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Meta-Analysis
. 2016 Apr 5;14:62.
doi: 10.1186/s12916-016-0607-5.

Quantification of the Smoking-Associated Cancer Risk With Rate Advancement Periods: Meta-Analysis of Individual Participant Data From Cohorts of the CHANCES Consortium

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Free PMC article
Meta-Analysis

Quantification of the Smoking-Associated Cancer Risk With Rate Advancement Periods: Meta-Analysis of Individual Participant Data From Cohorts of the CHANCES Consortium

José Manuel Ordóñez-Mena et al. BMC Med. .
Free PMC article

Abstract

Background: Smoking is the most important individual risk factor for many cancer sites but its association with breast and prostate cancer is not entirely clear. Rate advancement periods (RAPs) may enhance communication of smoking related risk to the general population. Thus, we estimated RAPs for the association of smoking exposure (smoking status, time since smoking cessation, smoking intensity, and duration) with total and site-specific (lung, breast, colorectal, prostate, gastric, head and neck, and pancreatic) cancer incidence and mortality.

Methods: This is a meta-analysis of 19 population-based prospective cohort studies with individual participant data for 897,021 European and American adults. For each cohort we calculated hazard ratios (HRs) for the association of smoking exposure with cancer outcomes using Cox regression adjusted for a common set of the most important potential confounding variables. RAPs (in years) were calculated as the ratio of the logarithms of the HRs for a given smoking exposure variable and age. Meta-analyses were employed to summarize cohort-specific HRs and RAPs.

Results: Overall, 140,205 subjects had a first incident cancer, and 53,164 died from cancer, during an average follow-up of 12 years. Current smoking advanced the overall risk of developing and dying from cancer by eight and ten years, respectively, compared with never smokers. The greatest advancements in cancer risk and mortality were seen for lung cancer and the least for breast cancer. Smoking cessation was statistically significantly associated with delays in the risk of cancer development and mortality compared with continued smoking.

Conclusions: This investigation shows that smoking, even among older adults, considerably advances, and cessation delays, the risk of developing and dying from cancer. These findings may be helpful in more effectively communicating the harmful effects of smoking and the beneficial effect of smoking cessation.

Keywords: Cancer; Cohort; Incidence; Meta-analysis; Mortality; Smoking.

Figures

Fig. 1
Fig. 1
Sex-stratified association of smoking status with cancer incidence and mortality. Hazard ratios (HR) and 95 % confidence intervals (CI) for cancer incidence and mortality are depicted on the vertical axis for current and former smokers (never smokers as reference). Cohort-specific HRs and 95 % CIs were pooled with meta-analyses separately for men (black squares) and women (white squares)
Fig. 2
Fig. 2
Sex-stratified association of time since smoking cessation with cancer incidence and mortality. Hazard ratios (HR) and 95 % confidence intervals (CI) for cancer incidence and mortality are depicted on the vertical axis for smoking cessation ≤ 9 years ago, 10–19 years ago, or ≥ 20 years ago (current smokers as reference). Cohort-specific HRs and 95 % CIs were pooled with meta-analyses separately for men (black squares) and women (white squares)
Fig. 3
Fig. 3
Age-stratified association of smoking status with cancer incidence and mortality. Hazard ratios (HR) and 95 % confidence intervals (CI) for cancer incidence and mortality are depicted on the vertical axis for current and former smokers (never smokers as reference). Cohort-specific HRs and 95 % CIs were pooled with meta-analyses separately for older than 65 years old (black circles) and younger than 65 years old (white circles)
Fig. 4
Fig. 4
Age-stratified association of time since smoking cessation with cancer incidence and mortality. Hazard ratios (HR) and 95 % confidence intervals (CI) for cancer incidence and mortality are depicted on the vertical axis for smoking cessation ≤ 9 years ago, 10–19 years ago, or ≥ 20 years ago (current smokers as reference). Cohort-specific HRs and 95%CIs were pooled with meta-analyses separately for older than 65 years old (black circles) and younger than 65 years old (white circles)

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