The effect of smoking on lung cancer: ethnic differences and the smoking paradox

Keum Ji Jung, Christina Jeon, Sun Ha Jee, Keum Ji Jung, Christina Jeon, Sun Ha Jee

Abstract

The objectives of this review were to determine whether the smoking paradox still exists and to summarize possible explanations for the smoking paradox. Based on published data, we compared the risk of cigarette smoking for lung cancer in Western and Asian countries. We extracted data from the relevant studies about annual tobacco consumption, lung cancer mortality rates according to smoking status from each country, and possible explanations for the smoking paradox. A significantly greater risk of lung cancer death was found among current smokers in Asian countries than among nonsmokers, with relative risks (RRs) of 4.0 to 4.6 for Koreans, 3.7 to 5.1 for Japanese, and 2.4 to 6.5 for Chinese. Although a significantly greater risk of lung cancer was present among current smokers in Asian countries, the RRs in Asian countries were much lower than those reported in Western countries (range, 9.4 to 23.2). Possible explanations for the smoking paradox included epidemiologic characteristics, such as the smoking amount, age at smoking initiation, and the use of filtered or mild tobacco. The smoking paradox definitely exists, but may be explained by major epidemiologic characteristics. Therefore, the smoking paradox should not be interpreted as indicating that tobacco is safer or less harmful for Asians.

Keywords: Ethnic groups; Lung neoplasms; Risk; Smoking.

Conflict of interest statement

The authors have no conflicts of interest to declare for this study.

Figures

Figure 1.
Figure 1.
Landmarks of the history of tobacco, from discovery to popularization.
Figure 2.
Figure 2.
Relative risk (RR) of smoking for lung cancer, UK. Adapted from Doll et al. [11-13].
Figure 3.
Figure 3.
Tobacco consumption and lung cancer deaths in Korea.
Figure 4.
Figure 4.
Hypothetical graph of relative risk (RR) in relation to death rate and smoking status.

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