Περίληψη:
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are unpublished.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and unpublished evidence.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.
Συγγραφείς:
Beral, V.
Gaitskell, K.
Hermon, C.
Moser, K.
Reeves, G.
and Peto, R.
Brinton, L.
Marchbanks, P.
Negri, E.
Ness,
R.
Peeters, P. H. M.
Vessey, M.
Calle, E. E.
Gapstur, S.
M.
Patel, A. V.
Dal Maso, L.
Talamini, R.
Chetrit, A.
and Hirsh-Yechezkel, G.
Lubin, F.
Sadetzki, S.
Banks, E. and
Bull, D.
Callaghan, K.
Crossley, B.
Goodill, A.
Green,
J.
Key, T.
Sitas, F.
Collins, R.
Doll, R.
Gonzalez,
A.
Lee, N.
Ory, H. W.
Peterson, H. B.
Wingo, P. A. and
Martin, N.
Pardthaisong, T.
Silpisornkosol, S.
Theetranont,
C.
Boosiri, B.
Chutivongse, S.
Jimakorn, P.
Virutamasen,
P.
Wongsrichanalai, C.
Tjonneland, A.
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Byers, T.
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E.
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S.
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Wolk, A.
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Chantarakul, N.
Koetsawang, S. and
Rachawat, D.
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Black, A.
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P.
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Schairer, C.
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Graff-Iversen, S.
Selmer, R. and
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Green, A. C.
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Siskind, V.
Webb,
P. M.
Moysich, K.
McCann, S. E.
Hannaford, P.
Kay, C.
and Binns, C. W.
Lee, A. H.
Zhang, M.
Nasca, P.
Coogan,
P. F.
Palmer, J. R.
Rosenberg, L.
Kelsey, J. and
Paffenbarger, R.
Whittemore, A.
Katsouyanni, K. and
Trichopoulou, A.
Trichopoulos, D.
Tzonou, A.
Dabancens, A.
and Martinez, L.
Molina, R.
Salas, O.
Goodman, M. T. and
Lurie, G.
Carney, M. E.
Wilkens, L. R.
Hartman, L. and
Manjer, J.
Olsson, H.
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Morgan, M.
Wheeler,
J. E.
Bunker, C. H.
Edwards, R. P.
Modugno, F. and
Casagrande, J.
Pike, M. C.
Ross, R. K.
Wu, A. H.
Miller,
A. B.
Kumle, M.
Gram, I. T.
Lund, E.
McGowan, L. and
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Zheng, W.
Farley, T. M. M.
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Meirik,
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Collaborative Grp Epidemiological
Natl
Israeli Study Ovarian Canc
Nurses Hlth Study
