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Epidemiology

Exposure to second-hand smoke and breast cancer risk in non-smoking women: a comprehensive systematic review and meta-analysis

British Journal of Cancer (2024)Cite this article

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Abstract

Through the use of an innovative method to identify original publications, we conducted a meta-analysis of all epidemiological studies evaluating the association between second-hand smoke (SHS) exposure and breast cancer risk among female non-smokers published in English up to October 2022. Pooled relative risks (RR) were obtained through the use of random-effects models. Dose–response relationships were derived using log-linear functions. Out of 73 identified eligible studies, 63 original articles were included in the meta-analysis. The pooled RR for breast cancer for overall exposure to SHS was 1.24 (95% confidence interval, CI, 1.15–1.34, number of articles, n = 52). Regarding the setting of exposure, RRs were 1.17 (95% CI 1.08–1.27, n = 37) for SHS exposure at home, 1.03 (95% CI 0.98–1.08, n = 15) at the workplace, 1.24 (95% CI 1.11–1.37, n = 16) at home or workplace, and 1.45 (95% CI 1.16–1.80, n = 13) for non-specified settings. The risk of breast cancer increased linearly with higher duration (RR 1.29; 95% CI 1.04–1.59 for 40 years of SHS exposure, n = 12), intensity (RR 1.38; 95% CI 1.14–1.67 for 20 cigarettes of SHS exposure per day, n = 6), and pack-years (RR 1.50; 95% CI 0.92–2.45 for 40 SHS pack-years, n = 6) of SHS exposure. This meta-analysis shows a statistically significant excess risk of breast cancer in women exposed to SHS.

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Fig. 1: Flowchart for the seletion of articles.
Fig. 2: Forest plot of the overall analysis* and pooled relative risk (RR) of breast cancer for women exposed to second-hand smoke (SHS) compared with non-exposed women by setting or source of exposure.
Fig. 3: Relative risk (RR) for the dose–response relationships between second-hand smoke (SHS) exposure duration, intensity, and pack-years and the risk of breast cancer:

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Acknowledgements

The authors thank Elisa Borroni for her contribution in the screening process.

Funding

The research leading to these results has received funding from AIRC under MFAG 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).

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Authors and Affiliations

  1. Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Irene Possenti, Marco Scala, Cristina Bosetti, Silvano Gallus & Alessandra Lugo

  2. Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy

    Giulia Carreras, Giuseppe Gorini, Caterina Maci & Maria Chiara Malevolti

  3. Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milan, Italy

    Vincenzo Bagnardi

  4. Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

    Anna Odone

  5. Faculty Health, Medicine and Life Sciences, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands

    Luc Smits

  6. Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy

    Claudia Specchia

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Contributions

Irene Possenti: methodology, data curation, investigation, formal analysis, software, visualisation and writing —original draft; Marco Scala: methodology, data curation, investigation, software and writing—review and editing; Giulia Carreras: funding acquisition, supervision and writing—review and editing; Vincenzo Bagnardi: methodology and writing—review and editing; Cristina Bosetti: methodology and writing—original draft; Giuseppe Gorini: writing—review and editing; Caterina Maci: writing—review and editing; Maria Chiara Malevolti: writing—review and editing; Anna Odone: supervision and writing—review and editing; Luc Smits: supervision and writing—review and editing; Claudia Specchia: writing—review and editing; Silvano Gallus: conceptualisation, methodology, funding acquisition, visualisation, supervision and writing—original draft; Alessandra Lugo: conceptualisation, methodology, formal analysis, software, funding acquisition, project administration, visualisation, supervision and writing—original draft.

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Possenti, I., Scala, M., Carreras, G. et al. Exposure to second-hand smoke and breast cancer risk in non-smoking women: a comprehensive systematic review and meta-analysis. Br J Cancer (2024). https://doi.org/10.1038/s41416-024-02732-5

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