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dc.contributor.authorE. E. Calleen_US
dc.contributor.authorS. M. Gapsturen_US
dc.contributor.authorA. V. Patelen_US
dc.contributor.authorL. Dal Masoen_US
dc.contributor.authorR. Talaminien_US
dc.contributor.authorA. Chetriten_US
dc.contributor.authorG. Hirsh-Yechezkelen_US
dc.contributor.authorF. Lubinen_US
dc.contributor.authorS. Sadetzkien_US
dc.contributor.authorE. Banksen_US
dc.contributor.authorV. Beralen_US
dc.contributor.authorD. Bullen_US
dc.contributor.authorK. Callaghanen_US
dc.contributor.authorB. Crossleyen_US
dc.contributor.authorK. Gaitskellen_US
dc.contributor.authorA. Goodillen_US
dc.contributor.authorJ. Greenen_US
dc.contributor.authorC. Hermonen_US
dc.contributor.authorT. Keyen_US
dc.contributor.authorK. Moseren_US
dc.contributor.authorG. Reevesen_US
dc.contributor.authorF. Sitasen_US
dc.contributor.authorR. Collinsen_US
dc.contributor.authorR. Dollen_US
dc.contributor.authorR. Petoen_US
dc.contributor.authorC. A. Gonzalezen_US
dc.contributor.authorN. Leeen_US
dc.contributor.authorP. Marchbanksen_US
dc.contributor.authorH. W. Oryen_US
dc.contributor.authorH. B. Petersonen_US
dc.contributor.authorP. A. Wingoen_US
dc.contributor.authorN. Martinen_US
dc.contributor.authorT. Pardthaisongen_US
dc.contributor.authorS. Silpisornkosolen_US
dc.contributor.authorC. Theetranonten_US
dc.contributor.authorB. Boosirien_US
dc.contributor.authorS. Chutivongseen_US
dc.contributor.authorP. Jimakornen_US
dc.contributor.authorP. Virutamasenen_US
dc.contributor.authorC. Wongsrichanalaien_US
dc.contributor.authorA. Tjonnelanden_US
dc.contributor.authorL. Titus-Ernstoffen_US
dc.contributor.authorT. Byersen_US
dc.contributor.authorT. Rohanen_US
dc.contributor.authorB. J. Mosgaarden_US
dc.contributor.authorM. Vesseyen_US
dc.contributor.authorD. Yeatesen_US
dc.contributor.authorJ. L. Freudenheimen_US
dc.contributor.authorJ. Chang-Claudeen_US
dc.contributor.authorR. Kaaksen_US
dc.contributor.authorK. E. Andersonen_US
dc.contributor.authorA. Folsomen_US
dc.contributor.authorK. Robienen_US
dc.contributor.authorJ. Hamptonen_US
dc.contributor.authorP. A. Newcomben_US
dc.contributor.authorM. A. Rossingen_US
dc.contributor.authorD. B. Thomasen_US
dc.contributor.authorN. S. Weissen_US
dc.contributor.authorE. Ribolien_US
dc.contributor.authorF. Clavel-Chapelonen_US
dc.contributor.authorD. Crameren_US
dc.contributor.authorS. E. Hankinsonen_US
dc.contributor.authorS. S. Tworogeren_US
dc.contributor.authorS. Franceschien_US
dc.contributor.authorC. La Vecchiaen_US
dc.contributor.authorE. Negrien_US
dc.contributor.authorH. O. Adamien_US
dc.contributor.authorC. Magnussonen_US
dc.contributor.authorT. Rimanen_US
dc.contributor.authorE. Weiderpassen_US
dc.contributor.authorA. Wolken_US
dc.contributor.authorL. J. Schoutenen_US
dc.contributor.authorP. A. van den Brandten_US
dc.contributor.authorN. Chantarakulen_US
dc.contributor.authorS. Koetsawangen_US
dc.contributor.authorD. Rachawaten_US
dc.contributor.authorD. Pallien_US
dc.contributor.authorA. Blacken_US
dc.contributor.authorL. A. Brintonen_US
dc.contributor.authorD. M. Freedmanen_US
dc.contributor.authorP. Hartgeen_US
dc.contributor.authorA. W. Hsingen_US
dc.contributor.authorJr V. Laceyen_US
dc.contributor.authorR. N. Hooveren_US
dc.contributor.authorC. Schaireren_US
dc.contributor.authorM. Urbanen_US
dc.contributor.authorS. Graff-Iversenen_US
dc.contributor.authorR. Selmeren_US
dc.contributor.authorC. J. Bainen_US
dc.contributor.authorA. C. Greenen_US
dc.contributor.authorD. M. Purdieen_US
dc.contributor.authorV. Siskinden_US
dc.contributor.authorP. M. Webben_US
dc.contributor.authorK. Moysichen_US
dc.contributor.authorS. E. McCannen_US
dc.contributor.authorP. Hannaforden_US
dc.contributor.authorC. Kayen_US
dc.contributor.authorC. W. Binnsen_US
dc.contributor.authorA. H. Leeen_US
dc.contributor.authorM. Zhangen_US
dc.description.abstractBackground Smoking has been linked to mucinous ovarian cancer, but its eff ects on other ovarian cancer subtypes and on overall ovarian cancer risk are unclear, and the fi ndings from most studies with relevant data are unpublished. To assess these associations, we review the published and unpublished evidence. Methods Eligible epidemiological studies were identifi ed 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 aff ected 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 specifi ed histology, 2314 (13%) were mucinous, 2360 (13%) endometrioid, 969 (5%) clear-cell, and 9086 (52%) serous. Smoking-related risks varied substantially across these subtypes (pheterogeneity<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; pheterogeneity=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 signifi cant association for serous ovarian cancers (0.99, 95% CI 0.93-1.06, p=0.8). These associations did not vary signifi cantly 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 defi cit of endometrioid and clear-cell ovarian cancers. The substantial variation in smoking-related risks by tumour subtype is important for understanding ovarian carcinogenesis.en_US
dc.titleOvarian cancer and smoking: Individual participant meta-analysis including 28 114 women with ovarian cancer from 51 epidemiological studiesen_US
article.title.sourcetitleThe Lancet Oncologyen_US
article.volume13en_US Cancer Societyen_US Centro Di Riferimento Oncologico Avianoen_US Gertner Instituteen_US National Israeli Study on Ovarian Cancer (NISOC) groupen_US Council New South Walesen_US Research UKen_US Catala Oncologiaen_US for Disease Control and Preventionen_US Mai Universityen_US Universityen_US of Cancer Epidemiology - Denmarken_US School of Medicine at Dartmouthen_US School of Public Healthen_US Einstein College of Medicine of Yeshiva Universityen_US i Herleven_US of Public Healthen_US at Buffalo, State University of New Yorken_US Cancer Research Centeren_US of Minnesota School of Public Healthen_US of Washington, Seattleen_US College Londonen_US de recherche en epidemiologie et sante des populationsen_US Medical Schoolen_US Agency for Research on Canceren_US degli Studi di Milanoen_US Instituteten_US Universityen_US Universityen_US Per Lo Studio E La Prevenzione Oncologicaen_US Cancer Instituteen_US Health Laboratory Servicesen_US Institute of Public Healthen_US Berghofer Medical Research Instituteen_US Park Cancer Instituteen_US College of General Practitioners' Oral Contraception Studyen_US Universityen_US
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