Cancer risk in waterpipe smokers: a meta-analysis

Ravinder Mamtani, Sohaila Cheema, Javaid Sheikh, Ahmad Al Mulla, Albert Lowenfels, Patrick Maisonneuve

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: To quantify by meta-analysis the relationship between waterpipe smoking and cancer, including cancer of the head and neck, esophagus, stomach, lung and bladder.

METHODS: We performed a systematic literature search to identify relevant studies, scored their quality, used fixed and random-effect models to estimate summary relative risks (SRR), evaluated heterogeneity and publication bias.

RESULTS: We retrieved information from 28 published reports. Considering only highquality studies, waterpipe smoking was associated with increased risk of head and neck cancer (SRR 2.97; 95 % CI 2.26-3.90), esophageal cancer (1.84; 1.42-2.38) and lung cancer (2.22; 1.24-3.97), with no evidence of heterogeneity or publication bias. Increased risk was also observed for stomach and bladder cancer but based mainly on poor-quality studies. For colorectum, liver and for all sites combined risk estimates were elevated, but there were insufficient reports to perform a meta-analysis.

CONCLUSIONS: Contrary to the perception of the relative safety of waterpipe smoking, this meta-analysis provides quantitative estimates of its association with cancers of the head and neck, esophagus and lung. The scarcity and limited quality of available reports point out the need for larger carefully designed studies in well-defined populations.

Original languageEnglish
Pages (from-to)73-83
Number of pages11
JournalSozial- und Praventivmedizin
Issue number1
Publication statusPublished - Jan 2017


  • Humans
  • Neoplasms/etiology
  • Risk
  • Smoking/adverse effects
  • Tobacco Products/adverse effects
  • Water


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