Journal
BMC MEDICINE
Volume 14, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12916-016-0607-5
Keywords
Smoking; Cancer; Incidence; Mortality; Cohort; Meta-analysis
Categories
Funding
- FP7 framework program of DG-RESEARCH the European Commission [242244]
- Swedish Research Council
- Swedish Cancer Foundation
- Baden-Wurttemberg state Ministry of Science, Research and Arts (Stuttgart, Germany)
- Federal Ministry of Education and Research (Berlin, Germany)
- Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (Berlin, Germany)
- Hellenic Health Foundation
- European Commission (DG SANCO)
- Dutch Ministry of Public Health, Welfare and Sports (VWS)
- National Institute for Public Health and the Environment (RIVM)
- Netherlands Cancer Registry (NKR)
- Netherlands Organizaton for Health Research and Development (ZONMW)
- World Cancer Research Fund (WCRF)
- Statistics Netherlands
- Health Research Fund (FIS) of the Spanish Ministry of Health RTICC 'Red Tematica de Investigacion Cooperativa en Cancer [Rd06/0070/0091, Rd12/0036/0018]
- Regional Governments of Andalucia, Asturias, Basque Country, Murcia [6236]
- Navarra, Institute de Salud Carlos III, Redes de Investigacion Cooperativa [RD06/0020]
- Swedish Cancer Society
- Swedish Scientific Council
- Regional Government of Skane
- Danish Cancer Society
- Welcome Trust [064947, 081081]
- US National Institute on Ageing [R01 AG23522]
- Mac Arthur Foundation
- Institut National de la Sante et de la Recherche Medicale (INSERM), Merck
- Sharp & Dohme-Chibret Laboratory
- Department of Health and Social Services
- Personal Safety for Northern Ireland
- European Union [HEALTH-F4-2007-201413, 278913]
- Intramural Program of the National Cancer Institute
- Erasmus Medical Center
- Erasmus University Rotterdam
- Netherlands Organization for Scientific Research
- Netherlands Organization for Health Research and Development
- Research Institute for Diseases in the Elderly
- Netherlands Genomics Initiative
- Ministry of 'Education Culture, and Science
- Ministry of Health, Welfare, and Sports
- European Commission
- Municipality of Rotterdam
- EU
- Norwegian Research Council
- Vasterbotten county Council
- Swedish Council for Working Life and Social Research
- Medical Research Council [MC_CF023241] Funding Source: researchfish
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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.
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