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

Abstract

BackgroundSmoking 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.MethodsThis 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.ResultsOverall, 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.ConclusionsThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0607-5) contains supplementary material, which is available to authorized users.

Tobacco and alcohol as risk factors for pancreatic cancer

“…In this regard, rate advancement periods is a useful statistic for lay people. A recent study showed that being a current smoker (compared with never smoking) increases the risk of developing pancreatic cancer by more than 7 years [46]. Quitting smoking within 10 years (compared with not quitting) delays the risk of development of pancreatic cancer by more than 3 years; within 20 years – by more than 5 years; and quitting for more than 20 years – by more than 10 years [46].…”

Survival model methods for analyses of cancer incidence trends in young adults

“…These results are in general consistent with findings from Sung et al based on age‐period‐cohort models (note that Sung et al did not distinguish men and women in their analysis). The decrease in non‐Hodgkin lymphoma was likely due to the control of HIV/AIDS epidemic whereas the decreases in the other five aforementioned cancers reflect and consolidate the success in smoking reduction through regulations (eg, smoking laws) and individual behavior changes (eg, smoking cessation) . However, our results support sex‐specific differences in smoking‐related cancer decreases and suggest that such regulations may have different impact and that specific programs to young women are needed.…”

Molecular and health effects in the upper respiratory tract associated with tobacco smoking other than cigarettes

“…Lung cancer outnumbering the other tobacco‐associated cancers is connected with easy penetration of tobacco smoke microparticles into lung . A high incidence of lung cancer has been convincingly demonstrated in numerous international studies . Similar epidemiologic data are also applicable to laryngeal cancer.…”

“…81,82 A high incidence of lung cancer has been convincingly demonstrated in numerous international studies. 83,84 Similar epidemiologic data are also applicable to laryngeal cancer. Cigarette smoking and consumption of strong alcoholic beverages are well known risk factors.…”