Abstract
Purpose: To determine the risk for malignant primary adult-onset glioma (MPAG) associated with cigarette smoking and other lifestyle behaviors in a large, multiethnic, managed-care cohort.
Methods: The study population included a cohort of 133,811 subscribers to the Kaiser Permanente Medical Care Program of Northern California who had received a multiphasic health checkup and questionnaire between 1977 and 1985, were at least 25 years old at their start of follow-up, and had no prior history of benign or malignant brain tumors. In this cohort, patients were followed for up to 21 years for the development of MPAG.
Results: Risk for MPAG among women increased with increasing packs of cigarettes smoked per day (p-for-trend = 0.04), adjusting for cigar and pipe smoking, patient age, sex, race, education, alcohol use and coffee consumption. A similar pattern was not observed for men. Individuals who smoked marijuana at least once a month, adjusting for cigarette smoking (packs smoked per day) and for the factors noted above, had a 2.8-fold (CI = 1.3–6.2) increased risk for MPAG. Relative risk for MPAG increased with increasing consumption of coffee (p-for-trend = 0.05).
Conclusions: Cigarette smoking was associated with an increased risk for MPAG among women but not among men. Individuals who smoked marijuana at least once a month had an increased risk for MPAG, although no dose-response relation was observed. Drinkers of >7 cups of coffee per day had a 70% increased risk for MPAG and smaller risk elevation for lower consumption. Alcohol usage was not associated with an increased risk for MPAG.
Similar content being viewed by others
References
Cancer Facts & Figures 2003/Cancer Prevention & Early Detection Facts & Figures 2003 (http://www.cancer.org). Atlanta, GA. 2003
Bondy M, Wrensch M: Epidemiology of primary malignant brain tumours. Baillieres Clin Neurol 5(2): 251–270, 1996
Choi N, Schuman L, Gullen W: Epidemiology of primary central nervous system neoplasms. II: case-control study. Am J Epidemiol 91: 467–485, 1970
Abramson Z, Kark J: Serum cholesterol and primary brain tumours: a case-control study. Br J Cancer 52: 93–98, 1985
Ahlbom A, Navier I, Norell S, Olin R, Spannare B: Non-occupational risk indicators for astrocytomas in adults. Am J Epidemiol 124: 334–337, 1986
Preston-Martin S, Mack W, Henderson B: Risk factors for gliomas and meningiomas in males in Los Angeles County. Cancer Res 49: 6137–6143, 1989
Mills P, Preston-Martin S, Annegers J, Beeson L, Phillips R, Fraser G: Risk factors for tumors of the brain and cranial meninges in Seventh-Day Adventists. Neuroepidemiology 8: 266–275, 1989
Hochberg F, Toniolo P, Cole P: Nonoccupational risk indicators of glioblastoma in adults. J Neuro-Oncol 8: 55–60, 1990
Brownson R, Reif J, Chang J, Davis J: An analysis of occupational risks for brain cancer. Am J Public Health 80: 169–172, 1990
Schlehofer B, Kunze S, Sachsenheimer W, Blettner M, Niehoff D, Wahrendorf J: Occupational risk factors for brain tumors: results from a population-based case-control study in Germany. Cancer Causes Control 1: 209–215, 1990
Blowers L, Preston-Martin S, Mack W: Dietary and other lifestyle factors of women with brain gliomas in Los Angeles County (California, USA). Cancer Causes Control 8: 5–12, 1997
Musicco M, Filippini G, Bordo B, Melotto A, Morello G, Berrino F: Gliomas and occupational exposure to carcinogens: case-control study. Am J Epidemiol 116: 782–790, 1982
Burch J, Craib K, Choi B, Miller A, Risch H, Howe G: An exploratory case-control study of brain tumors in adults. J Natl Cancer Inst 78: 601–609, 1987
Ryan P, Lee M, North B, McMichael A: Risk factors for tumors of the brain and meninges: results from the Adelaide adult brain tumor study. Int J Cancer 51: 20–27, 1992
Zampieri P, Meneghini F, Grigoletto F, Gerosa M, Licata C, Casentini L, Longatti P, Padoan A, Mingrino S: Risk factors for cerebral glioma in adults: a case-control study in an Italian population. J Neuro-Oncol 19: 61–67, 1994
Lee M, Wrensch M, Mike R: Dietary and tobacco risk factors for adult onset glioma in the San Francisco Bay Area (California, USA). Cancer Causes Control 8: 12–24, 1997
Preston-Martin S, Paganini-Hill A, Henderson B, Pike M, Wood C: Case-control study of intracranial meningiomas in women in Los Angeles County. California J Natl Cancer Inst 65: 67–73, 1980
Hirayama T: Cancer mortality in nonsmoking women with smoking husbands based on a large-scale cohort study in Japan. Prev Med 13: 680–690, 1984
Zhang Z, Morgenstern H, Spitz M, Tashkin D, Yu G, Marshall J, Hsu T, Schantz S: Marijuana use and increased risk of squamous cell carcinoma of the head and neck. Cancer Epidemiol Biomarkers Prev 8: 1071–1078, 1999
Donald P: Marijuana smoking — possible cause of head and neck carcinoma in young patients. Otolaryngol Head Neck Surg 94: 517–520, 1986
Almadori G, Cerullo P, Ottaviani F, D'Alatri L: Marijuana smoking as a possible cause of tongue carcinoma in young patients. J Laryngol Otol 104: 896–899, 1990
Taylor F: Marijuana as a potential respiratory tract carcinogen: a retrospective analysis of a community hospital population. South Med J 81: 1213–1216, 1988
Sridhar K, Raub W, Weatherby N, Metsch L, Surratt H, Inciardi J, Duncan R, Anwyl R, McCoy C: Possible role of marijuana smoking as a carcinogen in the development of lung cancer at a young age. J Psychoactive Drugs 26: 285–288, 1994
Sidney S, Quesenberry C, Friedman G, Tekawa I: Marijuana use and cancer incidence (California, United States). Cancer Causes Control 8: 722–728, 1997
Robison L, Buckley J, Daigle A, Wells R, Benjamin D, Arthur D, Hammond G: Maternal drug use and risk of childhood nonlymphoblastic leukemia among offspring. Cancer 63: 1904–1911, 1989
Kuijten R, Bunin G, Nass C, Meadows A: Gestational and familial risk factors for childhood astrocytoma: results of a case-control study. Cancer Res 50: 2608–2612, 1990
Grufferman S, Schwartz A, Ruymann F, Maurer H: Parents' use of cocaine and marijuana and increased risk of rhabdomyosarcoma in their children. Cancer Causes Control 4: 217–224, 1993
Boeing H, Schlehofer B, Blettner M, Wahrendorf J: Dietary carcinogens and the risk for glioma and meningioma in Germany. Int J Cancer 53: 561–565, 1993
Robinette C, Hrubec Z, Fraumeni J: Chronic alcoholism and subsequent mortality in world war II veterans. Am J Epidemiol 109: 687–700, 1979
Krieger N: Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82: 703–710, 1992
Hiatt R, Friedman G: The frequency of kidney and urinary tract diseases in a defined population. Kidney Int 22: 63–68, 1982
Karaffa M. ICD-9-CM: International classification of diseases, 9th revision, clinical modification. In: Karaffa MC (ed.) Practice Management Information Corporation, United States. 3rd edn., Vol 1–3. Health Care Financing Administration, Los Angeles, 1991
Friedman G: Effects of multiphasic health testing services (MHTS) on patients. In: Collen M (ed.) Multiphasic Health Testing Services. John Wiley & Sons, New York, 1978, pp 531-549
Percy C, Van Holten V, Muir C: International Classification of Diseases for Oncology = ICD-O. World Health Organization, Geneva, 1990
Friedman G, Habel L, Boles M, McFarland B: Kaiser Permanente Medical Care Program: Division of Research, Northern California, and Center for Health Research, Northwest Division. In: Strom B (ed.) Pharmacoepidemiology. 3rd edn., John Wiley & Sons, New York, 2000, pp 263-283
Crowder M, Kimber A, Smith R, Sweeting T: Statistical Analysis of Reliability Data. Chapman & Hall, London, 1991
Gurney J, Smith M, Bunin G: Chapter III: CNS and miscellaneous intracranial and intraspinal neoplasms. In: Ries L, Smith M, Gurney J, Linet M, Tamra T, Young J, Bunin G (eds) Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975–1995, National Cancer Institute, SEER Program. NIH Pub. No. 99-4649. Bethesda, MD, 1999, pp 51-63
Brada M, Thomas G: Tumours of the brain and spinal cord in adults. In: Peckham M, Pinedo H, Veronesi U (eds) Oxford Textbook on Oncology. Oxford University Press, New York, 15.2, 1995, p 2063
International Agency for Research on Cancer (IARC): IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. Vol 38. Tobacco Smoking. Lyon, 1986, pp 199-375
Johnson J, Houchens, Kluwe W, Craig D, Fisher G: Effects of mainstream and environmental tobacco smoke on the immune system in animals and humans: a review. Crit Rev Toxicol 20: 369–395, 1990.
Winkelstein W: Smoking and cervical cancer — current status: a review. Am J Epidemiol 131: 945–957, 1990
Yamasaki E, Ames B: Concentration of mutagens from urine by adsorption with the nonpolar resin XAD-2: cigarette smokers have mutagenic urine. Proc Natl Acad Sci USA 74: 3555–3559, 1977
Petrakis N, Maack C, Lee R, Lyon M: Mutagenic activity in nipple aspirates of human breast fluid. Cancer Res 40: 188–189, 1980
Sasson I, Haley N, Hoffmann D, Wynder E, Hellberg D: Cigarette smoking and neoplasia of the uterine cervix: smoke constituents in cervical mucus. N Engl J Med 312: 315–316, 1985
Baron J, Rohan T: Tobacco. In: Schottenfeld D, Fraumeni J (eds) Cancer Epidemiol Biomarkers Prev. Oxford University Press, New York, 1996, pp 269-289
International Agency for Research on Cancer (IARC): IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans, Vol 17, Some N-Nitroso Compounds. Lyon, 1978, pp 35-47
Avtsyn A, Yablonovskaya L: Effects of disturbances in the hormonal status on experimental brain tumors. Acta Unio Int Contra Cancrum 20: 1519–1522, 1964
Law M, Hackshaw A, Allaway S, Hale A: Cigarette smoking, sex hormones and bone density in women. Eur J Epidemiol 13: 553–558, 1997
Rich R, Fleisher T, Shearer W, Kotzin B, Schroeder H (eds) Clinical Immunology, 2nd edn., Mosby International Limited, London, 2001
Hochberg F, Miller D: Primary central nervous system lymphoma. J Neurosurg 68: 835–853, 1998
Sawamura Y, de Tribolet N: Immunobiology of brain tumors and implications for immunotherapy. In: Kaye A, Laws E (eds) Brain Tumors. Churchill Livingstone, Edinburgh, 1995, pp 113-124
George J, Levy Y, Shoenfeld Y: Smoking and immunity: an additional player in the mosaic of autoimmunity. Scand J Immunol 45: 1–6, 1997
Ahsan H, Neugut A, Gammon M: Association of adenocarcinoma and squamous cell carcinoma of the esophagus with tobacco-related and other malignancies. Cancer Epidemiol Biomarkers Prev 6: 779–782, 1997
Zang E, Wynder E: Differences in lung cancer risk between men and women: examination of the evidence. J Natl Cancer Inst 88: 183–192, 1996
Muscat J, Richie J, Thompson S, Wynder E: Gender differences in smoking and risk for oral cancer. Cancer Res 56: 5192–5197, 1996
Begg C, Zhang Z, Sun M, Herr H, Schantz S: Methodology for evaluating incidence of second primary cancers with application to smoking-related cancers from the surveillance epidemiology and end results (SEER) program. Am J Epidemiol 142: 653–665, 1995
Kure E, Ryberg D, Hewer A, Phillips D, Skaug V, Baera R, Haugen A: p53 mutations in lung tumours: relationship to gender and lung DNA adducts. Carcinogenesis 17: 2201–2205, 1996
Nelson H, Christiani D, Mark E, Wiencke J, Wain J, Kelsey K: Implications and prognostic value of K-ras mutation for early-stage lung cancer in women. J Natl Cancer Inst 91: 2032–2038, 1999
Ryberg D, Hewer A, Phillips D: Different susceptibility to smoking-induced DNA damage among male and female lung cancer patients. Cancer Res 54: 5801–5803, 1994
Mollerup S, Ryberg D, Hewer A, Phillips D, Haugen A: Sex differences in lung CYP1A1 expression and DNA adduct levels among lung cancer patients. Cancer Res 59: 3317–3320, 1999
Guengerich F, Shimada T: Activation of procarcinogens by human cytochrome P450 enzymes. Mutat Res 400: 201–213, 1998
Wei Q, Cheng L, Amos C, Wang L, Guo Z, Hong W, Spitz M: Repair of tobacco carcinogen-induced DNA adducts and lung cancer risk: a molecular epidemiologic study. J Natl Cancer Inst 92: 1764–1772, 2000
Gold E, Leviton A, Lopez R, Gilles F, Hedley-Whyte T, Kolonel L, Lyon J, Swanson G, Weiss N, West D, Aschenbrener C, Austin D: Parental smoking and risk of childhood brain tumors. Am J Epidemiol 137: 620–628, 1993
Filippini G, Maisonneuve P, McCredie M, Peris-Bonet R, Modan B, Preston-Martin S, Mueller B, Holly E, Cordier S, Choi N, Little J, Arslan A, Boyle P: Relationship of childhood brain tumors to exposure of parents and children to tobacco smoke: the SEARCH international case-control study. Int J Cancer 100: 206–213, 2002
Norman M, Holly E, Ahn D, Preston-Martin S, Mueller B, Bracci P: Prenatal exposure to tobacco smoke and childhood brain tumors: results from the United States west coast childhood brain tumor study. Cancer Epidemiol Biomarkers Prev 5: 127–133, 1996
Bunin G, Buckley J, Boesel C, Rorke L, Meadows A: Risk factors for astrocytic glioma and primitive neuroectodermal tumor of the brain in young children: a report from the children's cancer group. Cancer Epidemiol Biomarkers Prev 3: 197–204, 1994
Kuijten R, Bunin G, Nass C, Meadows A: Gestation and familial risk factors for children astrocytoma: results of a case-control study. Cancer Res 50: 2608–2612, 1990
Howe G, Burch J, Chiarelli A, Risch H, Choi B: An exploratory case-control study of brain tumors in children. Cancer Res 49: 4349–4352, 1989
Stjernfeldt M, Lindsten J, Berglund K, Ludvigsson J: Maternal smoking during pregnancy and risk of childhood cancer. Lancet 1: 1350–1352, 1986
McKinney P, Stiller C: Maternal smoking during pregnancy and the risk of childhood cancer. Lancet 2: 519–520, 1986
Cordier S, Iglesias M, Goaster C, Guyot M, Mandereau L, Hemon D: Incidence and risk factors for childhood brain tumors in the Ile de France. Int J Cancer 59: 776–782, 1994
Gold E, Gordis L, Tonascia J, Szklo M: Risk factors for brain tumors in children. Am J Epidemiol 109: 309–319, 1979
Neutel C, Buck C: Effect of smoking during pregnancy on the risk of cancer in children. J Natl Cancer Inst 47: 59–63, 1971
Schuz J, Kaletsch U, Kaatsch P, Meinert R, Michaelis J: Risk factors for pediatric tumors of the central nervous system: results from a German population-based case-control study. Med Pediatr Oncol 36: 274–282, 2001
John E, Savitz D, Sandler D: Prenatal exposure to parents' smoking and childhood cancer. Am J Epidemiol 133: 123–132, 1991
Filippini G, Farinotti M, Lovicu G, Masionneuve P, Boyle P: Mothers' active and passive smoking during pregnancy and the risk of brain tumours in children. Int J Cancer 57: 769–774, 1994
McCredie M, Maisonneuve P, Boyle P: Antenatal risk factors for malignant brain tumours in New South Wales children. Int J Cancer 56: 6–10, 1994
Preston-Martin S, Yu M, Benton B, Henderson B: N-nitroso compounds and children brain tumors: a case-control study. Cancer Res 42: 5240–5245, 1982
Sandler D, Everson R, Wilcox A, Browder J: Cancer risk in adulthood from early life exposure to parents' smoking. Am J Public Health 75: 487–492, 1985
Rogot E, Murray J: Smoking and causes of death among US veterans: 16 years of observation. Public Health Rep 95: 213–222, 1980
Roth M, Marques-Magallanes J, Yuan M, Sun W, Tashkin D, Hankinson O: Induction and regulation of the carcinogen-metabolizing enzyme CYP1A1 by marijuana smoke and delta9-tetrahydrocannabinol. Am J Respir Cell Mol Biol 24: 339–344, 2001
Hecht S: N-nitrosamines. In: Environmental and Occupational Medicine. 3rd edn., Lippincott-Raven Publishers, London, 1998, pp 1227-1238
Shapiro W, Shapiro J, Walker R: Central nervous system. In: Abeloff M, Armitage J, Lichter A, Niederhuber J (eds) Clinical Oncology. 2nd edn., Churchill Livington, New York, 2000
Roberts P: Neuroanatomy. 3rd edn., Springer-Verlag, New York, 1992
Tuomanen E: Breaching the blood-brain barrier. Sci Am 268: 80–84, 1993
Frey W: Bypassing the blood-brain barrier to deliver therapeutic agents to the brain and spinal cord. Drug Deliv Technol 2: 46–49, 2002
Liu X, Fawcett J, Thorne R, DeFor T, Frey W: Intranasal administration of insulin-like growth factor-I bypasses the blood-brain barrier and protects against focal cerebral ischemic damage. J Neurol Sci 187: 91–97, 2001
Kuratsune M, Hueper W: Polycyclic aromatic hydrocarbons in coffee soots. J Natl Cancer Inst 20: 37–51, 1958
Challis B, Bartlett C: Possible cocarcinogenic effects of coffee constituents. Nature 254: 532–533, 1975
Zimmerman H: Experimental brain tumors. In: Fields W, Sharkey P (eds) The Biology and Treatment of Intracranial Tumors. Charles C Thomas, Springfield, 1962, pp 49-74
Davidson B, Hsu T, Schantz S: The genetics of tobacco-induced malignancy. Arch Otolaryngol Head Neck Surg 119: 1198–1205, 1993
National Toxicology Program: NTP Carcinogenesis Studies of Trichloroethylene (Without Epichorohydrin) (CAS No. 79-01-6) in F344/N Rats and B6C3F1 Mice (Gavage Studies). Natl Toxicol Program Tech Rep Ser 243: 1-174, 1990
Waters E, Gerstner H, Huff J: Trichloroethylene. I. An overview. J Toxicol Environ Health 2: 671–707, 1977
Agency for Toxic Substances and Disease Registry (ATSDR): Toxicological profile for trichoroethylene. US Department of Health and Human Services, Public Health Service, Atlanta, GA, 1997
Peshin S, Lall S, Gupta S: Potential food contaminants and associated health risks. Acta Pharmacol Sin 23: 193–202, 2002
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Efird, J.T., Friedman, G.D., Sidney, S. et al. The Risk for Malignant Primary Adult-Onset Glioma in a Large, Multiethnic, Managed-Care Cohort: Cigarette Smoking and Other Lifestyle Behaviors. J Neurooncol 68, 57–69 (2004). https://doi.org/10.1023/B:NEON.0000024746.87666.ed
Issue Date:
DOI: https://doi.org/10.1023/B:NEON.0000024746.87666.ed