Japanese Journal of Clinical Oncology Advance Access originally published online on June 16, 2006
Japanese Journal of Clinical Oncology 2006 36(7):445-456; doi:10.1093/jjco/hyl040
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© 2006 Foundation for Promotion of Cancer Research
Cigarette Smoking and Liver Cancer Risk: An Evaluation Based on a Systematic Review of Epidemiologic Evidence among Japanese
1 Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, 2 Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, 3 Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, 4 Department of Epidemiology and Preventive Medicine, Gifu University School of Medicine, Gifu, 5 Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka and 6 Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
Received January 31, 2006; accepted March 22, 2006
Background: Emerging epidemiologic data suggest that cigarette smoking may increase the risk of primary liver cancer. We evaluated this association based on a systematic review of epidemiologic evidence among Japanese populations.
Methods: Original data were obtained from MEDLINE searches using PubMed, complemented with manual searches. The evaluation was performed in terms of the magnitude of association (‘strong’, ‘moderate’, ‘weak’ or ‘no association’) in each study and the strength of evidence (‘convincing’, ‘probable’, ‘possible’ or ‘insufficient’), together with biological plausibility as previously done by the International Agency for Research on Cancer.
Results: A total of 12 cohort studies and 11 case–control studies were identified. Nine cohort studies (two with adjustment for hepatitis B and C virus infections and seven without it) reported weak to strong positive associations between smoking and liver cancer, with dose–response relationships shown in three studies. Five case–controls studies (three with the virus adjustment and two without it) demonstrated such positive associations, with a dose–response relationship shown in only one study, while in six case–control studies, the observed associations were judged to be of the lowest magnitude or inverse due to the lack of any dose–response relationship.
Conclusion: We conclude that cigarette smoking ‘probably’ increases the risk of primary liver cancer among the Japanese. Potential confounding by hepatitis virus infection and virus–smoking interactions need to be addressed in future studies.
Key Words: systematic review • epidemiology • smoking • liver cancer • Japanese
* Research group members: Shoichiro Tsugane [principal investigator], Manami Inoue, Shizuka Sasazuki, Motoki Iwasaki, Tetsuya Otani (National Cancer Center, Tokyo); Ichiro Tsuji [since 2004], Yoshitaka Tsubono [in 2003], Taichi Shimazu (Tohoku University, Sendai); Kenji Wakai (Aichi Cancer Center, Nagoya); Chisato Nagata (Gifu University, Gifu); Tetsuya Mizoue (Kyushu University, Fukuoka); Keitaro Tanaka (Saga University, Saga). For reprints and all correspondence: Keitaro Tanaka, MD, Department of Preventive Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan; E-mail: tanakake{at}post.saga-med.ac.jp
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