title: Tobacco smoking and risk of endometriosis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Since conflicting results have been published on the role of tobacco smoking on the risk of endometriosis, we provide an up-to-date summary quantification of this potential association.
  
  
  METHODS
  We performed a PubMed/MEDLINE search of the relevant publications up to September 2014, considering studies on humans published in English. We searched the reference list of the identified papers to find other relevant publications. Case-control as well as cohort studies have been included reporting risk estimates on the association between tobacco smoking and endometriosis. 38 of the 1758 screened papers met the inclusion criteria. The selected studies included a total of 13,129 women diagnosed with endometriosis.
  
  
  METHODS
  Academic hospitals.
  
  
  METHODS
  Risk of endometriosis in tobacco smokers.
  
  
  RESULTS
  We obtained the summary estimates of the relative risk (RR) using the random effect model, and assessed the heterogeneity among studies using the χ(2) test and quantified it using the I(2) statistic. As compared to never-smokers, the summary RR were 0.96 (95% CI 0.86 to 1.08) for ever smokers, 0.95 (95% CI 0.81 to 1.11) for former smokers, 0.92 (95% CI 0.82 to 1.04) for current smokers, 0.87 (95% CI 0.70 to 1.07) for moderate smokers and 0.93 (95% CI 0.69 to 1.26) for heavy smokers.
  
  
  CONCLUSIONS
  The present meta-analysis provided no evidence for an association between tobacco smoking and the risk of endometriosis. The results were consistent considering ever, former, current, moderate and heavy smokers, and across type of endometriosis and study design.
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bravi
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy Department of Obstetrics, Gynecology and Neonatology, IRCSS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Parazzini
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy Department of Obstetrics, Gynecology and Neonatology, IRCSS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cipriani
authors.affiliation: Department of Obstetrics, Gynecology and Neonatology, IRCSS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiaffarino
authors.affiliation: Department of Obstetrics, Gynecology and Neonatology, IRCSS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Ricci
authors.affiliation: Department of Gynecology, Charitè Universitätsmedizin, Berlin, Germany.
authors.forename: Vito
authors.initials: V
authors.lastname: Chiantera
authors.affiliation: Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milan, Lombardia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Viganò
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
mesh_terms: D004715:Endometriosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D014943:Global Health; D006801:Humans; D009017:Morbidity / Q000639:trends; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods*
keywords: EPIDEMIOLOGY; GYNAECOLOGY