Am. J. Respir. Crit. Care Med.,
Volume 158, Number 4, October 1998, 1197-1203
Association between Diet and Lung Cancer Location
BURTON W.
LEE,
JOHN C.
WAIN,
KARL T.
KELSEY,
JOHN K.
WIENCKE,
and
DAVID C.
CHRISTIANI
Pulmonary and Critical Care Unit and Thoracic Surgery Unit, Massachusetts General Hospital; Department of Medicine, Harvard Medical
School; Departments of Environmental Health, Epidemiology, and Cancer Biology, Harvard School of Public Health, Boston,
Massachusetts; and Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
Lung cancers occur more commonly in the upper lobes than in the lower lobes, but its pathophysiologic basis is not well understood. Because numerous studies have reported a consistent inverse relationship between lung cancer risk and intake of certain vegetables and fruits, we hypothesized that
the balance between diet-derived protective substances delivered via the circulation and cigarette-derived carcinogenic substances delivered via the airways would be less favorable in the upper lobes
compared with the lower lobes, hence accounting for the upper lobe predominance of tumors
among smokers. Thus, we examined the association between diet and tumor location in 328 patients
with lung cancer. The ratio of upper to lower lobe tumors was 2.5:1.0. In univariate analysis, age,
height, weight, sex, race, family history of cancer, education level, tumor histology, calories consumed per day, and intake of animal fat did not differ significantly between patients with upper versus lower lobe tumors. Predictors of tumor location in univariate analysis were family history of lung
cancer; smoking history; history of asbestos exposure; and intakes of yellow-orange vegetables, 
-carotene, 
-carotene, and vitamins A, C, and E. In multivariable logistic regression analysis, the independent predictors of upper lobe tumor location were family history of lung cancer (p = 0.03), history of asbestos exposure (p = 0.02), less intake of yellow-orange vegetables (p < 0.04), and less intake of vitamin E (p = 0.05). Our results show a strong inverse association between upper lobe location of lung cancer and intake of yellow-orange vegetables and vitamin E.
