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Quantification of the smoking-associated cancer risk with rate advancement periods: meta-analysis of individual participant data from cohorts of the CHANCES consortium

Ordóñez-Mena JM 1 , Schöttker B 1 , Mons U 2 , Jenab M 3 , Freisling H 3 , Bueno-de-Mesquita B 4 Show all authors , O'Doherty MG 5 , Scott A 5 , Kee F 5 , Stricker BH 6 , Hofman A 6 , de Keyser CE 6 , Ruiter R 6 , Söderberg S 7 , Jousilahti P 8 , Kuulasmaa K 8 , Freedman ND 9 , Wilsgaard T 10 , de Groot LC 11 , Kampman E 11 , Håkansson N 12 , Orsini N 12 , Wolk A 12 , Nilsson LM 13 , Tjønneland A 14 , Pająk A 15 , Malyutina S 16 , Kubínová R 17 , Tamosiunas A 18 , Bobak M 19 , Katsoulis M 20 , Orfanos P 21 , Boffetta P 20 , Trichopoulou A 20 , Brenner H 22 , Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES)

Affiliations 

  • 1 Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
  • 2 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany
  • 3 International Agency for Research on Cancer (IARC), Lyon, France
  • 4 Department of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  • 5 UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, UK
  • 6 Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
  • 7 Department of Public Health and Clinical Medicine, Cardiology, and Heart Center, Umeå University, Umeå, Sweden
  • 8 National Institute for Health and Welfare (THL), Helsinki, Finland
  • 9 Nutritional Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD, USA
  • 10 Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  • 11 Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
  • 12 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  • 13 Nutritional Research, Department of Public Health and Clinical Medicine, and Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden
  • 14 Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
  • 15 Jagiellonian University Medical College, Faculty of Health Sciences, Krakow, Poland
  • 16 Institute of Internal and Preventive Medicine, Novosibirsk, Russia
  • 17 National Institute of Public Health, Prague, Czech Republic
  • 18 Institute of Cardiology of Lithuanian University of Health Sciences, Kaunas, Lithuania
  • 19 Department Epidemiology and Public Health, University College London, London, UK
  • 20 Hellenic Health Foundation, Athens, Greece
  • 21 University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, Athens, Greece
  • 22 Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany. h.brenner@dkfz.de
BMC Med, 2016;14(1):62.
PMID: 27044418 DOI: 10.1186/s12916-016-0607-5

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

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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