title: Quantification of the smoking-associated cancer risk with rate advancement periods: meta-analysis of individual participant data from cohorts of the CHANCES consortium.
abstract: BACKGROUND
  Smoking is the most important individual risk factor for many cancer sites but its association with breast and prostate cancer is not entirely clear. Rate advancement periods (RAPs) may enhance communication of smoking related risk to the general population. Thus, we estimated RAPs for the association of smoking exposure (smoking status, time since smoking cessation, smoking intensity, and duration) with total and site-specific (lung, breast, colorectal, prostate, gastric, head and neck, and pancreatic) cancer incidence and mortality.
  
  
  METHODS
  This is a meta-analysis of 19 population-based prospective cohort studies with individual participant data for 897,021 European and American adults. For each cohort we calculated hazard ratios (HRs) for the association of smoking exposure with cancer outcomes using Cox regression adjusted for a common set of the most important potential confounding variables. RAPs (in years) were calculated as the ratio of the logarithms of the HRs for a given smoking exposure variable and age. Meta-analyses were employed to summarize cohort-specific HRs and RAPs.
  
  
  RESULTS
  Overall, 140,205 subjects had a first incident cancer, and 53,164 died from cancer, during an average follow-up of 12 years. Current smoking advanced the overall risk of developing and dying from cancer by eight and ten years, respectively, compared with never smokers. The greatest advancements in cancer risk and mortality were seen for lung cancer and the least for breast cancer. Smoking cessation was statistically significantly associated with delays in the risk of cancer development and mortality compared with continued smoking.
  
  
  CONCLUSIONS
  This investigation shows that smoking, even among older adults, considerably advances, and cessation delays, the risk of developing and dying from cancer. These findings may be helpful in more effectively communicating the harmful effects of smoking and the beneficial effect of smoking cessation.
authors.affiliation: Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany.|Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Ordóñez-Mena
authors.affiliation: Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany.|Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
authors.forename: Ben
authors.initials: B
authors.lastname: Schöttker
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Mons
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Mazda
authors.initials: M
authors.lastname: Jenab
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Heinz
authors.initials: H
authors.lastname: Freisling
authors.affiliation: Department of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.|Division of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom.|Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Bas
authors.initials: B
authors.lastname: Bueno-de-Mesquita
authors.affiliation: UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, UK.
authors.forename: Mark G
authors.initials: MG
authors.lastname: O'Doherty
authors.affiliation: UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Scott
authors.affiliation: UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Bruno H
authors.initials: BH
authors.lastname: Stricker
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: de Keyser
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Rikje
authors.initials: R
authors.lastname: Ruiter
authors.affiliation: Department of Public Health and Clinical Medicine, Cardiology, and Heart Center, Umeå University, Umeå, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Söderberg
authors.affiliation: National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Jousilahti
authors.affiliation: National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Kuulasmaa
authors.affiliation: Nutritional Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD, USA.
authors.forename: Neal D
authors.initials: ND
authors.lastname: Freedman
authors.affiliation: Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: Lisette Cpgm
authors.initials: LC
authors.lastname: de Groot
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Kampman
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Niclas
authors.initials: N
authors.lastname: Håkansson
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Nicola
authors.initials: N
authors.lastname: Orsini
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Alicja
authors.initials: A
authors.lastname: Wolk
authors.affiliation: Nutritional Research, Department of Public Health and Clinical Medicine, and Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden.
authors.forename: Lena Maria
authors.initials: LM
authors.lastname: Nilsson
authors.affiliation: Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Jagiellonian University Medical College, Faculty of Health Sciences, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pająk
authors.affiliation: Institute of Internal and Preventive Medicine, Novosibirsk, Russia.
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.affiliation: National Institute of Public Health, Prague, Czech Republic.
authors.forename: Růžena
authors.initials: R
authors.lastname: Kubínová
authors.affiliation: Institute of Cardiology of Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Abdonas
authors.initials: A
authors.lastname: Tamosiunas
authors.affiliation: Department Epidemiology and Public Health, University College London, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: Michail
authors.initials: M
authors.lastname: Katsoulis
authors.affiliation: University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, Athens, Greece.
authors.forename: Philippos
authors.initials: P
authors.lastname: Orfanos
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany. h.brenner@dkfz.de.|Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany. h.brenner@dkfz.de.|German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. h.brenner@dkfz.de.|Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. h.brenner@dkfz.de.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000628:therapy; D016540:Smoking Cessation / Q000706:statistics & numerical data*
keywords: Cancer; Cohort; Incidence; Meta-analysis; Mortality; Smoking