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Effect modification of the association of cumulative exposure and cancer risk by intensity of exposure and time since exposure cessation: A flexible method applied to cigarette smoking and lung cancer in the SYNERGY study.
Am. J. Epidemiol. 179, 290-298 (2014)
The indiscriminate use of the cumulative exposure metric (the product of intensity and duration of exposure) might bias reported associations between exposure to hazardous agents and cancer risk. To assess the independent effects of duration and intensity of exposure on cancer risk, we explored effect modification of the association of cumulative exposure and cancer risk by intensity of exposure. We applied a flexible excess odds ratio model that is linear in cumulative exposure but potentially nonlinear in intensity of exposure to 15 case-control studies of cigarette smoking and lung cancer (19852009). Our model accommodated modification of the excess odds ratio per pack-year of cigarette smoking by time since smoking cessation among former smokers. We observed negative effect modification of the association of pack-years of cigarette smoking and lung cancer by intensity of cigarette smoke for persons who smoked more than 2030 cigarettes per day. Patterns of effect modification were similar across individual studies and across major lung cancer subtypes. We observed strong negative effect modification by time since smoking cessation. Application of our method in this example of cigarette smoking and lung cancer demonstrated that reducing a complex exposure history to a metric such as cumulative exposure is too restrictive.
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Publikationstyp
Artikel: Journalartikel
Dokumenttyp
Wissenschaftlicher Artikel
Schlagwörter
Cigarette Smoke ; Cumulative Exposure ; Effect Modification ; Lung Cancer ; Pooled Analysis; Modeling Total Exposure; Occupational-exposure; Pooled Analysis; Europe; Carcinoma; Alcohol; Smokers
ISSN (print) / ISBN
0002-9262
e-ISSN
1476-6256
Zeitschrift
American Journal of Epidemiology
Quellenangaben
Band: 179,
Heft: 3,
Seiten: 290-298
Verlag
Oxford University Press
Verlagsort
Cary
Nichtpatentliteratur
Publikationen
Begutachtungsstatus
Peer reviewed
Institut(e)
Institute of Epidemiology (EPI)