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Review

Chlamydia pneumoniae and Lung Cancer: Epidemiologic Evidence

Alyson J. Littman, Lisa A. Jackson and Thomas L. Vaughan
Alyson J. Littman
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Lisa A. Jackson
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Thomas L. Vaughan
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DOI: 10.1158/1055-9965.EPI-04-0599 Published April 2005
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Tables

  • Table 1.

    Summary of nested case-control studies of C. pneumoniae and lung cancer risk with blood collected before lung cancer diagnosis in cases and a comparable time in controls

    First author, year, locationPopulationNumber of subjectsTime between blood sampling and lung cancer diagnosis/censoring (y)Variables adjusted for in multivariate models
    Laurila, 1997 (23), FinlandMale smokers involved in a randomized trial of β-carotene and α-tocopherol230 cases/230 controls3-8 (median = 6.1)Years of smoking and cigarettes smoked per day
    Anttila, 2003 (28), FinlandWomen in 1st trimester of pregnancy in Finnish Maternity Cohort58 cases/287 controls1.6-16.7 (mean = 9.1)Current smoking defined by serum cotinine levels
    Littman, 2004 (29), USAMen and women involved in a randomized trial of β-carotene and retinol508 cases/508 controls0-16 (median = 9)Years of smoking, cigarettes smoked per day, education, and body mass index (kg/m2)
  • Table 2.

    Summary of case-control studies of C. pneumoniae and lung cancer risk with blood sampled at or after lung cancer diagnosis and at a comparable time in the controls

    First author, year, locationNumber of cases/controlsCase population/selectionControl population/selectionMatching factorsConfounders adjusted for
    Jackson, 2000 (26), USA148 cases/148 controlsMen in WA state diagnosed with LC between 5/93 and 7/96, identified through the SEER cancer registry. Population based.Men without LC identified through random digit dialing.Age (5-y categories) and genderSmoking status (current or former), pack-years (<40 or ≥40) and education
    Koyi, 2001 (25), Sweden177 cases/C1 = 68, C2 = 111Diagnosed with LC at a single hospital between 2/97 and 2/98. Hospital based.C1: Consecutive blood donors who were former or current smokers presenting at the same hospital during spring 1998 (exclusions: history of MI, medication for hypertension, or other CV diseases). C2: Participants in a study of current and ex-smokers >70 y oldNoneNone
    Kocazeybek, 2003 (27), Turkey123 cases/123 controlsSmokers admitted to an Istanbul hospital with a diagnosis of LC between 6/98 and 7/2000. Hospital based.Healthy hospital staff, relatives of the patients, blood donors, or persons with similar age, sex, and smoking habits and not having any medical treatment for a local or systemic disease and not admitted to the hospital in the previous 2 monthsAge (5-y age group), sex, living environment (i.e., province), smoking status (former or current), duration (10-y categories), and quantity of cigarettes smoked (4 categories)In primary analyses, none.
    • Abbreviations: WA, Washington; LC, lung cancer; MI, myocardial infarction; CV, cardiovascular; SEER, Surveillance, Epidemiology, and End Results; C1, control group 1; C2, control group 2.

  • Table 3.

    Selected results from studies on C. pneumoniae infection and lung cancer risk

    First author, year, locationDefinition of chronic infectionOverall resultsFindings by age at diagnosis/referenceOther subgroup findingsComments
    Laurila, 1997 (23), Finland“Strong or moderate” evidence*1.6 (1.0-2.3)50-59 y: OR, 2.9; 95% CI, 1.5-5.4Squamous or small cell cancer: OR, 1.7; 95% CI, 1.0-2.8
    ≥60 y: OR, 0.9; 95% CI, 0.5-1.6Follow-up
    <5 y: OR, 2.0; 95% CI, 1.1-3.6
    ≥5 y: OR, 1.2; 95% CI, 0.5-2.5
    Jackson, 2000 (26), USAIgA ≥ 161.4 (0.9-2.3)†<60 y: OR, 2.7; 95% CI, 1.2-5.9Association stronger among current smokers <60 y at diagnosis than former smokers:Blood specimens were obtained from only 47% of cases who completed interviews in counties where blood was collected, mainly because of death or illness.
    ≥ 60 y: OR, 0.7; 95% CI, 0.3-1.4Current: OR, 4.6; 95% CI, 1.4-13.7
    Former: OR, 1.5; 95% CI, 0.5-4.8
    Koyi, 2001 (25), SwedenIgA ≥ 64‡ORs were stronger among men than women (except for IgA ≥ 64 with cases compared with C2).Possible confounding by age, which differed between the case and control groups
    Cases vs. C19.9 (4.6-22.2)†For IgG ≥ 512:
    Cases vs. C25.0 (3.2-7.9)†C1: Men: OR, 10.2; 95% CI, 4.0-27.9
    IgG ≥ 512‡C1: Women: OR, 1.7; 95% CI, 0.5-7.0
    Cases vs. C14.2 (2.1-8.9)†C2: Men: OR, 3.6; 95% CI, 2.0-6.7
    Cases vs. C22.5 (1.6-4.0)†C2: Women: OR, 1.3; 95% CI, 0.6-2.6
    Kocazeybek, 2003 (27), TurkeyIgG ≥ 512 and IgA ≥ 40§4.6 (2.3-10.2)†Men < 55 y: OR, 18.0; 95% CI, 4.6-154Men: OR, 5.3; 95% CI, 2.4-12.9Possible selection bias; possible exposure misclassification due to use of higher value in cases only
    Men ≥ 55 y: OR, 1.0; 95% CI, 0.3-3.3Women: OR, 2.0; 95% CI, 0.3-22.1
    Anttila, 2003 (28), FinlandIgA ≥ 161.6 (0.9-2.8)ORs for IgG antibody titers (≥32 and ≥128) and IC (≥2 and ≥4) were of similar magnitude (1.7 to 2.2)Mean age of cases at diagnosis was 41 y (range 22-53 y)
    IgA ≥ 642.1 (1.2-3.9)
    Littman, 2004 (29), USAIgA ≥ 161.2 (0.9-1.6)Male asbestos-exposed workers: OR, 1.9; 95% CI, 0.9-3.7; former smokers: OR, 2.1; 95% CI, 1.1-4.1; squamous cell carcinoma: OR, 1.7; 95% CI, 1.1-2.8
    • Abbreviations: IC, immune complexes; OR, odds ratio; CI, confidence interval; CI, control group #1 (see Table 2); C2,control group #2 (see Table 2).

    • ↵* Blood sampled at baseline and at 3-y follow-up used to assess exposure. Strong evidence defined as IgA antibodies ≥16 and IC ≥ 4 in both samples, moderate evidence defined as IgA ≥ 16 in both samples or IC ≥ 4 in both samples and IgA ≥ 16 in second sample.

    • ↵† Calculated from data presented in published articles.

    • ↵‡ Final titer defined as higher value of blood sampled at diagnosis (all) or 3 months later (n = 127).

    • ↵§ Final titer defined as higher value of blood sampled at diagnosis or 1 month later.

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Cancer Epidemiology Biomarkers & Prevention: 14 (4)
April 2005
Volume 14, Issue 4
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Chlamydia pneumoniae and Lung Cancer: Epidemiologic Evidence
Alyson J. Littman, Lisa A. Jackson and Thomas L. Vaughan
Cancer Epidemiol Biomarkers Prev April 1 2005 (14) (4) 773-778; DOI: 10.1158/1055-9965.EPI-04-0599

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Chlamydia pneumoniae and Lung Cancer: Epidemiologic Evidence
Alyson J. Littman, Lisa A. Jackson and Thomas L. Vaughan
Cancer Epidemiol Biomarkers Prev April 1 2005 (14) (4) 773-778; DOI: 10.1158/1055-9965.EPI-04-0599
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