Oranges, Mandarins and lung cancer.

Lung cancer risk: Data about lung cancer risk was provided by a pooled analysis of 5 studies (24). A significant protective effect (RR = 0.74) was found at consumption of > 1 orange or tangerine/week, but it should be noted that significant between-study heterogeneity was found. In addition, a significant protective effect of mandarins was found in one single cohort (11).
Lung cancer mortality: Data about lung cancer mortality was provided by 2 cohorts. A significant protective effect was found among men in both studies (9, 17), but no association was found among women (17). Both studies measured food intake prior to cancer diagnosis. The protective effect was found at the level of consumption of > 3 oranges/wk. The average RR = 0.73 among men.

Conclusion: A significant protective effect of oranges/tangerines against lung cancer risk was found in a pooled analysis of 5 studies. Oranges/tangerines possibly protect against lung cancer risk at the level of consumption of > 1 orange or tangerine/week (- 26%).
Among men, 2 cohorts of moderate-large size found a significant protective effect of oranges against lung cancer mortality, and no other findings were done. Oranges possibly protect against lung cancer mortality among men at the level of consumption of > 3 oranges/week (- 27%).

**Prospective studies of oranges and lung cancer risk:**
Author	Cohort name	Subjects	Years of follow-up	Cases	End point	Consumption of	Relative Risk (RR)	Adjustments
24) Smith-Warner SA (2003)	Pooled analysis of 5 prospective studies.	336,157	6-16	2,670	Lung cancer risk	Oranges, tangerines	INCLUSION CRITERIA: At least 50 incident lung cancer cases. Assessment of usual diet. Conduct of a validation of the diet assessment method or a closely related instrument. Assessment of smoking habits. INCLUDED STUDIES (Follow-up years/No. of lung cancer cases): The Health Professionals' Follow-up Study. (1986-1996/244 men) Feskanich D, Ziegler RG, Michaud DS, Giovannucci EL, Speizer FE, Willet WC. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Intst. 2000 Nov 15;92(22):1812-23. Full text The Iowa Women's Health Study. (1986-1996/433 women) Steinmetz KA, Potter JD, Folsom AR. Vegetables, fruit, and lung cancer in the Iowa Women's Health Study. Cancer Res. 1993 Feb 1;53(3):536-43. Full text The Netherlands Cohort Study. (1986-1992/843 men, 131 women) Voorrips LE, Goldbohm RA, Verhoeven DT, van Poppel GA, Sturmans F, Hermus RJ. Vegetable and fruit consumption and lung cancer risk in the Netherlands Cohort Study on diet and cancer. Cancer Causes Control. 2000 Feb;11(2):101-15. Abstract The New York State Cohort. (1980-1987/392 men, 130 women) Bandera EV, Freudenheim JL, Marshall JR, Zielezny M, Priore RL, Basure J. Diet and alcohol consumption and lung cancer risk in the New York State Cohort (United States). Cancer Causes Control. 1997 Nov;8(6):828-40. Abstract The Nurses' Health Study. A + B (A = 1980-1986/156 women. B = 1986-1996/379 women) Feskanich D, Ziegler RG, Michaud DS, Giovannucci EL, Speizer FE, Willet WC. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Intst. 2000 Nov 15;92(22):1812-23. Full text RELATIVE RISK: RR = 0.74 (0.58-0.95; P = 0.006) for the highest vs lowest quartile of consumption. Amount specific data (servings): 0: RR = 1. > 0 to < 1/week: RR = 0.82 (0.66-1.02). > 1/week to 1/2/day: RR = 0.74 (0.62-0.89). ≥ 1/2/day: RR = 0.74 (0.58-0.95). One serving = 1 orange/tangerine. There were inverse associations for apples and pears; oranges and tangerines; and orange and grapefruit juice. After further adjustment for total fruit consumption, only the association for oranges and tangerines remained statistically significant (results not shown). P for between-study heterogeneity: 0.01. P for between-study heterogeneity due to sex: 0.93.	Adjusted for education, BMI, alcohol intake, calories, smoking status, smoking duration for past/current smokers, amount smoked for current smokers.
14) Feskanich D (2000)	The Nurses' Health Study & The Health Professionals' Follow-up Study	77,283 US women (38-63 years) and 47,778 men (40-75 years)	Women: 1984-1996. Men: 1986-1996.	516? women, and 258? men	Total lung cancer risk	Oranges	Women: A significantly lower risk: RR = 0.58 (0.37-0.91; No P-value) for increases of 1 serving/day. Men: none of the individual fruits were significantly associated with the risk of lung cancer.	Not defined, but probably: age, follow-up cycle, smoking status,years since quitting among past smokers, cigarettes smoked/day among current smokers, age at start of smoking, total energy intake, and availability of diet data after baseline measure.
14) Speizer FE (1999)	The Nurses' Health Study.	89,284 women aged 34-59 years. (USA)	12 (1980-1992)	399?	Lung cancer risk	Oranges	RR = 0.7 (No 95% CI; P = 0.01) for the highest vs the lowest quintile of consumption. Amount specific data (Frequency of consumption): Never: RR = 1. 1-3/mo: RR = 0.7. 2-4/wk: RR = 0.6. 5-6/wk: RR = 0.8. ≥ 1/day: RR = 0.7.	age, smoking (past, current, amount in 1980), and age of starting to smoke
11) Voorrips LE (2000)	The Netherlands Cohort Study	62,573 women and 58,279 men aged 55-69.	6.3 (1986-1992)	963	lung cancer risk	Oranges and fresh orange juice	RR = 0.8 (0.5-1.1; P = 0.007) for the highest vs lowest quintile of consumption. Amount specific data (g/day): 0: RR = 1. 12: RR = 0.6 (0.5-0.8). 32: RR = 0.7 (0.5-0.9). 83: RR = 0.7 (0.5-0.9). 167: RR = 0.8 (0.5-1.1). Additional adjustment for total vegetable intake did not change results at all (No data shown).	age, sex, family history of lung cancer, highest educational level, current smoker, years of smoking, number of cigarettes/day and total fruit intake.
11) Voorrips LE (2000)	The Netherlands Cohort Study	62,573 women and 58,279 men aged 55-69.	6.3 (1986-1992)	963	lung cancer risk	Mandarins	RR = 0.8 (0.6-0.9; P = 0.002) for the highest vs lowest tertile of consumption. Amount specific data (g/day): 0: RR = 1. 2: RR = 0.9 (0.7-1.1). 8: RR = 0.8 (0.6-0.9). Additional adjustment for total vegetable intake did not change results at all (No data shown).	age, sex, family history of lung cancer, highest educational level, current smoker, years of smoking, number of cigarettes/day and total fruit intake.

Prospective studies of oranges and lung cancer risk:

Author

Cohort name

Subjects

Years of follow-up

Cases

End point

Consumption of

Relative Risk (RR)

Adjustments

24) Smith-Warner SA (2003)

Pooled analysis of 5 prospective studies.

336,157

6-16

2,670

Lung cancer risk

Oranges, tangerines

INCLUSION CRITERIA:

At least 50 incident lung cancer cases.
Assessment of usual diet.
Conduct of a validation of the diet assessment method or a closely related instrument.
Assessment of smoking habits.

INCLUDED STUDIES (Follow-up years/No. of lung cancer cases):

The Health Professionals' Follow-up Study. (1986-1996/244 men)
Feskanich D, Ziegler RG, Michaud DS, Giovannucci EL, Speizer FE, Willet WC. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Intst. 2000 Nov 15;92(22):1812-23. Full text
The Iowa Women's Health Study. (1986-1996/433 women)
Steinmetz KA, Potter JD, Folsom AR. Vegetables, fruit, and lung cancer in the Iowa Women's Health Study. Cancer Res. 1993 Feb 1;53(3):536-43. Full text
The Netherlands Cohort Study. (1986-1992/843 men, 131 women)
Voorrips LE, Goldbohm RA, Verhoeven DT, van Poppel GA, Sturmans F, Hermus RJ. Vegetable and fruit consumption and lung cancer risk in the Netherlands Cohort Study on diet and cancer. Cancer Causes Control. 2000 Feb;11(2):101-15. Abstract
The New York State Cohort. (1980-1987/392 men, 130 women)
Bandera EV, Freudenheim JL, Marshall JR, Zielezny M, Priore RL, Basure J. Diet and alcohol consumption and lung cancer risk in the New York State Cohort (United States). Cancer Causes Control. 1997 Nov;8(6):828-40. Abstract
The Nurses' Health Study. A + B (A = 1980-1986/156 women. B = 1986-1996/379 women)
Feskanich D, Ziegler RG, Michaud DS, Giovannucci EL, Speizer FE, Willet WC. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Intst. 2000 Nov 15;92(22):1812-23. Full text

RELATIVE RISK:

RR = 0.74 (0.58-0.95; P = 0.006) for the highest vs lowest quartile of consumption.

Amount specific data (servings):
0: RR = 1.
> 0 to < 1/week: RR = 0.82 (0.66-1.02).
> 1/week to 1/2/day: RR = 0.74 (0.62-0.89).
≥ 1/2/day: RR = 0.74 (0.58-0.95).

One serving = 1 orange/tangerine.

There were inverse associations for apples and pears; oranges and tangerines; and orange and grapefruit juice. After further adjustment for total fruit consumption, only the association for oranges and tangerines remained statistically significant (results not shown).
P for between-study heterogeneity: 0.01.
P for between-study heterogeneity due to sex: 0.93.

Adjusted for education, BMI, alcohol intake, calories, smoking status, smoking duration for past/current smokers, amount smoked for current smokers.

14) Feskanich D (2000)

The Nurses' Health Study

&

The Health Professionals' Follow-up Study

77,283 US women (38-63 years) and 47,778 men (40-75 years)

Women: 1984-1996.

Men: 1986-1996.

516? women, and
258? men

Total lung cancer risk

Oranges

Women: A significantly lower risk: RR = 0.58 (0.37-0.91; No P-value) for increases of 1 serving/day.

Men: none of the individual fruits were significantly associated with the risk of lung cancer.

Not defined, but probably: age, follow-up cycle, smoking status,years since quitting among past smokers, cigarettes smoked/day among current smokers, age at start of smoking, total energy intake, and availability of diet data after baseline measure.

14) Speizer FE (1999)

The Nurses' Health Study.

89,284 women aged 34-59 years.
(USA)

12
(1980-1992)

399?

Lung cancer risk

Oranges

RR = 0.7 (No 95% CI; P = 0.01) for the highest vs the lowest quintile of consumption.

Amount specific data (Frequency of consumption):
Never: RR = 1.
1-3/mo: RR = 0.7.
2-4/wk: RR = 0.6.
5-6/wk: RR = 0.8.
≥ 1/day: RR = 0.7.

age, smoking (past, current, amount in 1980), and age of starting to smoke

11) Voorrips LE (2000)

The Netherlands Cohort Study

62,573 women and 58,279 men aged 55-69.

6.3
(1986-1992)

963

lung cancer risk

Oranges and fresh orange juice

RR = 0.8 (0.5-1.1; P = 0.007) for the highest vs lowest quintile of consumption.

Amount specific data (g/day):
0: RR = 1.
12: RR = 0.6 (0.5-0.8).
32: RR = 0.7 (0.5-0.9).
83: RR = 0.7 (0.5-0.9).
167: RR = 0.8 (0.5-1.1).

Additional adjustment for total vegetable intake did not change results at all (No data shown).

age, sex, family history of lung cancer, highest educational level, current smoker, years of smoking, number of cigarettes/day and total fruit intake.

11) Voorrips LE (2000)

The Netherlands Cohort Study

62,573 women and 58,279 men aged 55-69.

6.3
(1986-1992)

963

lung cancer risk

Mandarins

RR = 0.8 (0.6-0.9; P = 0.002) for the highest vs lowest tertile of consumption.

Amount specific data (g/day):
0: RR = 1.
2: RR = 0.9 (0.7-1.1).
8: RR = 0.8 (0.6-0.9).

Additional adjustment for total vegetable intake did not change results at all (No data shown).

age, sex, family history of lung cancer, highest educational level, current smoker, years of smoking, number of cigarettes/day and total fruit intake.

Stratified by sex:

Men

Women

HR = 0.75 (0.57-0.99; P = 0.041) for the highest vs lowest tertile of consumption.

Amount specific data (times):
≤ 2/mo: HR = 1.
1-2/we: HR = 0.88 (0.65-1.19).
≥ 3/we: HR = 0.75 (0.57-0.99).

Male current smokers: RR = 0.66 (0.47-0.91; P = 0.013).
Male ex-smokers: RR = 1.22 (0.64-2.33; P = 0.67).

HR = 1.10 (0.58-2.09; P = 0.63) for the highest vs lowest tertile of consumption.

Amount specific data (times):
≤ 2/mo: HR = 1.
1-2/we: HR = 0.92 (0.43-1.97).
≥ 3/we: HR = 1.10 (0.58-2.09).

Female nonsmokers: RR = 1.18 (0.54-2.57; P = 0.053). RRs for increasing tertiles (1, 0.95, 1.18).

Cancer & Diet. A systematic review.

Literature review.

Relating various aspects of our diet
to lung cancer risk & mortality.

Oranges, Mandarins and lung cancer.

Cancer & Diet. A systematic review.

Literature review.

Relating various aspects of our dietto lung cancer risk & mortality.

Oranges, Mandarins and lung cancer.

Relating various aspects of our diet
to lung cancer risk & mortality.