexes. Our results indicate that smokers should be warned that snus use may prevent successful smoking cessation.
Language	English
Publishing date	2022-10-31
Publishing country	Greece
Document type	Journal Article
ISSN	2459-3087
ISSN (online)	2459-3087
DOI	10.18332/tpc/155287
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Article ; Online: Smoking and pancreatic cancer: a sex-specific analysis in the Multiethnic Cohort study.

Gram, Inger T / Park, Song-Yi / Wilkens, Lynne R / Le Marchand, Loïc / Setiawan, Veronica Wendy

Cancer causes & control : CCC

2022 Volume 34, Issue 1, Page(s) 89–100

Abstract: Purpose: To examine whether the detrimental smoking-related association with pancreatic cancer (PC) is the same for women as for men.: Methods: We analyzed data from 192,035 participants aged 45-75 years, enrolled in the Multiethnic Cohort study (MEC) ...

Abstract	Purpose: To examine whether the detrimental smoking-related association with pancreatic cancer (PC) is the same for women as for men. Methods: We analyzed data from 192,035 participants aged 45-75 years, enrolled in the Multiethnic Cohort study (MEC) in 1993-1996. We identified PC cases via linkage to the Hawaii and California Surveillance, Epidemiology, and End Results Program cancer registries through December 2017. Results: During a mean follow-up of 19.2 years, we identified 1,936 incident PC cases. Women smokers smoked on average less than men smokers. In multivariate Cox regression models, as compared with sex-specific never smokers, current smokers had a similar elevated risk of PC for women, hazard ratio (HR) 1.49 (95% CI 1.24, 1.79) and as for men, HR 1.48 (95% CI 1.22, 1.79) (p Conclusion: Although MEC women smoke on average less than their men counterparts, the smoking-related increase in PC risk and the benefits of cessation seem to be of similar magnitudes for women as for men.
MeSH term(s)	Male ; Humans ; Female ; Cohort Studies ; Risk Factors ; Smoking/adverse effects ; Smoking/epidemiology ; Smoking Cessation ; Proportional Hazards Models ; Pancreatic Neoplasms/epidemiology ; Pancreatic Neoplasms/etiology
Language	English
Publishing date	2022-10-17
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1064022-8
ISSN	1573-7225 ; 0957-5243
ISSN (online)	1573-7225
ISSN	0957-5243
DOI	10.1007/s10552-022-01637-z
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Article ; Online: Never-smokers and the fraction of breast cancer attributable to second-hand smoke from parents during childhood: the Norwegian Women and Cancer Study 1991-2018.

Gram, Inger T / Wiik, Arne Bastian / Lund, Eiliv / Licaj, Idlir / Braaten, Tonje

International journal of epidemiology

2021 Volume 50, Issue 6, Page(s) 1927–1935

Abstract: Background: Second-hand smoke (SHS) is not an established risk factor for breast cancer. We examined exposure to SHS from parents during childhood and breast-cancer risk overall and by oestrogen- and progesterone-receptor status in the Norwegian Women ... ...

Abstract	Background: Second-hand smoke (SHS) is not an established risk factor for breast cancer. We examined exposure to SHS from parents during childhood and breast-cancer risk overall and by oestrogen- and progesterone-receptor status in the Norwegian Women and Cancer Study. Furthermore, we utilized our nationally representative prospective cohort study to estimate the fraction of breast cancer attributable to parental SHS during childhood. Methods: We followed 45 923 never-smoking women, aged 34-70 years, who completed a baseline questionnaire between 1991 and 2007 through linkages to national registries through December 2018. We used Cox proportional-hazards models to estimate age-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). We estimated the attributable and the population attributable fraction of breast cancer with 95% CIs. Results: During a mean follow-up of 19.8 (6.8) years, 2185 women developed invasive breast cancer, confirmed by histology. Women exposed to SHS from parents during childhood had an 11% higher (95% CI: 1.02-1.22) risk of breast cancer compared with those who were not. No difference was found for oestrogen (Pheterogeneity = 0.31) and progesterone (Pheterogeneity = 0.95) receptor status. For women exposed, the attributable fraction was 10.3% (95% CI: 1.8-18.0), whereas the population attributable fraction of breast cancer was 7.0% (95% CI: 1.0-13.0). Conclusions: Our results suggest that 1 in 14 breast-cancer cases could have been avoided in the absence of SHS exposure from parents during childhood in a population of never-smoking women. The cancer burden attributable to SHS may be underestimated.
MeSH term(s)	Adult ; Aged ; Breast Neoplasms/epidemiology ; Breast Neoplasms/etiology ; Female ; Humans ; Middle Aged ; Parents ; Prospective Studies ; Risk Factors ; Smokers ; Tobacco Smoke Pollution/adverse effects
Chemical Substances	Tobacco Smoke Pollution
Language	English
Publishing date	2021-08-01
Publishing country	England
Document type	Journal Article
ZDB-ID	187909-1
ISSN	1464-3685 ; 0300-5771
ISSN (online)	1464-3685
ISSN	0300-5771
DOI	10.1093/ije/dyab153
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Article ; Online: Smoking-Related Risks of Colorectal Cancer by Anatomical Subsite and Sex.

Gram, Inger T / Park, Song-Yi / Wilkens, Lynne R / Haiman, Christopher A / Le Marchand, Loïc

American journal of epidemiology

2020 Volume 189, Issue 6, Page(s) 543–553

Abstract: The purpose of this study was to examine whether the increased risk of colorectal cancer due to cigarette smoking differed by anatomical subsite or sex. We analyzed data from 188,052 participants aged 45-75 years (45% men) who were enrolled in the ... ...

Abstract	The purpose of this study was to examine whether the increased risk of colorectal cancer due to cigarette smoking differed by anatomical subsite or sex. We analyzed data from 188,052 participants aged 45-75 years (45% men) who were enrolled in the Multiethnic Cohort Study in 1993-1996. During a mean follow-up period of 16.7 years, we identified 4,879 incident cases of invasive colorectal adenocarcinoma. In multivariate Cox regression models, as compared with never smokers of the same sex, male ever smokers had a 39% higher risk (hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.16, 1.67) of cancer of the left (distal or descending) colon but not of the right (proximal or ascending) colon (HR = 1.03, 95% CI: 0.89, 1.18), while female ever smokers had a 20% higher risk (HR = 1.20, 95% CI: 1.06, 1.36) of cancer of the right colon but not of the left colon (HR = 0.96, 95% CI: 0.80, 1.15). Compared with male smokers, female smokers had a greater increase in risk of rectal cancer with number of pack-years of smoking (P for heterogeneity = 0.03). Our results suggest that male smokers are at increased risk of left colon cancer and female smokers are at increased risk of right colon cancer. Our study also suggests that females who smoke may have a higher risk of rectal cancer due to smoking than their male counterparts.
MeSH term(s)	Adenocarcinoma/epidemiology ; Adenocarcinoma/ethnology ; Adenocarcinoma/mortality ; Aged ; Aged, 80 and over ; Alcohol Drinking/epidemiology ; Body Weights and Measures ; Cigarette Smoking/epidemiology ; Cigarette Smoking/ethnology ; Cohort Studies ; Colonic Neoplasms/epidemiology ; Colorectal Neoplasms/epidemiology ; Colorectal Neoplasms/ethnology ; Colorectal Neoplasms/mortality ; Educational Status ; Exercise ; Female ; Humans ; Male ; Menopause ; Middle Aged ; Proportional Hazards Models ; Rectal Neoplasms/epidemiology ; Risk Assessment ; Risk Factors ; Sex Factors ; United States/epidemiology
Language	English
Publishing date	2020-01-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwaa005
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Article ; Online: The fraction of breast cancer attributable to smoking: The Norwegian women and cancer study 1991-2012.

Gram, Inger T / Little, Melissa A / Lund, Eiliv / Braaten, Tonje

British journal of cancer

2016 Volume 115, Issue 5, Page(s) 616–623

Abstract: Background: Results from several recent cohort studies on smoking and breast cancer incidence and mortality suggest that the burden of smoking on society is underestimated. We estimated the fraction of breast cancer attributable to smoking in the ... ...

Abstract	Background: Results from several recent cohort studies on smoking and breast cancer incidence and mortality suggest that the burden of smoking on society is underestimated. We estimated the fraction of breast cancer attributable to smoking in the Norwegian Women and Cancer Study, a nationally representative prospective cohort study. Methods: We followed 130 053 women, aged 34-70 years, who completed a baseline questionnaire between 1991 and 2007, through linkages to national registries through December 2012. We used Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), while adjusting for confounders. Never smokers, excluding passive smokers, were used as the reference group in all main analyses. We estimated attributable fractions (AFs) % in smokers and in the population (PAFs) % with 95% CIs. Results: Altogether, 4293 women developed invasive breast cancer, confirmed by histology. Compared with never active, never passive smokers, ever (former and current) smokers had an overall risk of breast cancer that was 21% higher (HR=1.21; 95% CI=1.08-1.34). For ever smokers, the AF was 17.3% (95% CI =7.4-25.4) and for the population the PAF of breast cancer was 11.9% (95% CI=5.3-18.1). For passive smokers, the PAF of breast cancer was 3.2% (95% CI=1.0-5.4). When we applied PAF estimates for ever smoking on the 2907 new breast cancer cases among Norwegian women aged 35+ at diagnosis in 2012, this yielded 345 (95% CI=154-526) breast cancer cases that could have been avoided in the absence of active smoking that year. Conclusions: In smokers, one in six and in the population, one in nine breast cancer cases could have been avoided in the absence of active smoking. Our findings support the notion that the global cancer burden due to smoking is substantially underestimated.
MeSH term(s)	Adult ; Breast Neoplasms/epidemiology ; Breast Neoplasms/etiology ; Female ; Humans ; Incidence ; Middle Aged ; Norway/epidemiology ; Smoking
Language	English
Publishing date	2016-08-23
Publishing country	England
Document type	Journal Article
ZDB-ID	80075-2
ISSN	1532-1827 ; 0007-0920
ISSN (online)	1532-1827
ISSN	0007-0920
DOI	10.1038/bjc.2016.154
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Article ; Online: Sex Differences in Risk of Smoking-Associated Lung Cancer: Results From a Cohort of 600,000 Norwegians.

Hansen, Merethe S / Licaj, Idlir / Braaten, Tonje / Langhammer, Arnulf / Le Marchand, Loic / Gram, Inger T

American journal of epidemiology

2017 Volume 187, Issue 5, Page(s) 971–981

Abstract: Whether women are more susceptible than men to smoking-related lung cancer has been a topic of controversy. To address this question, we compared risks of lung cancer associated with smoking by sex. Altogether, 585,583 participants from 3 Norwegian ... ...

Abstract	Whether women are more susceptible than men to smoking-related lung cancer has been a topic of controversy. To address this question, we compared risks of lung cancer associated with smoking by sex. Altogether, 585,583 participants from 3 Norwegian cohorts (Norwegian Counties Study, 40 Years Study, and Cohort of Norway (CONOR) Study) were followed until December 31, 2013, through linkage of data to national registries. We used Cox proportional hazards models and 95% confidence intervals to estimate risks. During nearly 12 million person-years of follow-up, 6,534 participants (43% women) were diagnosed with lung cancer. More men than women were heavier smokers. Compared with never smokers, male and female current smokers with ≥16 pack-years of smoking had hazard ratios for lung cancer of 27.24 (95% confidence interval (CI): 22.42, 33.09) and 23.90 (95% CI: 20.57, 27.76), respectively (P for heterogeneity = 0.30). In contrast, for current smokers, in a model with pack-years measured continuously, men had a hazard ratio of 1.43 (95% CI: 1.39, 1.48) and women a hazard ratio of 1.64 (95% CI: 1.57, 1.71) for each 10-pack-year increment of smoking (P for heterogeneity < 0.01). Our results suggest that women have an increased susceptibility to lung cancer compared with men, given the same lifetime smoking exposure.
MeSH term(s)	Adult ; Cohort Studies ; Disease Susceptibility/etiology ; Female ; Humans ; Lung Neoplasms/epidemiology ; Lung Neoplasms/etiology ; Male ; Middle Aged ; Norway/epidemiology ; Proportional Hazards Models ; Registries ; Risk Factors ; Sex Distribution ; Sex Factors ; Smoking/adverse effects ; Time Factors ; Young Adult
Language	English
Publishing date	2017-10-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwx339
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Article: Breast cancer screening programme as setting for an adjunct research project: effect on programme attendance.

Gram, Inger T / Lund, Eiliv

Journal of medical screening

2008 Volume 15, Issue 1, Page(s) 44–45

Abstract: The purpose of this randomized controlled trial was to examine if an adjunct research project to a breast cancer screening programme would affect the high programme attendance. Women residing in the municipality of Tromsø aged 55 years or older, ... ...

Abstract	The purpose of this randomized controlled trial was to examine if an adjunct research project to a breast cancer screening programme would affect the high programme attendance. Women residing in the municipality of Tromsø aged 55 years or older, scheduled to receive an invitation letter to their first screening round in the Norwegian Breast Cancer Screening Programme during our 15-week recruitment period, were eligible. We randomly selected up to 25 invitees per screening day to receive a mailed request to participate in the research project named the Tromsø Mammography and Breast Cancer study. These women constituted the study arm, while the remaining eligible invitees served as the control arm. The attendance rate to the screening programme was 80.1% among the 253 women in the study arm and 74.8% among the 397 women in the control arm (P = 0.09). Our trial finds no effect on the high attendance to the breast cancer screening programme indicating that cancer screening programmes might be suitable settings for adjunct research projects.
MeSH term(s)	Biomedical Research/methods ; Breast Neoplasms/diagnosis ; Female ; Humans ; Mass Screening/methods ; Mass Screening/statistics & numerical data ; Middle Aged ; Norway ; Patient Acceptance of Health Care/statistics & numerical data
Language	English
Publishing date	2008
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1235253-6
ISSN	1475-5793 ; 0969-1413
ISSN (online)	1475-5793
ISSN	0969-1413
DOI	10.1258/jms.2008.007014
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Article ; Online: Smoking and breast cancer risk by race/ethnicity and oestrogen and progesterone receptor status: the Multiethnic Cohort (MEC) study.

Gram, Inger T / Park, Song-Yi / Maskarinec, Gertraud / Wilkens, Lynne R / Haiman, Christopher A / Le Marchand, Loïc

International journal of epidemiology

2018 Volume 48, Issue 2, Page(s) 501–511

Abstract: Background: The purpose of this study was to examine if the smoking-related higher breast cancer risk was similar for the five race/ethnicity groups in the Multiethnic Cohort (MEC) study and by oestrogen (ER) and progesterone (PR) receptor status.: ... ...

Abstract	Background: The purpose of this study was to examine if the smoking-related higher breast cancer risk was similar for the five race/ethnicity groups in the Multiethnic Cohort (MEC) study and by oestrogen (ER) and progesterone (PR) receptor status. Methods: From 1993 to 2013, we followed 67 313 women who were enrolled in the MEC study at 45-75 years of age. We identified breast cancer cases and tumour receptor status via linkage to the Hawaii and California Surveillance, Epidemiology and End Results Program cancer registries through December 2013. We used Cox proportional hazards regression to estimate multivariable-adjusted hazard ratios with 95% confidence intervals (CI). Results: During a mean follow-up of 16.7 years, we identified 4230 incident, invasive breast cancer cases. Compared with parous never smokers, parous ever smokers who had smoked more than 5 years before their first live childbirth had a higher risk of breast cancer overall of 31% (95% CI: 1.14-1.51). This higher risk was 51% (95% CI: 1.05-2.16) for African Americans, 66% (95% CI: 1.10-2.50) for Native Hawaiians, 42% (95% CI: 1.13-1.78) for Whites, 37% (95% CI: 1.17-1.61) for ER-positive (ER+) tumours and 33% (95% CI: 1.11-1.59) for PR+ tumours. No difference was suggested by racial/ethnic groups (Pheterogeneity = 0.15) or tumour receptor status (Pheterogeneity = 0.60 by ER status and 0.95 by PR status). Conclusions: We find that the higher breast cancer risk related to smoking is similar across racial/ethnic groups and by ER and PR status, indicating that breast cancer should be considered as a smoking-related cancer.
MeSH term(s)	African Americans/statistics & numerical data ; Aged ; Breast Neoplasms/epidemiology ; Breast Neoplasms/etiology ; California/epidemiology ; Ethnic Groups/statistics & numerical data ; Female ; Hawaii/epidemiology ; Humans ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; Receptors, Estrogen/genetics ; Receptors, Progesterone/genetics ; Registries ; Risk Factors ; SEER Program ; Smoking/adverse effects ; Smoking/epidemiology
Chemical Substances	Receptors, Estrogen ; Receptors, Progesterone
Language	English
Publishing date	2018-12-05
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	187909-1
ISSN	1464-3685 ; 0300-5771
ISSN (online)	1464-3685
ISSN	0300-5771
DOI	10.1093/ije/dyy290
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Article: Cigarette smoking and colorectal cancer mortality among 602,242 Norwegian males and females.

Parajuli, Ranjan / Bjerkaas, Eivind / Tverdal, Aage / Le Marchand, Loïc / Weiderpass, Elisabete / Gram, Inger T

Clinical epidemiology

2014 Volume 6, Page(s) 137–145

Abstract: Background: Colorectal cancer (CRC) is one of the main cancer types, with high incidence and mortality in Norway. We examined the association between different measures of smoking exposure and CRC mortality overall and by subsite in a large Norwegian ... ...

Abstract	Background: Colorectal cancer (CRC) is one of the main cancer types, with high incidence and mortality in Norway. We examined the association between different measures of smoking exposure and CRC mortality overall and by subsite in a large Norwegian cohort. Methods: We followed 602,242 participants from four Norwegian health surveys, aged 19-67 years at enrollment between 1972 and 2003 by linkage to the national registries through December 2007. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) by smoking categories for different CRC endpoints. Results: During a mean follow-up of 14 years, 2,333 Norwegian males and females died of CRC (60% men). Male and female ever smokers had a 20% (HR 1.23, CI 1.08-1.40 and HR 1.22, 95% CI 1.06-1.40, respectively) increased risk of death from CRC compared with sex-specific never smokers. For proximal colon cancer mortality, female ever smokers had a 50% (HR 1.49, 95% CI 1.20-1.87) increased risk compared with female never smokers. The increased risk of rectal cancer mortality was about 40% higher for male ever smokers (HR 1.43, 95% CI 1.14-1.81) compared with male never smokers. A test for heterogeneity by sex showed an increased risk of rectal cancer mortality among men which was significant for former smokers (Wald χ(2) =0.02) and an increased risk of proximal colon cancer mortality among women which was significant for ever and former smokers (Wald χ(2) =0.02 and χ(2) =0.04, respectively). Conclusion: Smoking is associated with increased CRC mortality in both sexes. The risk of rectal and proximal colon cancer mortality was most pronounced among male and female smokers respectively.
Language	English
Publishing date	2014-04-07
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2494772-6
ISSN	1179-1349
ISSN	1179-1349
DOI	10.2147/CLEP.S58722
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