3.5.12.1 Hodgkin lymphoma
Studies of Hodgkin lymphoma and smoking reviewed by the IARC reported weak or no association.1 A number of studies indicate a slightly higher risk for people who smoke, but few have adjusted for potential confounding factors that are likely to be alternative explanations for the apparent higher risks for smokers. One study published in 2009 found that people who smoked for 25 years or more were at increased risk of Hodgkin lymphoma, after adjusting for some potential confounding factors.2
3.5.12.2 Prostate cancer
Both the IARC in 2004 and the US Surgeon General in 2014 concluded that the evidence did not support a causal relationship between smoking and prostate cancer diagnosis.1,3 A meta-analysis of cohort studies found no increase in risk of prostate cancer overall in smokers, but did find a slightly increased risk associated with higher daily consumption of cigarettes or greater pack-years of smoking.4 A review of the epidemiologic evidence found that smokers are not at appreciably higher risk of developing prostate cancer.5
Some studies have indicated a slightly lower risk of prostate cancer diagnosis in men who smoke compared to non-smokers.6 A large prospective US cohort study, involving over a quarter of a million men, found that current and former smokers may be at decreased risk of being diagnosed with prostate cancer.7 Prostate cancer diagnosis rates are strongly influenced by the level of PSA testing in the community.8 It is likely that a lower uptake of regular PSA blood tests to find prostate cancer early in men who smoke is responsible for this observation.6,9,10 Therefore, smoking is probably not the cause of this slightly lower risk of prostate cancer.
The US Surgeon General concluded that the evidence suggests that smokers have a higher mortality rate from prostate cancer than non-smokers, as well as a higher risk of advanced-stage disease, less well-differentiated cancer, and a higher risk of disease progression.3 The elevated risk of death from prostate cancer noted by the US Surgeon General has also been reported in a meta-analysis4 and other studies.7
Prostate cancer has a high survival rate as more than half of cases are localised and treatable with surgery or radiotherapy. However, some forms of the disease are more aggressive, with a high likelihood of progression to a fatal metastatic stage. There is evidence that smoking increases the risks of a more aggressive form of prostate cancer.3 A 2009 review concluded that smoking is likely to be a risk factor for prostate cancer progression. People who smoked had more advanced disease at diagnosis, a worse prognosis and a greater risk of dying from prostate cancer.5 A meta-analysis of smoking status in men with localised prostate cancer found that those who smoked were at higher risk of their cancer returning after initial treatment, spreading by metastasis and of dying from prostate cancer.11 A study from Japan indicated that people who currently smoked were more likely than non-smokers to have their prostate cancer reoccur after surgery plus radiotherapy treatment.12
Smoking may increase the risk of prostate cancer spreading and mortality by changing the nature of the cancer cells. Two studies have shown that men with prostate cancer who smoke have distinct patterns of gene variants in their prostate cancer cells.13,14
3.5.12.3 Skin cancers
Melanoma is a dangerous form of skin cancer with a poor survival rate in people who have late-stage disease. People who currently smoke appear to have a slightly reduced risk of getting melanoma.15 Whether smoking is causing this risk reduction, or it is caused by other differences between people who do and do not smoke, is currently unknown.
There is some evidence that people who smoke have a greater risk of dying from melanoma. In one study, people diagnosed with early-stage (stage I or II) melanoma had greater risk of dying from melanoma if they currently smoked, compared to never smokers.16 The risks were even higher for people who smoked 20 or more cigarettes per day. In people diagnosed with late-stage (stage IV) melanoma, smoking was also associated with a greater risk of dying of melanoma.17
3.5.12.4 Cancer of unknown primary origin
Cancer of unknown primary (CUP) origin is any cancer that has spread by metastasis, but the site of tumour origin remains unidentified. Many different types of cancer are included under the definition of CUP. A case–control study that adjusted for alcohol intake and other potential confounding factors showed that people who currently smoked had a 1.6-fold increased risk of getting CUP compared to never smokers.18 Australian data show that people (aged 45 and over) who smoke have a 3.3-fold higher risk of CUP compared to non-smokers of similar ages.19 Given the lack of information on the nature and causes of CUP, it is currently unknown whether smoking is a cause of some forms of CUP.
3.5.12.5 Gallbladder and bile duct cancers
The gallbladder is a small organ of the digesting system that serves as a temporary storage for digestive fluids produced by the liver, collectively known as bile. A meta-analysis has found a 1.3-fold increased risk of gallbladder cancer for people who smoke compared to never smokers.20 There was also dose response whereby the risk of gallbladder cancer increased with both intensity and duration of smoking. No evidence of an increase in risk was found for former smokers.20 A more recent study has also found that the risk of gallbladder cancer was higher for people who smoke heavily.21
One large prospective study has assessed the risk of cancer of the intrahepatic bile duct (which moves bile out of the liver) for people who smoke.22 The results suggest that there is an increased risk of intrahepatic bile duct cancer in men who smoke (there were too few women who smoked in this Japanese cohort).22
3.5.12.6 Second primary cancer
A second primary cancer is a new cancer diagnosed in a person who has already has a cancer diagnosis. This is different from the spreading of a primary cancer to other regions by metastasis.
A meta-analysis of studies published in 2022 determined that people who currently smoke had a 2.8-fold increased risk, compared to never smokers, of a smoking-related second primary cancer (defined as a lung, upper head and neck, stomach, oesophagus, pancreas, colorectum, liver, kidney, ureter or bladder cancer, or acute myeloid leukaemia).23 People who had quit smoking had a 1.4-fold increased risk of a second primary cancer in this study.23 Studies have found that people who smoke have an increased risk of a second primary cancer after initial diagnosis with lung cancer,24 breast cancer,25,26 and some other types of cancers.23 Smoking at greater intensity or duration is associated with an increased risk of a second primary cancer after lung cancer24,27 and smoking cessation after initial diagnosis reduces this risk.24,28
3.5.12.7 Other cancers
Hepatoblastoma (a liver cancer in babies)
A 2009 review by the International Agency for Research in Cancer (IARC) concluded that children born of parents who smoke during pregnancy are at a significantly higher risk of hepatoblastoma, a rare childhood cancer of the liver. See Section 4.17.9 for more details.
Blood cell cancers
Apart from acute myeloid leukaemia which is a well-established health risk of smoking (see Sub-Section 3.5.6) preliminary evidence indicates that people who smoke have a higher risk of two further types of cancer of the blood cells: chronic myeloid leukaemia29 and follicular lymphoma.30 However, further evidence from prospective studies is necessary to confirm these results.
Two pooled analysis studies have found no evidence for an association of smoking and multiple myeloma.31,32
Glioma (a type of brain cancer)
Two meta-analyses have found no evidence of an association between current smoking and the brain cancer glioma.33,34
Related reading
Test your knowledge
References
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3. US Department of Health and Human Services. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2014. Available from: https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf.
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16. Jackson KM, Jones PC, Fluke LM, Fischer TD, Thompson JF, et al. Smoking status and survival in patients with early-stage primary cutaneous melanoma. JAMA Network Open, 2024; 7(2):e2354751. Available from: https://www.ncbi.nlm.nih.gov/pubmed/38319662
17. Mattila K, Vihinen H, Karlsson A, Minn H, Vihinen P, et al. Smoking is an independent marker of poor prognosis in cutaneous melanoma. Acta Dermato-Venereologica, 2023; 103:adv00860. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36748330
18. Hermans K, van den Brandt PA, Loef C, Jansen RLH, and Schouten LJ. Alcohol consumption, cigarette smoking and cancer of unknown primary risk: Results from the Netherlands Cohort Study. International Journal of Cancer, 2021; 148(7):1586-97. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33022785
19. Weber MF, Sarich PEA, Vaneckova P, Wade S, Egger S, et al. Cancer incidence and cancer death in relation to tobacco smoking in a population-based Australian cohort study. International Journal of Cancer, 2021; 149(5):1076-88. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34015143
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