1. Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
2. Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
3. School of Public Health, Wannan Medical College, Wuhu 241002, China
4. Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht 6229ER, the Netherlands
5. VieCuri Medical Center, Department of Clinical Epidemiology, Venlo, The Netherlands
6. School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, the Netherlands
7. Ma’anshan Center for Disease Control and Prevention, Ma’anshan 243011, China
Corresponding author:
qqr2022@163.com
evan.yu@maastrichtuniversity.nl
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History+
Received
Accepted
Published Online
2025-09-16
2026-03-16
2026-07-21
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Abstract
This study used UK Biobank data from ~500 000 participants to examine how smoking intensity and duration jointly shape the risk of 12 smoking-related cancers. We modeled excess relative risks (ERRs) per pack-year, separating the effect of smoking intensity while holding total pack-years constant to compare low-intensity/long-duration with high-intensity/short-duration patterns. For the same cumulative exposure, cancer risk increases differed across these smoking patterns, indicating that pack-years alone do not fully capture carcinogenic risk. We further evaluated time since cessation (TSC) and found that longer TSC was associated with lower ERR/pack-year for most cancers. Lifestyle factors modified these associations: participants with favorable behaviors (e.g., regular physical activity and healthier diet) generally had lower ERRs/pack-year than those with unfavorable behaviors. Overall, our findings show that smoking pattern and cessation history meaningfully influence pan-cancer risk beyond cumulative exposure, supporting the incorporation of detailed smoking histories—intensity, duration, and cessation—into risk stratification, screening eligibility, and prevention strategies.
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