Abstract C46: Fruit and vegetable intake and lung cancer incidence among Black women according to cigarette smoking status
Authors: Nomura Sarah JO , Dash Chiranjeev , Rosenberg Lynn , Palmer Julie , Adams-Campbell Lucile L. 
Published: February 2019

Objective: The objective of this project was to evaluate associations of fruit and vegetable intake, according to cigarette smoking history, with lung cancer incidence among U.S. Black women.

Methods: The Black Women's Health Study is a prospective cohort study (analytic cohort=46,889) among Black women between the ages 21-69 at baseline (1995). Fruit and vegetable intake (collected in 1995 and 2001only) and smoking history were ascertained via questionnaires at baseline and during follow-up (every other year). Combined fruit and vegetable (&lt;3, 3-5, ≥5 servings/day), total fruit (&lt;1, 1-&lt;2, ≥2 servings/day), citrus fruit (&lt;1, 1-&lt;2, ≥2 servings/day), total vegetable (&lt;1, 1-&lt;2, ≥2 servings/day), starchy vegetable (&lt;1, 1-&lt;2, ≥2 servings/day), non-starchy vegetable (&lt;0.5, 0.5-&lt;1, &gt;1 servings/day), and cruciferous vegetable (&lt;0.5, 0.5-&lt;1, &gt;1 servings/day) intakes were evaluated. Cigarette smoking measures that were evaluated include: 1) current smoking status (never, former, current &lt;15 cigarettes/day, current ≥15 cigarettes/day); (2) age started smoking (never, &lt;18, ≥18 years); (3) pack-years (never smoked, &lt;10, 10-19, ≥20 pack-years); and (4) combined pack-years + age started smoking (never smoked, &lt;18 years + &lt;10 pack-years, &lt;18 years + 10-19 pack-years, &lt;18 years + ≥20 pack-years, ≥18 years + &lt;10 pack-years, ≥18 years + 10-19 pack-years, ≥18 years + ≥20 pack-years). Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for associations between fruit and vegetable intake and smoking and lung cancer incidence (N=306 cases through 2013) with exposures updated through follow-up. Associations between smoking history and lung cancer were additionally evaluated stratified by fruit and vegetable intake. Likelihood ratio X2 tests were utilized to assess interactions between smoking history and fruit and vegetable intake.

Results: More than half the women reported no history of cigarette smoking (66.4%), while 18.4% were former smokers and 15.1% were current smokers (&lt;15 cigarettes/day: 9.7%, ≥15 cigarettes/day: 5.4%). Reported fruit and vegetable intake was low, with 6.1% and 5.6% consuming at least 3 servings/day of fruit or vegetables, respectively. Smoking history was associated with increased lung cancer incidence. The adjusted HR of current cigarette smoking of ≥15 cigarettes/day compared to never smoking was 17.4 (95% CI: 11.5, 26.4). Combined fruit and vegetable intake was not significantly associated with lung cancer incidence in covariate-adjusted models (≥5 versus &lt;3 servings/day HR:0.86, 95% CI: 0.54, 1.36). Similar, total intakes of fruit, citrus fruit, vegetable, starchy vegetable, non-starchy vegetable, and cruciferous vegetables were not associated with lung cancer incidence in adjusted models. Associations between smoking and lung cancer incidence did not differ by fruit and vegetable intake. Among women who reported “low” (&lt;3 servings/day) fruits and vegetable intake the HR for women with ≥20 pack-years compared to never smokers was 12.3 (95% CI: 8.18, 18.5), while among women with “high” (≥3 servings/day) intake the HR was 15.2 (95% CI: 7.46, 30.8) (p-interaction=0.67).

Conclusion: Low fruit and vegetable intake was widespread in this population of U.S. Black women, but results do not support an association between fruit and vegetable intake and lung cancer incidence, regardless of cigarette smoking history.

Citation Format: Sarah JO Nomura, Chiranjeev Dash, Lynn Rosenberg, Julie Palmer, Lucile L. Adams-Campbell. Fruit and vegetable intake and lung cancer incidence among Black women according to cigarette smoking status [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C46.