Malevolti Maria Chiara, Maci Caterina, Lugo Alessandra, Possenti Irene, Gallus Silvano, Gorini Giuseppe, Carreras Giulia
Oncologic Network, Prevention and Research Institute (ISPRO), Via Cosimo il Vecchio 2, 50139, Florence, Italy.
Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
J Cancer Res Clin Oncol. 2023 Nov;149(15):14353-14363. doi: 10.1007/s00432-023-04841-9. Epub 2023 Jul 30.
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.
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.
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.
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.
二手烟暴露与宫颈癌风险之间的关联仍不明确。本研究的目的是对这种关联进行准确且最新的评估。
通过一种识别原始出版物的原始方法，我们对截至2022年10月发表的所有评估女性非吸烟者二手烟暴露与宫颈癌风险之间关联的流行病学研究进行了系统综述和荟萃分析。使用随机效应模型获得荟萃分析估计值，并使用对数线性函数推导剂量反应关系。
在25项符合条件的研究中，21项被纳入荟萃分析，总体二手烟暴露与未暴露相比，二级或更高级别宫颈上皮内瘤变（CIN）的合并相对风险（RR）为1.52（95%置信区间，CI 1.30 - 1.78，21项研究）。当将分析限制在浸润性宫颈癌时，合并RR为1.42（95%CI 1.17 - 1.71，13项研究），而CIN的合并RR为1.50（95%CI 1.22 - 1.84，6项研究）。按二手烟暴露的环境或来源分析RR，结果显示在家中暴露于二手烟与宫颈癌风险存在显著关联（CIN2+的RR为1.49，95%CI 1.21 - 1.84，14项研究），在未明确的环境中（CIN2+的RR为1.64，95%CI 1.20 - 2.23，8项研究）以及来自伴侣的二手烟暴露（CIN2+的RR为1.55，95%CI 1.25 - 1.94，10项研究）。CIN2+的风险随着二手烟暴露强度和包年数显著线性增加。
这项全面的综述和荟萃分析证实了二手烟暴露与宫颈癌之间的关联，进一步表明有必要提高人群对二手烟暴露的关注。
