Risk of endometrial cancer in relationship to cigarette smoking: results from the EPIC study.
Current epidemiologic evidence indicates that cigarette smoking reduces the risk of endometrial cancer. We examined data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to analyze further aspects of the smoking-endometrial cancer relationship, such as possible modifying effects of menopausal status, HRT use, BMI and parity. In a total of 249,986 women with smoking exposure and menopausal status information, 619 incident endometrial cancer cases were identified during 1.56 million person-years of follow-up. Among postmenopausal women, the hazard ratio (HR) for current smokers versus never smokers was 0.70 (95% CI = 0.53-0.93), while it was 1.75 (95% CI = 1.13-2.70) among premenopausal women at recruitment. After adjustment for risk factors, the HR for postmenopausal women was slightly attenuated to 0.78 (95% CI = 0.59-1.03). No heterogeneity of effect was observed with HRT use or BMI. Among premenopausal women, current smokers of more than 15 cigarettes per day or who smoked for 30 years or more at the time of recruitment had a more than 2-fold increased risk of endometrial cancer compared to never smokers (HR = 2.54; 95% CI = 1.47-4.38 and HR = 2.23; 95% CI = 1.04-4.77, respectively). Past smoking was not associated with endometrial cancer risk, either among pre- or postmenopausal women. In this prospective study, we observed an increased risk of endometrial cancer with cigarette smoking in premenopausal women. The reduction of endometrial cancer risk observed among postmenopausal women does not have direct public health relevance since cigarette smoking is the main known risk factor for cancer.
Al-Zoughool
Mustafa
M
Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France.
Dossus
Laure
L
Kaaks
Rudolf
R
Clavel-Chapelon
Françoise
F
Tjønneland
Anne
A
Olsen
Anja
A
Overvad
Kim
K
Boutron-Ruault
Marie-Christine
MC
Gauthier
Estelle
E
Linseisen
Jakob
J
Chang-Claude
Jenny
J
Boeing
Heiner
H
Schulz
Mandy
M
Trichopoulou
Antonia
A
Chryssa
Travezea
T
Trichopoulos
Dimitrios
D
Berrino
Franco
F
Palli
Domenico
D
Mattiello
Amalia
A
Tumino
Rosario
R
Sacerdote
Carlotta
C
Bueno-de-Mesquita
H Bas
HB
Boshuizen
Hendriek C
HC
Peeters
Petra H M
PH
Gram
Inger T
IT
Braaten
Tonje
T
Lund
Eiliv
E
Chirlaque
Maria-Dolores
MD
Ardanaz
Eva
E
Agudo
Antonio
A
Larrañaga
Nerea
N
Quirós
Jose Ramon
JR
Berglund
Göran
G
Manjer
Jonas
J
Lundin
Eva
E
Hallmans
Göran
G
Khaw
Kay-Tee
KT
Bingham
Sheila
S
Allen
Naomi
N
Key
Tim
T
Jenab
Mazda
M
Cust
Anne E
AE
Rinaldi
Sabina
S
Riboli
Elio
E
D000328:Adult; D000367:Age Factors; D000368:Aged; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D017698:Postmenopause; D017697:Premenopause; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors