ArticleAmerican journal of epidemiology2014
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.
Article in American journal of epidemiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 48 citations in OpenAlex.
- A Validated Clinical Risk Prediction Model for Lung Cancer in Smokers of All Ages and Exposure Types: A HUNT Study.EBioMedicine · 2018Trial
- Eligibility and Prognostic Performance of Smoking Duration-Based Versus Pack-Year-Based U.S. National Lung Cancer Screening Criteria Across Racial and Ethnic Groups.Annals of internal medicine · 2026Article
- Article
- Pack-Year Smoking History: An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2024Article
- Impact of smoking reduction on lung cancer risk in patients with COPD who smoked fewer than 30 pack-years: a nationwide population-based cohort study.Respiratory research · 2024Article
- Respirable Crystalline Silica Exposure, Smoking, and Lung Cancer Subtype Risks. A Pooled Analysis of Case-Control Studies.American journal of respiratory and critical care medicine · 2020Article
- Smoking, air pollution, and lung cancer risk in the Nurses' Health Study cohort: time-dependent confounding and effect modification.Critical reviews in toxicology · 2020Review
- Article
- Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach.Oral oncology · 2019Article
- Modeling the Complex Exposure History of Smoking in Predicting Bladder Cancer: A Pooled Analysis of 15 Case-Control Studies.Epidemiology (Cambridge, Mass.) · 2019Article
- Trends in Lung Cancer and Cigarette Smoking: California Compared to the Rest of the United States.Cancer prevention research (Philadelphia, Pa.) · 2019Article
- Risk of lung cancer in relation to various metrics of smoking history: a case-control study in Montreal.BMC cancer · 2018Article
- Alcohol Consumption and Lung Cancer According to Ile349Val Polymorphism inJournal of Cancer · 2017Article
- Early Life Exposures and Adult Cancer Risk.Epidemiologic reviews · 2017Review
- Cigarette use, comorbidities, and prognosis in a prospective head and neck squamous cell carcinoma population.Head & neck · 2016Article
- Hypomethylation of smoking-related genes is associated with future lung cancer in four prospective cohorts.Nature communications · 2015Article
- Dynamics of smoking-induced genome-wide methylation changes with time since smoking cessation.Human molecular genetics · 2015Article
- Article
- The impact of smoking on the clinical outcome of locoregionally advanced nasopharyngeal carcinoma after chemoradiotherapy.Radiation oncology (London, England) · 2014Article
- Invited commentary: is it time to retire the "pack-years" variable? Maybe not!American journal of epidemiology · 2014Article
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Authors and funding
45 authors at 20 institutions in 16 countries.
Funding
Abstract
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 (1985-2009). 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 20-30 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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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.