Abstract
BackgroundSmoking is one of the well-established risk factors for gastric cancer incidence, yet whether men are more or equally susceptible to gastric cancer due to smoking compared with women is a matter of controversy. The aim of this study was to investigate and compare the effect of sex on gastric cancer risk associated with smoking.MethodsWe conducted a systemic literature search in MEDLINE, EMBASE, and the Cochrane CENTRAL databases to identify studies published from inception to December 2018. We included prospective observational studies which reported effect estimates with 95% confidence intervals (CIs) for associations of current or former smokers with the incidence of gastric cancer by sex. We calculated the ratio of relative risk (RRR) with corresponding 95% CI based on sex-specific effect estimates for current or former smokers versus non-smokers on the risk of gastric cancer.ResultsWe included 10 prospective studies with 3,381,345 participants in our analysis. Overall, the summary RRR (male to female) for gastric cancer risk in current smokers was significantly increased compared with non-smokers (RRR: 1.30; 95% CI: 1.05–1.63; P = 0.019). Furthermore, there was no significant sex difference for the association between former smokers and gastric cancer risk (RRR: 1.20; 95% CI: 0.92–1.55; P = 0.178). However, the result of sensitivity analysis indicated the pooled result was not stable, which was altered by excluding a nested case-control study (RRR: 1.31; 95% CI: 1.10–1.57; P = 0.002).ConclusionThis systematic review showed a potential sex difference association between current smokers and the risk of gastric cancer. The sex differential in smokers can give important clues for the etiology of gastric cancers and should be examined in further studies.
Highlights
Smoking is one of the well-established risk factors for gastric cancer incidence, yet whether men are more or susceptible to gastric cancer due to smoking compared with women is a matter of controversy
We could conclude that male former smokers had a significantly increased risk of gastric cancer over non-smokers compared to female former smokers (RRR: 1.31; 95% confidence intervals (CIs): 1.10–1.57; P = 0.002; Table 2)
The results of our study suggested that male current smokers had a significantly higher risk of gastric cancer compared to women, while no sex differences were found for the association between former smokers and gastric cancer risk
Summary
Smoking is one of the well-established risk factors for gastric cancer incidence, yet whether men are more or susceptible to gastric cancer due to smoking compared with women is a matter of controversy. The aim of this study was to investigate and compare the effect of sex on gastric cancer risk associated with smoking. Several studies have suggested that smoking was associated with a higher risk of gastric cancer and a previous meta-analysis considered smoking to be most important behavioral risk factor for. Clarifying the association of smoking status with the risk of gastric cancer in men compared with women is important since the prevalence of smoking in women is increasing and tobacco use is seen as a “contemporary epidemic” in women in the United States and many other countries. We further evaluated the sex difference according to the baseline characteristics of the participants
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