Background: In Japan, lung cancer is the top cause of cancer death in men and the third leading cause in women. Updated information on risk factors for lung cancer, therefore, is of great importance. The Japan Collaborative Cohort Study, a large prospective study started in 1988, has provided such information. Methods: We reviewed published findings for lung cancer from the study. The endpoint was death from this cancer. Results: The major findings were as follows. (1) The relative risks in current smokers versus nonsmokers were 4.46 in men and 3.58 in women. (2) Cigarette smoking accounted for 67.0% of lung cancer deaths in men and only 14.6% in women. (3) More than 15 years of smoking cessation may be required to decrease the risk of lung cancer to the level of never smokers. (4) A reduced risk was associated with frequent intake of green-leafy vegetables and fruit in men but not in women. These foods seemed to decrease the risk in male current or former smokers more than in female nonsmokers. (5) Serum levels of α- and β-carotenes, β-cryptoxanthin, and lycopene were inversely correlated with the risk in men. (6) In a preliminary study, serum 8-hydroxy-deoxyguanosine was higher in current smokers than in nonsmokers. Conclusions: The relative and attributable risks of smoking were smaller in Japan than in Western countries. In addition to smoking habits, therefore, we must pay attention to other risk factors for lung cancer or factors that modify the adverse effects of smoking including dietary factors.
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