title: Cigarette smoking and colorectal cancer incidence and mortality: systematic review and meta-analysis.
abstract: The association between cigarette smoking and colorectal cancer (CRC) has been controversial. To synthesize the available data, we conducted a comprehensive meta-analysis of all prospective studies. A total of 36 studies were included in our meta-analysis. We examined the association between smoking and CRC, colon cancer and rectal cancer in terms of incidence and mortality. Separate analyses were conducted for smoking status, daily cigarette consumption, duration, pack-years and age of initiation. Relative to nonsmokers, current and former smokers had a significantly increased risk of CRC incidence and mortality, respectively. When CRC data were combined with colon/rectal cancer data, current smokers had a significantly increased risk of CRC incidence. All 4 dose-response variables examined-daily cigarette consumption (RR = 1.38 for an increase of 40 cigarettes/day), duration (RR = 1.20 for an increase of 40 years of duration), pack-years (RR = 1.51 for an increase of 60 pack-years) and age of initiation (RR = 0.96 for a delay of 10 years in smoking initiation)-were significantly associated with CRC incidence (all p-values < 0.0001). The relationship between duration of smoking and rectal cancer incidence was also significant. Among the subset of studies that distinguished cancer by site, a higher risk was seen for rectal cancer than for colon cancer for all analyses. Among prospective studies, a consistent association exists between smoking and CRC. The association is stronger for rectal cancer than for colon cancer in the subset of studies that differentiated cancer by site.
authors.affiliation: Harvard School of Public Health, Boston, MA 02215, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Liang
authors.forename: Ting-Yi
authors.initials: TY
authors.lastname: Chen
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
mesh_terms: D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D012907:Smoking / Q000009:adverse effects*; D014026:Nicotiana; D014481:United States / Q000453:epidemiology