Conclusions

The past three decades have witnessed a tremendous increase in the information on diet and lung cancer. People who eat more fruits and vegetables in general have a lower risk of lung cancer than people who consume less of these foods. In observational studies, the same holds true for specific micronutrients, such as provitamin A carotenoids and vitamin C. The specific constituents of fruits and vegetables that confer protection are not known, and the results of the chemoprevention trials suggest a more complex role than researchers had previously thought. An important unanswered question is whether fruits and vegetables directly confer protection against cancer or whether estimates of fruit and vegetable consumption are indicators of differences between individuals who eat healthy and unhealthy diets that are leading to uncontrolled confounding. Nevertheless, the protective association noted for fruit and vegetable consumption has the potential to contribute to prevention. A diet adequate in fruit and vegetables is prudent for preventing chronic diseases in general.

Even for a dietary factor such as fruit or vegetable consumption that is generally associated with a reduced risk of lung cancer, the highest exposure category is usually associated with at most a halving of the risk of lung cancer. An association of this magnitude may result from residual confounding by cigarette smoking. Studies that control for cigarette smoking in the design are best suited to address the persistent concern about residual confounding by cigarette smoking. Examples are case-control studies in which cases and controls are closely matched on cigarette smoking history and studies limited to never-smokers.

Advances in the understanding of the role of diet in the etiology of lung cancer should not obscure the irrefutable fact that cigarette smoking is the predominant cause of lung cancer. Many important questions about the complex relationship between dietary habits and the development of lung cancer remain, but the path to permanently ending the epidemic of lung cancer is known: Prevent children from starting cigarette smoking and effectively assist addicted smokers to stop smoking cigarettes.

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