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Impact of cigarette smoking on cancer risk in the European prospective investigation into cancer and nutrition study

Agudo, Antonio and Bonet, Catalina and Travier, Noémie and González, Carlos A and Vineis, Paolo and Bueno-de-Mesquita, H Bas and Trichopoulos, Dimitrios and Boffetta, Paolo and Clavel-Chapelon, Françoise and Boutron-Ruault, Marie-Christine and Kaaks, Rudolf and Lukanova, Annekatrin and Schütze, Madlen and Boeing, Heiner and Tjonneland, Anne and Halkjaer, Jytte and Overvad, Kim and Dahm, Christina C and Quirós, J Ramon and Sánchez, María-José and Larrañaga, Nerea and Navarro, Carmen and Ardanaz, Eva and Khaw, Kay-Tee and Wareham, Nicholas J and Key, Timothy J and Allen, Naomi E and Trichopoulou, Antonia and Lagiou, Pagona and Palli, Domenico and Sieri, Sabina and Tumino, Rosario and Panico, Salvatore and Boshuizen, Hendriek and Büchner, Frederike L and Peeters, Petra H M and Borgquist, Signe and Almquist, Martin and Hallmans, Göran and Johansson, Ingegerd and Gram, Inger T and Lund, Eiliv and Weiderpass, Elisabete and Romieu, Isabelle and Riboli, Elio (2012) Impact of cigarette smoking on cancer risk in the European prospective investigation into cancer and nutrition study. Journal of Clinical Oncology, 30 (36). pp. 4550-4557.

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Abstract

Purpose: Our aim was to assess the impact of cigarette smoking on the risk of the tumors classified by the International Agency for Research on Cancer as causally associated with smoking, referred to as tobacco-related cancers (TRC). Methods: The study population included 441,211 participants (133,018 men and 308,193 women) from the European Prospective Investigation Into Cancer and Nutrition. We investigated 14,563 participants who developed a TRC during an average follow-up of 11 years. The impact of smoking cigarettes on cancer risk was assessed by the population attributable fraction (AFp), calculated using the adjusted hazard ratios and 95% CI for current and former smokers, plus either the prevalence of smoking among cancer cases or estimates from surveys in representative samples of the population in each country. Results: The proportion of all TRC attributable to cigarette smoking was 34.9% (95% CI, 32.5 to 37.4) using the smoking prevalence among cases and 36.2% (95% CI, 33.7 to 38.6) using the smoking prevalence from the population. The AFp were above 80% for cancers of the lung and larynx, between 20% and 50% for most respiratory and digestive cancers and tumors from the lower urinary tract, and below 20% for the remaining TRC. Conclusion: Using data on cancer incidence for 2008 and our AFp estimates, about 270,000 new cancer diagnoses per year can be considered attributable to cigarette smoking in the eight European countries with available data for both men and women (Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Sweden, Denmark).