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The association of active smoking with multiple cancers: national census-cancer registry cohorts with quantitative bias analysis

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An Erratum to this article was published on 22 October 2013

Abstract

Purposes

(1) Determine the association of multiple cancers with smoking, focusing on cancers with an uncertain association; and (2) illustrate quantitative bias analysis as applied to registry data, to adjust for misclassification of smoking and residual confounding by alcohol and obesity.

Methods

New Zealand 1981 and 1996 censuses, including smoking questions, were linked to cancer registry data giving 14.8 million person-years of follow-up. Rate ratios (RR) for current versus never smokers, adjusting for age, sex, ethnicity and socioeconomic factors were calculated and then subjected to quantitative bias analysis.

Results

RR estimates for lung, larynx (including ear and nasosinus), and bladder cancers adjusted for measured confounders and exposure misclassification were 9.28 (95 % uncertainty interval 8.31–10.4), 6.14 (4.55–8.30), and 2.22 (1.94–2.55), respectively. Moderate associations were found for cervical (1.82; 1.51–2.20), kidney (1.29; 1.07–1.56), liver cancer (1.75; 1.37–2.24; European only), esophageal (2.14; 1.73–2.65), oropharyngeal (2.30; 1.94–2.72), pancreatic (1.68; 1.44–1.96), and stomach cancers (1.42; 1.22–1.66). Protective associations were found for endometrial (0.67; 0.56–0.79) and melanoma (0.72; 0.65–0.81), and borderline association for thyroid (0.76; 0.58–1.00), colon (0.89; 0.81–0.98), and CML (0.66; 0.44–0.99). Remaining cancers had near null associations. Adjustment for residual confounding suggested little impact, except the RRs for endometrial, kidney, and esophageal cancers were slightly increased, and the oropharyngeal and liver (European/other) RRs were decreased.

Conclusions

Our large study confirms the strong association of smoking with many cancers and strengthens the evidence for protective associations with thyroid cancer and melanoma. With large data sets, considering and adjusting for residual systematic error is as important as quantifying random error.

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Acknowledgments

Access to the data used in this study was provided by Statistics New Zealand under conditions designed to give effect to the security and confidentiality provisions of the Statistics Act 1975. The results presented in this study are the work of the authors, not Statistics New Zealand.

Ethical standards

The Wellington Ethics Committee granted ethics approval for CancerTrends (Ref 04/10/093).

Funding

The authors received funds from Health Research Council of New Zealand.

Conflict of interest

JJB is founder and owner of Epigear, which sells the Ersatz software used in the analysis.

Author information

Authors and Affiliations

  1. Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand

    Tony Blakely, Rachel H. Foster, June Atkinson, Diana Sarfati & Richard Edwards

  2. Centre for Burden of Disease and Cost Effectiveness, School of Population Health, University of Queensland, Brisbane, Australia

    Jan J. Barendregt

  3. Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, Scotland, UK

    Sarah Hill

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  1. Tony Blakely
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Correspondence to Tony Blakely.

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Blakely, T., Barendregt, J.J., Foster, R.H. et al. The association of active smoking with multiple cancers: national census-cancer registry cohorts with quantitative bias analysis. Cancer Causes Control 24, 1243–1255 (2013). https://doi.org/10.1007/s10552-013-0204-2

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  • DOI: https://doi.org/10.1007/s10552-013-0204-2

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