{"doi":"10.1002/ijc.33694","title":"The enduring need for prospective cohort studies to more completely characterize the tobacco‐caused burden of cancer","abstract":"In the mid-20th century before any causal associations between smoking of combustible tobacco cigarettes (henceforth referred to as “cigarettes”) and any disease had been established, case-control studies provided the first evidence from observational studies that cigarette smoking may be linked to cancer (eg, Refs. 1, 2). At that time case-control studies were an unorthodox new study design, raising questions about the validity of this approach and hence how to properly interpret the strong statistical associations that had been observed between smoking and lung cancer.3 The need for data from cohort studies to augment the results of case-control studies was clear. Cohort studies such as the British Doctor's Study,4 American Cancer Society Cancer Prevention Study5 and US Veterans Study6 contributed essential additional evidence that reduced concerns about selection bias and information bias and established the temporal sequence by measuring smoking before cancer occurred, thus making a key contribution to the eventual conclusion that cigarette smoking was a cause of lung cancer (reviewed in Ref. 3). Additional research accumulated in the ensuing decades to document that cigarette smoking is a cause of numerous other malignancies, to the extent that an estimated 48% of all cancer deaths in the United States are attributable to cigarette smoking.7 With such an enormous body of evidence documenting the health consequences of cigarette smoking, it is possible to get lulled into thinking that investments in prospective cohort studies of cigarette smoking and cancer are no longer necessary. This is certainly not the case. The article authored by Weber and colleagues in this issue entitled “Cancer incidence and cancer death in relation to tobacco smoking in a population-based Australian cohort study” provides an excellent example of why contemporary prospective cohort studies remain vital.8 This report, based on the 45 and Up Study, addresses the familiar topic of cigarette smoking and cancer, but with features that add important evidence on the topic. The 45 and Up Study is a prospective cohort study of approximately 229 000 people in Australia, a nation-continent that has been underrepresented in large-scale cohort studies on this topic. The study's baseline data collection took place in 2006-2009. A cohort assembled this recently has advantages for characterizing the magnitude of the associations between cigarette smoking and cancer in the modern era. Thus, the major novelty of this report does not lie in the study questions addressed, but rather that the study was carried out in a new place and during modern times. Of course, the tobacco marketplace has continued to evolve beyond combustible tobacco products to include a vast array of options. Prominent among these are electronic nicotine delivery systems, specifically e-cigarettes. To address the need for global evidence, intergenerational and regional differences in tobacco use patterns, the changes in health consequences based on evolution in products and to advance new knowledge, the cohort studies of the future will need to adapt to generate needed evidence on the health effects of newer tobacco products such as e-cigarettes. Just as cohort studies were a critical ingredient to initially identifying cigarette smoking as a cause of cancer, so the need persists for cohort studies to characterize the cancer risks relevant to today's tobacco product users and today's tobacco products. This research was supported in part by the USC Behavioral-Biomedical Interface Program, which is a NIGMS/NIH-T32 supported program. Contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIGMS or NIH. The authors declare no conflicts of interest.","journal":"International Journal of Cancer","year":2021,"id":224397,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9215,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":702464,"name":"Stephanie K. Jones","orcid":"0000-0002-4334-3551","position":1,"is_corresponding":false},{"id":826431,"name":"Maxwell Akonde","orcid":"0000-0002-0869-1219","position":2,"is_corresponding":false},{"id":48343,"name":"Rajat Das Gupta","orcid":"0000-0002-7680-676X","position":3,"is_corresponding":false},{"id":826822,"name":"Reston Hartsell","orcid":null,"position":4,"is_corresponding":false},{"id":71790,"name":"Anthony J. Alberg","orcid":"0000-0002-5579-1685","position":0,"is_corresponding":true}],"reference_count":12,"raw_metadata":null,"created_at":"2026-07-18T23:54:18.470602Z","pmid":"34043825","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}