Cigarette smoking and risk of histological subtypes of epithelial ovarian cancer in the EPIC cohort study

Inger T. Gram, Annekatrin Lukanova, Ilene Brill, Tonje Braaten, Eiliv Lund, Eva Lundin, Kim Overvad, Anne Tjã̧nneland, Francoise Clavel-Chapelon, Nathalie Chabbert-Buffet, Christina Bamia, Antonia Trichopoulou, Dimosthenis Zylis, Giovanna Masala, Franco Berrino, Rocco Galasso, Rosario Tumino, Carlotta Sacerdote, Oxana Gavrilyuk, Steinar KristiansenLaudina Rodríguez, Catalina Bonet, José María Huerta, Aurelio Barricarte, Maria José Sánchez, Miren Dorronsoro, Karin Jirström, Martin Almquist, Annika Idahl, H. Bas Bueno-De-Mesquita, Marie Braem, Charlotte Onland-Moret, Konstantinos K. Tsilidis, Naomi E. Allen, Veronika Fedirko, E. Riboli, Rudolf Kaaks

Research output: Contribution to journalArticle


New data regarding a positive association between smoking and risk of epithelial ovarian cancer (EOC), especially the mucinous tumor type, has started to emerge. The purpose of this study was to examine the association between different measures of smoking exposures and subtypes of EOC in a large cohort of women from 10 European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC) cohort is a multicenter prospective study initiated in 1992. The questionnaires included data about dietary, lifestyle, and health factors. Information about cigarette smoking was collected from individuals in all participating countries. We used Cox proportional hazard regression models to estimate hazard ratio (HR) of EOC overall and serous, mucinous, and endometroid histological subtypes, with 95% confidence intervals (CIs) associated with different measures of smoking exposures adjusting for confounding variables. Altogether 836 incident EOC cases were identified among 326,831 women. The tumors were classified as 400 serous, 83 mucinous, 80 endometroid, 35 clear cell, and 238 unspecified. Compared with never smokers, current smokers had a significantly increased risk for mucinous tumors [HR = 1.85 (95% CI 1.08-3.16)] and those smoking more than 10 cigarettes per day had a doubling in risk [HR = 2.25(95% CI 1.26-4.03)] as did those who had smoked less than 15 pack-years of cigarettes [HR = 2.18 (95% CI 1.07-4.43)]. The results from the EPIC study add further evidence that smoking increases risk of mucinous ovarian cancer and support the notion that the effect of smoking varies according to histological subtype.

Original languageEnglish
Pages (from-to)2204-2210
Number of pages7
JournalInternational Journal of Cancer
Issue number9
Publication statusPublished - May 1 2012



  • EPIC cohort
  • mucinous
  • ovarian cancer
  • serous
  • smoking

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Gram, I. T., Lukanova, A., Brill, I., Braaten, T., Lund, E., Lundin, E., Overvad, K., Tjã̧nneland, A., Clavel-Chapelon, F., Chabbert-Buffet, N., Bamia, C., Trichopoulou, A., Zylis, D., Masala, G., Berrino, F., Galasso, R., Tumino, R., Sacerdote, C., Gavrilyuk, O., ... Kaaks, R. (2012). Cigarette smoking and risk of histological subtypes of epithelial ovarian cancer in the EPIC cohort study. International Journal of Cancer, 130(9), 2204-2210.