한국인에서 흡연이 방광암에 미치는 영향에 관한 전향적 Cohort 연구 = The Effect of Cigarette Smoking on Bladder Cancer in Korean: A Prospective Cohort Study

다국어 초록 (Multilingual Abstract)

Purpose: To verify the association between cigarette smoking and bladder cancer in the Korean population, as smoking is well known as a risk factor on bladder cancer. The risk of bladder cancer was compared among never- smokers, ex-smokers and current-smokers using a multivariate adjusted incidence rate and the mortality rate of bladder cancer of Koreans.
Materials and Methods: A total of 348,010 participants were enrolled in this prospective study between 1993(to 1994) and 2002. All participants completed a self administered questionnaire on cancer risk factors, including smoking habit. Follow up for incident bladder cancer was established. We classified all participants into three categories: current-smoker, ex- smoker and never-smoker, on the basis of their smoking habits. We confirmed bladder cancer from the data of the Korea National Cancer Registry and National Health Insurance Corporation up to(December?) 2002. The multivariate adjusted incidence and the mortality due to bladder cancer were used for both genders for a statistical analysis using a Cox proportional hazards model.
Results: The incidence rate of bladder cancer per 100,000 persons in male never-smokers, ex-smokers and current-smokers were 27, 41 and 48, respectively, and the multivariate adjusted relative risks (RR) were 1.3 (95% confidence interval(CI), 0.9-2.0) and 1.7(95% CI, 1.2-2.3) in ex- and current smokers, respectively. The incidence rate of bladder cancer in women was 4.7, 8.4 and 13, respectively. There was no significant association between the risk of bladder cancer and the amount and duration of smoking.
Conclusions: We concluded that current smokers have an increased incidence and mortality rate of bladder cancer in both genders in the Korean population, but there was no significant difference in relation to the amount and duration of smoking

국문 초록 (Abstract)

이 연구는 한국인 대규모 인구집단을 장기간 추적한 전향적 코호트연구방법을 통해, 흡연 여부가 방광암발생에 미치는 영향을 파악하고자 실시한 역학연구이다. 남여 공히 비 흡연자에 비하여 현재 흡연자의 경우 방광암 발생은 남자는 1.7배, 여자는 1.6배 높았으며, 방광암으로 인한 사망은 남자 1.7배, 여자 2.3배 높은 것으로 나타났다. 외국의 경우 이미 흡연과 방광암에 대한 연구가 많이 보고되어 있으나, 흡연율이 매우 높은 우리나라에서 흡연이 방광암을 유발하는 확실한 위험인자로 확인되었기에 적극적인 예방과 대처가 필요할 것으로 생각하며 향후 좀더 정확하고 객관적인 연구가 필요할 것으로 생각한다.

참고문헌 (Reference)

• 1 "p53:an importment key to understanding urologic cancer" 14 : 257-268, 1995
• 2 "p53 mutations in human cancers" 253 : 49-53, 1991
• 3 "Vitamin C and vitamin E supplement use and bladder cancer mortality in a large cohort of US men and women" 156 : 1002-1010, 2002
• 4 "Tumor suppressor genes" 254 : 1138-46, 1991
• 5 "The impact of smoking habits on lung cancer risk:28 years,observation of 26,000 Norwegian men and women" 7 : 366-376, 1996
• 6 "The impact of cigarette smoking on stage,grade,and number of recurrences of transitional cell carcinoma of the bladder" 137 : 401-3, 1987
• 7 "Selective targeting of p53 gene mutational hotspots in human cancers by etiologically defined carcinogens" 51 : 6185-9, 1991
• 8 "Role of oxygen free radicals in cancer development" 32 : 30-38, 1996
• 9 "Risk of bladder cancer by source and type of tobacco exposure:a case control study" 44 : 622-8, 1989
• 10 "P53 point mutations in initial superficial bladder cancer occur only in tumors from current or recent cigarette smokers" 21 : 101-106, 2000
• 11 "Modern nutrition in health and disease. 9th ed" Williams & Wilkins 467-483, 1999
• 12 "Influence of smoking on status on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma of the bladder" 86 : 2337-2345, 1999
• 13 "Estimates of the worldwide incidence of 25 major cancers in 1990" 80 : 827-841, 1999
• 14 "Effect of smoking on bladder cancer as a single risk factor" 45 : 1-6, 2004
• 15 "Damage to DNA by reactive oxygen and nitrogen species:role in inflammatory disease and progression to cancer" 313 : 17-29, 1996
• 16 "DNA adducts in biopsy samples of humen urinary bladder identification of N- -4-aminobiphenyl as a major adduct" deoxygua (deoxygua): 5350-4,
• 17 "Contribution of genetic and nutritional factors to DNA damage in heavy smokers" 18 : 503-509, 1997
• 18 "An international study of smoking and bladder cancer" 131 : 650-654, 1984
• 19 "An epidemiological review of tobacco use and bladder cancer" 2 : 129-43, 1991
• 20 "A prospective study on active and environmental tobacco smoking and bladder cancer risk(The Netherlands)" 13 : 83-90, 2002
• 21 "A molecular and epidemiological study on bladder cancer:p53 mutations,tobacco smoking,and occupational exposure to asbestos" 5 : 33-39, 1996