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Ovarian cancer and smoking: individual participant meta-analysis including 28 114 women with ovarian cancer from 51 epidemiological studies

Beral, V.; Gaitskell, K.; Hermon, C.; Moser, K.; Reeves, G.; Peto, R.; Brinton, L.; Marchbanks, P.; Negri, E. and Ness, R., et al. (2012) In The Lancet Oncology 13(9). p.946-956
Abstract
Background Smoking has been linked to mucinous ovarian cancer, but its effects on other ovarian cancer subtypes and on overall ovarian cancer risk are unclear, and the findings from most studies with relevant data are unpublished. To assess these associations, we review the published and unpublished evidence. Methods Eligible epidemiological studies were identified 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... (More)
Background Smoking has been linked to mucinous ovarian cancer, but its effects on other ovarian cancer subtypes and on overall ovarian cancer risk are unclear, and the findings from most studies with relevant data are unpublished. To assess these associations, we review the published and unpublished evidence. Methods Eligible epidemiological studies were identified 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 affected 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 specified histology, 2314 (13%) were mucinous, 2360 (13%) endometrioid, 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 significant association for serous ovarian cancers (0.99, 95% CI 0.93-1.06, p=0.8). These associations did not vary significantly 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 deficit of endometrioid and clear-cell ovarian cancers. The substantial variation in smoking-related risks by tumour subtype is important for understanding ovarian carcinogenesis. (Less)
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The Lancet Oncology
volume
13
issue
9
pages
946 - 956
publisher
Elsevier
external identifiers
  • wos:000308425600022
  • scopus:84877875955
ISSN
1474-5488
DOI
10.1016/S1470-2045(12)70322-4
language
English
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yes
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c1a1fd7e-5d1f-43e4-bb38-7b42c5b60d15 (old id 3146896)
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2012-11-01 10:35:04
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2017-10-29 03:17:09
@article{c1a1fd7e-5d1f-43e4-bb38-7b42c5b60d15,
  abstract     = {Background Smoking has been linked to mucinous ovarian cancer, but its effects on other ovarian cancer subtypes and on overall ovarian cancer risk are unclear, and the findings from most studies with relevant data are unpublished. To assess these associations, we review the published and unpublished evidence. Methods Eligible epidemiological studies were identified 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 affected 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 specified histology, 2314 (13%) were mucinous, 2360 (13%) endometrioid, 969 (5%) clear-cell, and 9086 (52%) serous. Smoking-related risks varied substantially across these subtypes (p(heterogeneity)&lt;0.0001). For mucinous cancers, incidence was increased in current versus never smokers (1.79, 95% CI 1.60-2.00, p&lt;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 significant association for serous ovarian cancers (0.99, 95% CI 0.93-1.06, p=0.8). These associations did not vary significantly 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 deficit of endometrioid and clear-cell ovarian cancers. The substantial variation in smoking-related risks by tumour subtype is important for understanding ovarian carcinogenesis.},
  author       = {Beral, V. and Gaitskell, K. and Hermon, C. and Moser, K. and Reeves, G. and Peto, R. and Brinton, L. and Marchbanks, P. and Negri, E. and Ness, R. and Peeters, P. H. M. and Vessey, M. and Calle, E. E. and Gapstur, S. M. and Patel, A. V. and Dal Maso, L. and Talamini, R. and Chetrit, A. and Hirsh-Yechezkel, G. and Lubin, F. and Sadetzki, S. and Banks, E. and Beral, V. and Bull, D. and Callaghan, K. and Crossley, B. and Gaitskell, K. and Goodill, A. and Green, J. and Hermon, C. and Key, T. and Moser, K. and Reeves, G. and Sitas, F. and Collins, R. and Doll, R. and Peto, R. and Gonzalez, A. and Lee, N. and Marchbanks, P. and Ory, H. W. and Peterson, H. B. and Wingo, P. A. and Martin, N. and Pardthaisong, T. and Silpisornkosol, S. and Theetranont, C. and Boosiri, B. and Chutivongse, S. and Jimakorn, P. and Virutamasen, P. and Wongsrichanalai, C. and Tjonneland, A. and Titus-Ernstoff, L. and Byers, T. and Rohan, T. and Mosgaard, B. J. and Vessey, M. and Yeates, D. and Freudenheim, J. L. and Chang-Claude, J. and Kaaks, R. and Anderson, K. E. and Folsom, A. and Robien, K. and Hampton, J. and Newcomb, P. A. and Rossing, M. A. and Thomas, D. B. and Weiss, N. S. and Riboli, E. and Clavel-Chapelon, F. and Cramer, D. and Hankinson, S. E. and Tworoger, S. S. and Franceschi, S. and La Vecchia, C. and Negri, E. and Adami, H. O. and Magnusson, C. and Riman, T. and Weiderpass, E. and Wolk, A. and Schouten, L. J. and van den Brandt, P. A. and Chantarakul, N. and Koetsawang, S. and Rachawat, D. and Palli, D. and Black, A. and Brinton, L. A. and Freedman, D. M. and Hartge, P. and Hsing, A. W. and Lacey, J. V. and Hoover, R. N. and Schairer, C. and Urban, M. and Graff-Iversen, S. and Selmer, R. and Bain, C. J. and Green, A. C. and Purdie, D. M. and Siskind, V. and Webb, P. M. and Moysich, K. and McCann, S. E. and Hannaford, P. and Kay, C. and Binns, C. W. and Lee, A. H. and Zhang, M. and Ness, R. B. and Nasca, P. and Coogan, P. F. and Palmer, J. R. and Rosenberg, L. and Kelsey, J. and Paffenbarger, R. and Whittemore, A. and Katsouyanni, K. and Trichopoulou, A. and Trichopoulos, D. and Tzonou, A. and Dabancens, A. and Martinez, L. and Molina, R. and Salas, O. and Goodman, M. T. and Lurie, G. and Carney, M. E. and Wilkens, L. R. and Werner Hartman, Linda and Manjer, Jonas and Olsson, Håkan and Grisso, J. A. and Morgan, M. and Wheeler, J. E. and Bunker, C. H. and Edwards, R. P. and Modugno, F. and Peeters, P. H. M. and Casagrande, J. and Pike, M. C. and Ross, R. K. and Wu, A. H. and Miller, A. B. and Kumle, M. and Gram, I. T. and Lund, E. and McGowan, L. and Shu, X. O. and Zheng, W. and Farley, T. M. M. and Holck, S. and Meirik, O. and Risch, H. A.},
  issn         = {1474-5488},
  language     = {eng},
  number       = {9},
  pages        = {946--956},
  publisher    = {Elsevier},
  series       = {The Lancet Oncology},
  title        = {Ovarian cancer and smoking: individual participant meta-analysis including 28 114 women with ovarian cancer from 51 epidemiological studies},
  url          = {http://dx.doi.org/10.1016/S1470-2045(12)70322-4},
  volume       = {13},
  year         = {2012},
}