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American Journal of Epidemiology Advance Access published online on October 9, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn257
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Menstrual and Reproductive Factors in Association With Lung Cancer in Female Lifetime Nonsmokers

Jocelyn M. Weiss, James V. Lacey, Jr., Xiao-Ou Shu, Bu-Tian Ji, Lifang Hou, Gong Yang, Honglan Li, Nathaniel Rothman, Aaron Blair, Yu-Tang Gao, Wong-Ho Chow and Wei Zheng

Correspondence to Dr. Jocelyn Weiss, International Epidemiology Institute, 1455 Research Boulevard, Suite 550, Rockville, MD 20850 (e-mail: jocelyn{at}iei.us).

Received for publication February 27, 2008. Accepted for publication July 25, 2008.

Cigarette smoking is irrefutably the strongest risk factor for lung cancer; however, approximately 25% of cases worldwide occur among nonsmokers. The age-adjusted annual incidence rate of lung cancer in Shanghai, a region where relatively few women smoke cigarettes, is one of the highest in the world. To help further elucidate the etiology of lung cancer among nonsmokers, the authors examined hormonal factors among women who were lifetime nonsmokers. They analyzed data from the prospective Shanghai Women's Health Study, which recruited Chinese women aged 40–70 years between 1996 and 2000 from selected urban communities. The current analysis included 71,314 women (n = 220 cases) who were lifetime nonsmokers and had no history of cancer at baseline. Later age at menopause (≥51 vs. <46 years; hazard ratio (HR) = 0.63, 95% confidence interval (CI): 0.40, 1.00), longer reproductive period (≥36 vs. <31 years; HR = 0.60, 95% CI: 0.39, 0.93), higher parity (≥4 vs. 0 children; HR = 0.42, 95% CI: 0.19, 0.90), and intrauterine device use (HR = 0.59, 95% CI: 0.41, 0.86) were associated with decreased risks of lung cancer. This large prospective study suggests a potential role for hormonal factors in the etiology of lung cancer among nonsmoking women.

hormones; lung; menstrual cycle; neoplasms; parity

Abbreviations: CI, confidence interval; HR, hazard ratio


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