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Title: Ovarian cancer and smoking: Individual participant meta-analysis including 28 114 women with ovarian cancer from 51 epidemiological studies
Authors: E. E. Calle
S. M. Gapstur
A. V. Patel
L. Dal Maso
R. Talamini
A. Chetrit
G. Hirsh-Yechezkel
F. Lubin
S. Sadetzki
E. Banks
V. Beral
D. Bull
K. Callaghan
B. Crossley
K. Gaitskell
A. Goodill
J. Green
C. Hermon
T. Key
K. Moser
G. Reeves
F. Sitas
R. Collins
R. Doll
R. Peto
C. A. Gonzalez
N. Lee
P. Marchbanks
H. W. Ory
H. B. Peterson
P. A. Wingo
N. Martin
T. Pardthaisong
S. Silpisornkosol
C. Theetranont
B. Boosiri
S. Chutivongse
P. Jimakorn
P. Virutamasen
C. Wongsrichanalai
A. Tjonneland
L. Titus-Ernstoff
T. Byers
T. Rohan
B. J. Mosgaard
M. Vessey
D. Yeates
J. L. Freudenheim
J. Chang-Claude
R. Kaaks
K. E. Anderson
A. Folsom
K. Robien
J. Hampton
P. A. Newcomb
M. A. Rossing
D. B. Thomas
N. S. Weiss
E. Riboli
F. Clavel-Chapelon
D. Cramer
S. E. Hankinson
S. S. Tworoger
S. Franceschi
C. La Vecchia
E. Negri
H. O. Adami
C. Magnusson
T. Riman
E. Weiderpass
A. Wolk
L. J. Schouten
P. A. van den Brandt
N. Chantarakul
S. Koetsawang
D. Rachawat
D. Palli
A. Black
L. A. Brinton
D. M. Freedman
P. Hartge
A. W. Hsing
Jr V. Lacey
R. N. Hoover
C. Schairer
M. Urban
S. Graff-Iversen
R. Selmer
C. J. Bain
A. C. Green
D. M. Purdie
V. Siskind
P. M. Webb
K. Moysich
S. E. McCann
P. Hannaford
C. Kay
C. W. Binns
A. H. Lee
M. Zhang
American Cancer Society
IRCCS Centro Di Riferimento Oncologico Aviano
The Gertner Institute
The National Israeli Study on Ovarian Cancer (NISOC) group
Cancer Council New South Wales
Cancer Research UK
Institute Catala Oncologia
Centers for Disease Control and Prevention
Chiang Mai University
Chulalongkorn University
Institute of Cancer Epidemiology - Denmark
Geisel School of Medicine at Dartmouth
Colorado School of Public Health
Albert Einstein College of Medicine of Yeshiva University
Amtssygehuset i Herlev
Department of Public Health
University at Buffalo, State University of New York
German Cancer Research Center
University of Minnesota School of Public Health
University of Washington, Seattle
Imperial College London
Centre de recherche en epidemiologie et sante des populations
Harvard Medical School
International Agency for Research on Cancer
Universita degli Studi di Milano
Karolinska Institutet
Maastricht University
Mahidol University
Centro Per Lo Studio E La Prevenzione Oncologica
National Cancer Institute
National Health Laboratory Services
Norwegian Institute of Public Health
Queensland Institute of Medical Research
Roswell Park Cancer Institute
Royal College of General Practitioners' Oral Contraception Study
Curtin University
University of Texas School of Public Health
University of Massachusetts Boston
Boston University - Slone Epidemiology Unit
Stanford University
University of Athens Medical School
Universidad de Chile
University of Hawaii at Manoa
Skånes universitetssjukhus
University of Pennsylvania
University of Pittsburgh
University Medical Center Utrecht
University of Southern California
University of Toronto
Universitetet i Tromso
George Washington University
Vanderbilt University
Organisation Mondiale de la Sante
Yale University
Keywords: Medicine
Issue Date: 1-Jan-2012
Citation: The Lancet Oncology. Vol.13, No.9 (2012), 946-956
Abstract: Background Smoking has been linked to mucinous ovarian cancer, but its eff ects on other ovarian cancer subtypes and on overall ovarian cancer risk are unclear, and the fi ndings from most studies with relevant data are unpublished. To assess these associations, we review the published and unpublished evidence. Methods Eligible epidemiological studies were identifi ed by electronic searches, review articles, and discussions with colleagues. Individual participant data for 28 114 women with and 94 942 without ovarian cancer from 51 epidemiological studies were analysed centrally, yielding adjusted relative risks (RRs) of ovarian cancer in smokers compared with never smokers. Findings After exclusion of studies with hospital controls, in which smoking could have aff ected recruitment, overall ovarian cancer incidence was only slightly increased in current smokers compared with women who had never smoked (RR 1.06, 95% CI 1.01-1.11, p=0.01). Of 17 641 epithelial cancers with specifi ed histology, 2314 (13%) were mucinous, 2360 (13%) endo metrioid, 969 (5%) clear-cell, and 9086 (52%) serous. Smoking-related risks varied substantially across these subtypes (p heterogeneity < 0.0001). For mucinous cancers, incidence was increased in current versus never smokers (1.79, 95% CI 1.60-2.00, p < 0.0001), but the increase was mainly in borderline malignant rather than in fully malignant tumours (2.25, 95% CI 1.91-2.65 vs 1.49, 1.28-1.73; p heterogeneity =0.01; almost half the mucinous tumours were only borderline malignant). Both endometrioid (0.81, 95% CI 0.72-0.92, p=0.001) and clear-cell ovarian cancer risks (0.80, 95% CI 0.65-0.97, p=0.03) were reduced in current smokers, and there was no signifi cant association for serous ovarian cancers (0.99, 95% CI 0.93-1.06, p=0.8). These associations did not vary signifi cantly by 13 sociodemographic and personal characteristics of women including their body-mass index, parity, and use of alcohol, oral contraceptives, and menopausal hormone therapy. Interpretation The excess of mucinous ovarian cancers in smokers, which is mainly of tumours of borderline malignancy, is roughly counterbalanced by the defi cit of endometrioid and clear-cell ovarian cancers. The substantial variation in smoking-related risks by tumour subtype is important for understanding ovarian carcinogenesis.
ISSN: 14745488
Appears in Collections:Scopus 2011-2015

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