Abstract
Purpose
The association between second-hand smoke (SHS) exposure and cervical cancer (CC) risk is still unclear. The aim of this study is to provide an accurate and updated estimate of this association.
Methods
Through an original methodology to identify original publications, we conducted a systematic review and meta-analysis of all epidemiological studies published up to October 2022 evaluating the association between SHS exposure and CC risk among female non-smokers. Meta-analytic estimates were obtained using random-effects models and dose–response relationships were derived using log-linear functions.
Results
Out of 25 eligible studies, 21 were included in the meta-analysis, providing a pooled relative risk (RR) of cervical intraepithelial neoplasia (CIN) of grade 2 or higher of 1.52 (95% confidence interval, CI 1.30–1.78, 21 studies) for overall SHS exposure versus non-exposure. When restricting the analysis to invasive CC, the pooled RR was 1.42 (95% CI 1.17–1.71, 13 studies), whereas the pooled RR for CIN was 1.50 (95% CI 1.22–1.84, 6 studies). Analyzing RR by setting or source of SHS exposure resulted in significant associations with CC risk for SHS exposure at home (RR for CIN2+ 1.49, 95% CI 1.21–1.84, 14 studies), in non-specified settings (RR for CIN2+ 1.64, 95% CI 1.20–2.23, 8 studies) and from partner (RR for CIN2+ 1.55, 95% CI 1.25–1.94, 10 studies). The risk of CIN2+ significantly increased linearly with the intensity and pack-years of SHS exposure.
Conclusion
This comprehensive review and meta-analysis confirmed the association of SHS exposure with CC, further suggesting the need to raise concern about SHS exposure in the population.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
The research leading to these results has received funding from AIRC (Associazione italiana per la Ricerca sul Cancro) under MFAG (My First AIRC Grant) 2021—ID. 25840 project—P.I. Lugo Alessandra. The work of SG is partially supported by the Italian League Against Cancer (LILT, Milan). The work of GC and MCM is partially supported by the 2018 Health Research Grant by the Tuscany Region within the project ‘Attributable CAncer Burden in Tuscany: smoking, environmental and occupational risk factors, and evaluation of prevention strategies’ (ACAB).
Funding
This work was supported by AIRC under MFAG 2021—ID. 25840 project—P.I. Lugo Alessandra, Italian League Against Cancer (LILT, Milan) and Regione Toscana Bando Ricerca Salute 2018 (Project: Attributable CAncer Burden in Tuscany: smoking, environmental and occupational risk factors and evaluation of prevention strategies, ACAB)—P.I. Giulia Carreras.
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All authors contributed to the study conception and design. Material preparation was performed by GC and AL. Data collection was performed by MCM and CM. Analysis was performed by MCM. The first draft of the manuscript was written by GC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Malevolti, M.C., Maci, C., Lugo, A. et al. Second-hand smoke exposure and cervical cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 149, 14353–14363 (2023). https://doi.org/10.1007/s00432-023-04841-9
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DOI: https://doi.org/10.1007/s00432-023-04841-9