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ZhangAmerican Cancer SocietyIRCCS Centro Di Riferimento Oncologico AvianoThe Gertner InstituteThe National Israeli Study on Ovarian Cancer (NISOC) groupCancer Council New South WalesCancer Research UKInstitute Catala OncologiaCenters for Disease Control and PreventionChiang Mai UniversityChulalongkorn UniversityInstitute of Cancer Epidemiology - DenmarkGeisel School of Medicine at DartmouthColorado School of Public HealthAlbert Einstein College of Medicine of Yeshiva UniversityAmtssygehuset i HerlevDepartment of Public HealthUniversity at Buffalo, State University of New YorkGerman Cancer Research CenterUniversity of Minnesota School of Public HealthUniversity of Washington, SeattleImperial College LondonCentre de recherche en epidemiologie et sante des populationsHarvard Medical SchoolInternational Agency for Research on CancerUniversita degli Studi di MilanoKarolinska InstitutetMaastricht UniversityMahidol UniversityCentro Per Lo Studio E La Prevenzione OncologicaNational Cancer InstituteNational Health Laboratory ServicesNorwegian Institute of Public HealthQueensland Institute of Medical ResearchRoswell Park Cancer InstituteRoyal College of General Practitioners' Oral Contraception StudyCurtin UniversityUniversity of Texas School of Public HealthUniversity of Massachusetts BostonBoston University - Slone Epidemiology UnitStanford UniversityUniversity of Athens Medical SchoolUniversidad de ChileUniversity of Hawaii at ManoaSkånes universitetssjukhusUniversity of PennsylvaniaUniversity of PittsburghUniversity Medical Center UtrechtUniversity of Southern CaliforniaUniversity of TorontoUniversitetet i TromsoGeorge Washington UniversityVanderbilt UniversityOrganisation Mondiale de la SanteYale University2018-06-112018-06-112012-01-01The Lancet Oncology. Vol.13, No.9 (2012), 946-95614745488147020452-s2.0-84877875955https://repository.li.mahidol.ac.th/handle/20.500.14594/15124Background 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subtypes and on overall ovarian cancer risk are unclear, and the fi ndings from most studies with relevant data are unpublished. To assess these associations, we review the published and unpublished evidence.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.Mahidol UniversityMedicineArticleSCOPUS10.1016/S1470-2045(12)70322-4