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

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. MoserG. 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, R. B. Ness, P. Nasca, P. F. Coogan, J. R. Palmer, L. Rosenberg, J. Kelsey, R. Paffenbarger, A. Whittemore, K. Katsouyanni, A. Trichopoulou, D. Trichopoulos, A. Tzonou, A. Dabancens, L. Martinez, R. Molina, O. Salas, M. T. Goodman, G. Lurie, M. E. Carney, L. R. Wilkens, L. Hartman, J. Manjer, H. Olsson, J. A. Grisso, M. Morgan, J. E. Wheeler, C. H. Bunker, R. P. Edwards, F. Modugno, P. H M Peeters, J. Casagrande, M. C. Pike, R. K. Ross, A. H. Wu, A. B. Miller, M. Kumle, I. T. Gram, E. Lund, L. McGowan, X. O. Shu, W. Zheng, T. M M Farley, S. Holck, O. Meirik, H. A. Risch

Research output: Contribution to journalArticle

80 Citations (Scopus)

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subtypes and on overall ovarian cancer risk are unclear, and the fi ndings from most studies with relevant data are unpublished. To assess these associations, we review the published and unpublished evidence.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%) endometrioid, 969 (5%) clear-cell, and 9086 (52%) serous. Smoking-related risks varied substantially across these subtypes (pheterogeneityheterogeneity=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.

Original languageEnglish
Pages (from-to)946-956
Number of pages11
JournalThe Lancet Oncology
Volume13
Issue number9
DOIs
Publication statusPublished - Sep 2012

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Ovarian Neoplasms
Meta-Analysis
Epidemiologic Studies
Smoking
Neoplasms
Oral Contraceptives
Parity
Histology
Carcinogenesis
Body Mass Index
Alcohols
Hormones
Incidence

ASJC Scopus subject areas

  • Oncology

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Ovarian cancer and smoking : Individual participant meta-analysis including 28 114 women with ovarian cancer from 51 epidemiological studies. / Calle, E. E.; Gapstur, S. M.; Patel, A. V.; Dal Maso, L.; Talamini, R.; Chetrit, A.; Hirsh-Yechezkel, G.; Lubin, F.; Sadetzki, S.; Banks, E.; Beral, V.; Bull, D.; Callaghan, K.; Crossley, B.; Gaitskell, K.; Goodill, A.; Green, J.; Hermon, C.; Key, T.; Moser, K.; Reeves, G.; Sitas, F.; Collins, R.; Doll, R.; Peto, R.; Gonzalez, C. A.; Lee, N.; Marchbanks, P.; Ory, H. W.; Peterson, H. B.; Wingo, P. A.; Martin, N.; Pardthaisong, T.; Silpisornkosol, S.; Theetranont, C.; Boosiri, B.; Chutivongse, S.; Jimakorn, P.; Virutamasen, P.; Wongsrichanalai, C.; Tjonneland, A.; Titus-Ernstoff, L.; Byers, T.; Rohan, T.; Mosgaard, B. J.; Vessey, M.; Yeates, D.; Freudenheim, J. L.; Chang-Claude, J.; Kaaks, R.; Anderson, K. E.; Folsom, A.; Robien, K.; Hampton, J.; Newcomb, P. A.; Rossing, M. A.; Thomas, D. B.; Weiss, N. S.; Riboli, E.; Clavel-Chapelon, F.; Cramer, D.; Hankinson, S. E.; Tworoger, S. S.; Franceschi, S.; La Vecchia, C.; Negri, E.; Adami, H. O.; Magnusson, C.; Riman, T.; Weiderpass, E.; Wolk, A.; Schouten, L. J.; van den Brandt, P. A.; Chantarakul, N.; Koetsawang, S.; Rachawat, D.; Palli, D.; Black, A.; Brinton, L. A.; Freedman, D. M.; Hartge, P.; Hsing, A. W.; Lacey, Jr V.; Hoover, R. N.; Schairer, C.; Urban, M.; Graff-Iversen, S.; Selmer, R.; Bain, C. J.; Green, A. C.; Purdie, D. M.; Siskind, V.; Webb, P. M.; Moysich, K.; McCann, S. E.; Hannaford, P.; Kay, C.; Binns, C. W.; Lee, A. H.; Zhang, M.; Ness, R. B.; Nasca, P.; Coogan, P. F.; Palmer, J. R.; Rosenberg, L.; Kelsey, J.; Paffenbarger, R.; Whittemore, A.; Katsouyanni, K.; Trichopoulou, A.; Trichopoulos, D.; Tzonou, A.; Dabancens, A.; Martinez, L.; Molina, R.; Salas, O.; Goodman, M. T.; Lurie, G.; Carney, M. E.; Wilkens, L. R.; Hartman, L.; Manjer, J.; Olsson, H.; Grisso, J. A.; Morgan, M.; Wheeler, J. E.; Bunker, C. H.; Edwards, R. P.; Modugno, F.; Peeters, P. H M; Casagrande, J.; Pike, M. C.; Ross, R. K.; Wu, A. H.; Miller, A. B.; Kumle, M.; Gram, I. T.; Lund, E.; McGowan, L.; Shu, X. O.; Zheng, W.; Farley, T. M M; Holck, S.; Meirik, O.; Risch, H. A.

In: The Lancet Oncology, Vol. 13, No. 9, 09.2012, p. 946-956.

Research output: Contribution to journalArticle

Calle, EE, Gapstur, SM, Patel, AV, Dal Maso, L, Talamini, R, Chetrit, A, Hirsh-Yechezkel, G, Lubin, F, Sadetzki, S, Banks, E, Beral, V, Bull, D, Callaghan, K, Crossley, B, Gaitskell, K, Goodill, A, Green, J, Hermon, C, Key, T, Moser, K, Reeves, G, Sitas, F, Collins, R, Doll, R, Peto, R, Gonzalez, CA, Lee, N, Marchbanks, P, Ory, HW, Peterson, HB, Wingo, PA, Martin, N, Pardthaisong, T, Silpisornkosol, S, Theetranont, C, Boosiri, B, Chutivongse, S, Jimakorn, P, Virutamasen, P, Wongsrichanalai, C, Tjonneland, A, Titus-Ernstoff, L, Byers, T, Rohan, T, Mosgaard, BJ, Vessey, M, Yeates, D, Freudenheim, JL, Chang-Claude, J, Kaaks, R, Anderson, KE, Folsom, A, Robien, K, Hampton, J, Newcomb, PA, Rossing, MA, Thomas, DB, Weiss, NS, Riboli, E, Clavel-Chapelon, F, Cramer, D, Hankinson, SE, Tworoger, SS, Franceschi, S, La Vecchia, C, Negri, E, Adami, HO, Magnusson, C, Riman, T, Weiderpass, E, Wolk, A, Schouten, LJ, van den Brandt, PA, Chantarakul, N, Koetsawang, S, Rachawat, D, Palli, D, Black, A, Brinton, LA, Freedman, DM, Hartge, P, Hsing, AW, Lacey, JV, Hoover, RN, Schairer, C, Urban, M, Graff-Iversen, S, Selmer, R, Bain, CJ, Green, AC, Purdie, DM, Siskind, V, Webb, PM, Moysich, K, McCann, SE, Hannaford, P, Kay, C, Binns, CW, Lee, AH, Zhang, M, Ness, RB, Nasca, P, Coogan, PF, Palmer, JR, Rosenberg, L, Kelsey, J, Paffenbarger, R, Whittemore, A, Katsouyanni, K, Trichopoulou, A, Trichopoulos, D, Tzonou, A, Dabancens, A, Martinez, L, Molina, R, Salas, O, Goodman, MT, Lurie, G, Carney, ME, Wilkens, LR, Hartman, L, Manjer, J, Olsson, H, Grisso, JA, Morgan, M, Wheeler, JE, Bunker, CH, Edwards, RP, Modugno, F, Peeters, PHM, Casagrande, J, Pike, MC, Ross, RK, Wu, AH, Miller, AB, Kumle, M, Gram, IT, Lund, E, McGowan, L, Shu, XO, Zheng, W, Farley, TMM, Holck, S, Meirik, O & Risch, HA 2012, 'Ovarian cancer and smoking: Individual participant meta-analysis including 28 114 women with ovarian cancer from 51 epidemiological studies', The Lancet Oncology, vol. 13, no. 9, pp. 946-956. https://doi.org/10.1016/S1470-2045(12)70322-4
Calle, E. E. ; Gapstur, S. M. ; Patel, A. V. ; Dal Maso, L. ; Talamini, R. ; Chetrit, A. ; Hirsh-Yechezkel, G. ; Lubin, F. ; Sadetzki, S. ; Banks, E. ; Beral, V. ; Bull, D. ; Callaghan, K. ; Crossley, B. ; Gaitskell, K. ; Goodill, A. ; Green, J. ; Hermon, C. ; Key, T. ; Moser, K. ; Reeves, G. ; Sitas, F. ; Collins, R. ; Doll, R. ; Peto, R. ; Gonzalez, C. A. ; Lee, N. ; Marchbanks, P. ; Ory, H. W. ; Peterson, H. B. ; Wingo, P. A. ; Martin, N. ; Pardthaisong, T. ; Silpisornkosol, S. ; Theetranont, C. ; Boosiri, B. ; Chutivongse, S. ; Jimakorn, P. ; Virutamasen, P. ; Wongsrichanalai, C. ; Tjonneland, A. ; Titus-Ernstoff, L. ; Byers, T. ; Rohan, T. ; Mosgaard, B. J. ; Vessey, M. ; Yeates, D. ; Freudenheim, J. L. ; Chang-Claude, J. ; Kaaks, R. ; Anderson, K. E. ; Folsom, A. ; Robien, K. ; Hampton, J. ; Newcomb, P. A. ; Rossing, M. A. ; Thomas, D. B. ; Weiss, N. S. ; Riboli, E. ; Clavel-Chapelon, F. ; Cramer, D. ; Hankinson, S. E. ; Tworoger, S. S. ; Franceschi, S. ; La Vecchia, C. ; Negri, E. ; Adami, H. O. ; Magnusson, C. ; Riman, T. ; Weiderpass, E. ; Wolk, A. ; Schouten, L. J. ; van den Brandt, P. A. ; Chantarakul, N. ; Koetsawang, S. ; Rachawat, D. ; Palli, D. ; Black, A. ; Brinton, L. A. ; Freedman, D. M. ; Hartge, P. ; Hsing, A. W. ; Lacey, Jr V. ; Hoover, R. N. ; Schairer, C. ; Urban, M. ; Graff-Iversen, S. ; Selmer, R. ; Bain, C. J. ; Green, A. C. ; Purdie, D. M. ; Siskind, V. ; Webb, P. M. ; Moysich, K. ; McCann, S. E. ; Hannaford, P. ; Kay, C. ; Binns, C. W. ; Lee, A. H. ; Zhang, M. ; Ness, R. B. ; Nasca, P. ; Coogan, P. F. ; Palmer, J. R. ; Rosenberg, L. ; Kelsey, J. ; Paffenbarger, R. ; Whittemore, A. ; Katsouyanni, K. ; Trichopoulou, A. ; Trichopoulos, D. ; Tzonou, A. ; Dabancens, A. ; Martinez, L. ; Molina, R. ; Salas, O. ; Goodman, M. T. ; Lurie, G. ; Carney, M. E. ; Wilkens, L. R. ; Hartman, L. ; Manjer, J. ; Olsson, H. ; Grisso, J. A. ; Morgan, M. ; Wheeler, J. E. ; Bunker, C. H. ; Edwards, R. P. ; Modugno, F. ; Peeters, P. H M ; Casagrande, J. ; Pike, M. C. ; Ross, R. K. ; Wu, A. H. ; Miller, A. B. ; Kumle, M. ; Gram, I. T. ; Lund, E. ; McGowan, L. ; Shu, X. O. ; Zheng, W. ; Farley, T. M M ; Holck, S. ; Meirik, O. ; Risch, H. A. / Ovarian cancer and smoking : Individual participant meta-analysis including 28 114 women with ovarian cancer from 51 epidemiological studies. In: The Lancet Oncology. 2012 ; Vol. 13, No. 9. pp. 946-956.
@article{0f9a01c4a35646649873746bba2a7f2a,
title = "Ovarian cancer and smoking: Individual participant meta-analysis including 28 114 women with ovarian cancer from 51 epidemiological studies",
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{\%}) endometrioid, 969 (5{\%}) clear-cell, and 9086 (52{\%}) serous. Smoking-related risks varied substantially across these subtypes (pheterogeneityheterogeneity=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.",
author = "Calle, {E. E.} and Gapstur, {S. M.} and Patel, {A. V.} and {Dal Maso}, L. and R. Talamini and A. Chetrit and G. Hirsh-Yechezkel and F. Lubin and S. Sadetzki and E. Banks and V. Beral and D. Bull and K. Callaghan and B. Crossley and K. Gaitskell and A. Goodill and J. Green and C. Hermon and T. Key and K. Moser and G. Reeves and F. Sitas and R. Collins and R. Doll and R. Peto and Gonzalez, {C. A.} and N. Lee and P. Marchbanks and Ory, {H. W.} and Peterson, {H. B.} and Wingo, {P. A.} and N. Martin and T. Pardthaisong and S. Silpisornkosol and C. Theetranont and B. Boosiri and S. Chutivongse and P. Jimakorn and P. Virutamasen and C. Wongsrichanalai and A. Tjonneland and L. Titus-Ernstoff and T. Byers and T. Rohan and Mosgaard, {B. J.} and M. Vessey and D. Yeates and Freudenheim, {J. L.} and J. Chang-Claude and R. Kaaks and Anderson, {K. E.} and A. Folsom and K. Robien and J. Hampton and Newcomb, {P. A.} and Rossing, {M. A.} and Thomas, {D. B.} and Weiss, {N. S.} and E. Riboli and F. Clavel-Chapelon and D. Cramer and Hankinson, {S. E.} and Tworoger, {S. S.} and S. Franceschi and {La Vecchia}, C. and E. Negri and Adami, {H. O.} and C. Magnusson and T. Riman and E. Weiderpass and A. Wolk and Schouten, {L. J.} and {van den Brandt}, {P. A.} and N. Chantarakul and S. Koetsawang and D. Rachawat and D. Palli and A. Black and Brinton, {L. A.} and Freedman, {D. M.} and P. Hartge and Hsing, {A. W.} and Lacey, {Jr V.} and Hoover, {R. N.} and C. Schairer and M. Urban and S. Graff-Iversen and R. Selmer and Bain, {C. J.} and Green, {A. C.} and Purdie, {D. M.} and V. Siskind and Webb, {P. M.} and K. Moysich and McCann, {S. E.} and P. Hannaford and C. Kay and Binns, {C. W.} and Lee, {A. H.} and M. Zhang and Ness, {R. B.} and P. Nasca and Coogan, {P. F.} and Palmer, {J. R.} and L. Rosenberg and J. Kelsey and R. Paffenbarger and A. Whittemore and K. Katsouyanni and A. Trichopoulou and D. Trichopoulos and A. Tzonou and A. Dabancens and L. Martinez and R. Molina and O. Salas and Goodman, {M. T.} and G. Lurie and Carney, {M. E.} and Wilkens, {L. R.} and L. Hartman and J. Manjer and H. Olsson and Grisso, {J. A.} and M. Morgan and Wheeler, {J. E.} and Bunker, {C. H.} and Edwards, {R. P.} and F. Modugno and Peeters, {P. H M} and J. Casagrande and Pike, {M. C.} and Ross, {R. K.} and Wu, {A. H.} and Miller, {A. B.} and M. Kumle and Gram, {I. T.} and E. Lund and L. McGowan and Shu, {X. O.} and W. Zheng and Farley, {T. M M} and S. Holck and O. Meirik and Risch, {H. A.}",
year = "2012",
month = "9",
doi = "10.1016/S1470-2045(12)70322-4",
language = "English",
volume = "13",
pages = "946--956",
journal = "The Lancet Oncology",
issn = "1470-2045",
publisher = "Lancet Publishing Group",
number = "9",

}

TY - JOUR

T1 - Ovarian cancer and smoking

T2 - Individual participant meta-analysis including 28 114 women with ovarian cancer from 51 epidemiological studies

AU - Calle, E. E.

AU - Gapstur, S. M.

AU - Patel, A. V.

AU - Dal Maso, L.

AU - Talamini, R.

AU - Chetrit, A.

AU - Hirsh-Yechezkel, G.

AU - Lubin, F.

AU - Sadetzki, S.

AU - Banks, E.

AU - Beral, V.

AU - Bull, D.

AU - Callaghan, K.

AU - Crossley, B.

AU - Gaitskell, K.

AU - Goodill, A.

AU - Green, J.

AU - Hermon, C.

AU - Key, T.

AU - Moser, K.

AU - Reeves, G.

AU - Sitas, F.

AU - Collins, R.

AU - Doll, R.

AU - Peto, R.

AU - Gonzalez, C. A.

AU - Lee, N.

AU - Marchbanks, P.

AU - Ory, H. W.

AU - Peterson, H. B.

AU - Wingo, P. A.

AU - Martin, N.

AU - Pardthaisong, T.

AU - Silpisornkosol, S.

AU - Theetranont, C.

AU - Boosiri, B.

AU - Chutivongse, S.

AU - Jimakorn, P.

AU - Virutamasen, P.

AU - Wongsrichanalai, C.

AU - Tjonneland, A.

AU - Titus-Ernstoff, L.

AU - Byers, T.

AU - Rohan, T.

AU - Mosgaard, B. J.

AU - Vessey, M.

AU - Yeates, D.

AU - Freudenheim, J. L.

AU - Chang-Claude, J.

AU - Kaaks, R.

AU - Anderson, K. E.

AU - Folsom, A.

AU - Robien, K.

AU - Hampton, J.

AU - Newcomb, P. A.

AU - Rossing, M. A.

AU - Thomas, D. B.

AU - Weiss, N. S.

AU - Riboli, E.

AU - Clavel-Chapelon, F.

AU - Cramer, D.

AU - Hankinson, S. E.

AU - Tworoger, S. S.

AU - Franceschi, S.

AU - La Vecchia, C.

AU - Negri, E.

AU - Adami, H. O.

AU - Magnusson, C.

AU - Riman, T.

AU - Weiderpass, E.

AU - Wolk, A.

AU - Schouten, L. J.

AU - van den Brandt, P. A.

AU - Chantarakul, N.

AU - Koetsawang, S.

AU - Rachawat, D.

AU - Palli, D.

AU - Black, A.

AU - Brinton, L. A.

AU - Freedman, D. M.

AU - Hartge, P.

AU - Hsing, A. W.

AU - Lacey, Jr V.

AU - Hoover, R. N.

AU - Schairer, C.

AU - Urban, M.

AU - Graff-Iversen, S.

AU - Selmer, R.

AU - Bain, C. J.

AU - Green, A. C.

AU - Purdie, D. M.

AU - Siskind, V.

AU - Webb, P. M.

AU - Moysich, K.

AU - McCann, S. E.

AU - Hannaford, P.

AU - Kay, C.

AU - Binns, C. W.

AU - Lee, A. H.

AU - Zhang, M.

AU - Ness, R. B.

AU - Nasca, P.

AU - Coogan, P. F.

AU - Palmer, J. R.

AU - Rosenberg, L.

AU - Kelsey, J.

AU - Paffenbarger, R.

AU - Whittemore, A.

AU - Katsouyanni, K.

AU - Trichopoulou, A.

AU - Trichopoulos, D.

AU - Tzonou, A.

AU - Dabancens, A.

AU - Martinez, L.

AU - Molina, R.

AU - Salas, O.

AU - Goodman, M. T.

AU - Lurie, G.

AU - Carney, M. E.

AU - Wilkens, L. R.

AU - Hartman, L.

AU - Manjer, J.

AU - Olsson, H.

AU - Grisso, J. A.

AU - Morgan, M.

AU - Wheeler, J. E.

AU - Bunker, C. H.

AU - Edwards, R. P.

AU - Modugno, F.

AU - Peeters, P. H M

AU - Casagrande, J.

AU - Pike, M. C.

AU - Ross, R. K.

AU - Wu, A. H.

AU - Miller, A. B.

AU - Kumle, M.

AU - Gram, I. T.

AU - Lund, E.

AU - McGowan, L.

AU - Shu, X. O.

AU - Zheng, W.

AU - Farley, T. M M

AU - Holck, S.

AU - Meirik, O.

AU - Risch, H. A.

PY - 2012/9

Y1 - 2012/9

N2 - 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%) endometrioid, 969 (5%) clear-cell, and 9086 (52%) serous. Smoking-related risks varied substantially across these subtypes (pheterogeneityheterogeneity=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.

AB - 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%) endometrioid, 969 (5%) clear-cell, and 9086 (52%) serous. Smoking-related risks varied substantially across these subtypes (pheterogeneityheterogeneity=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.

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U2 - 10.1016/S1470-2045(12)70322-4

DO - 10.1016/S1470-2045(12)70322-4

M3 - Article

AN - SCOPUS:84877875955

VL - 13

SP - 946

EP - 956

JO - The Lancet Oncology

JF - The Lancet Oncology

SN - 1470-2045

IS - 9

ER -