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.
Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France.
Mustafa
M
Al-Zoughool
Laure
L
Dossus
Rudolf
R
Kaaks
Françoise
F
Clavel-Chapelon
Anne
A
Tjønneland
Anja
A
Olsen
Kim
K
Overvad
Marie-Christine
MC
Boutron-Ruault
Estelle
E
Gauthier
Jakob
J
Linseisen
Jenny
J
Chang-Claude
Heiner
H
Boeing
Mandy
M
Schulz
Antonia
A
Trichopoulou
Travezea
T
Chryssa
Dimitrios
D
Trichopoulos
Franco
F
Berrino
Domenico
D
Palli
Amalia
A
Mattiello
Rosario
R
Tumino
Carlotta
C
Sacerdote
H Bas
HB
Bueno-de-Mesquita
Hendriek C
HC
Boshuizen
Petra H M
PH
Peeters
Inger T
IT
Gram
Tonje
T
Braaten
Eiliv
E
Lund
Maria-Dolores
MD
Chirlaque
Eva
E
Ardanaz
Antonio
A
Agudo
Nerea
N
Larrañaga
Jose Ramon
JR
Quirós
Göran
G
Berglund
Jonas
J
Manjer
Eva
E
Lundin
Göran
G
Hallmans
Kay-Tee
KT
Khaw
Sheila
S
Bingham
Naomi
N
Allen
Tim
T
Key
Mazda
M
Jenab
Anne E
AE
Cust
Sabina
S
Rinaldi
Elio
E
Riboli
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