Breast Cancer Research and Treatment

, Volume 136, Issue 2, pp 521–533

Smoking and survival after breast cancer diagnosis: a prospective observational study and systematic review

Authors

    • Helen Diller Family Comprehensive Cancer CenterUniversity of California
    • Department of Epidemiology and BiostatisticsUniversity of California
  • Monika Izano
    • Department of Epidemiology and BiostatisticsUniversity of California
  • Dan H. Moore
    • Department of Epidemiology and BiostatisticsUniversity of California
  • Marilyn L. Kwan
    • Division of ResearchKaiser Permanente Northern California
  • Martin C. Tammemagi
    • Department of Community Health SciencesBrock University
  • Robert A. Hiatt
    • Helen Diller Family Comprehensive Cancer CenterUniversity of California
    • Department of Epidemiology and BiostatisticsUniversity of California
  • Karla Kerlikowske
    • Helen Diller Family Comprehensive Cancer CenterUniversity of California
    • Department of Epidemiology and BiostatisticsUniversity of California
  • Candyce H. Kroenke
    • Division of ResearchKaiser Permanente Northern California
  • Carol Sweeney
    • Department of MedicineUniversity of Utah
  • Laurel Habel
    • Division of ResearchKaiser Permanente Northern California
  • Adrienne Castillo
    • Division of ResearchKaiser Permanente Northern California
  • Erin Weltzien
    • Division of ResearchKaiser Permanente Northern California
  • Bette Caan
    • Division of ResearchKaiser Permanente Northern California
Epidemiology

DOI: 10.1007/s10549-012-2276-1

Cite this article as:
Braithwaite, D., Izano, M., Moore, D.H. et al. Breast Cancer Res Treat (2012) 136: 521. doi:10.1007/s10549-012-2276-1

Abstract

The association of smoking with outcomes following breast cancer prognosis is not well understood. In a cohort study called Life After Cancer Epidemiology (LACE), 2,265 women diagnosed with breast cancer were followed for a median of 12 years. We used multivariable proportional-hazards models to determine whether smoking, assessed approximately two years post-diagnosis, was associated with risk of death among these women. We also undertook a systematic review of all cohort studies to date that have examined the association between smoking and breast cancer mortality. Compared with never smokers, women who were current smokers had a twofold higher rate of dying from breast cancer [hazard ratio (HR) = 2.01, 95 % confidence interval (CI) 1.27–3.18] and an approximately fourfold higher rate of dying from competing (non-breast cancer) causes (HR = 3.84, 95 % CI 2.50–5.89). Among seven studies that met the inclusion criteria in the systematic review, three studies and our own reported significantly increased risk of breast cancer death with current smoking. We found little evidence of an association between former smoking and breast cancer mortality (HR = 1.24, 95 % CI 0.94–1.64). Consistent with findings from our prospective observational study, the systematic review of seven additional studies indicates positive association of current smoking with breast cancer mortality, but weak association with former smoking. Women who smoke following breast cancer diagnosis and treatment are at higher risk of death both from breast cancer and other causes.

Keywords

Cigarette smokingBreast cancerSurvivalCohort studySystematic review

Supplementary material

10549_2012_2276_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 27 kb)

Copyright information

© Springer Science+Business Media New York 2012