Breast Cancer Research and Treatment

, Volume 100, Issue 3, pp 293–299 | Cite as

Cigarette smoking and breast cancer risk: update of a prospective cohort study

  • Yan CuiEmail author
  • Anthony B. Miller
  • Thomas E. Rohan


The results of epidemiologic studies of the association between cigarette smoking and breast cancer risk have been inconsistent. In spite of the inconsistency, several recent analyses have suggested an increased risk of breast cancer among women who smoked cigarettes for a long period of time and/or who started smoking before their first pregnancy. Our analyses were conducted in the Canadian National Breast Screening Study (NBSS), a multi-center, randomized controlled trial of mammographic screening for breast cancer among 89,835 women aged 40–59 at enrollment. Participants were recruited between 1980 and 1985 from the general Canadian population. During an average of 16.1 years of follow-up, we identified 4,445 incident breast cancer cases. We used the Cox proportional hazards models to estimate multivariate rate ratios (RRs) and 95% confidence limits (CLs) for the association between cigarette smoking and breast cancer. We found that breast cancer risk was associated with the duration (40 years versus 0: RR = 1.50, 95% CL = 1.19, 1.89), intensity (40 cigarettes per day versus 0: RR = 1.20, 95% CL = 1.00, 1.44), cumulative exposure (40 pack-years versus 0: RR = 1.17, 95% CL = 1.02, 1.34), and latency of cigarette smoking (40 years since commencement of smoking versus 0: RR = 1.28, 95% CL = 1.06, 1.55), as well as smoking initiation before a first full-term pregnancy (among parous women, more than 5 years of smoking versus 0: RR = 1.13, 95% CL = 1.01–1.25). These results strongly suggest that cigarette smoking might play an important role in the etiology of breast cancer, particularly when initiated relatively early in life and when engaged in for long durations.


Smoking Breast cancer Risk Cohort study 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.



We are indebted to the study participants for their dedication and commitment.


  1. 1.
    Conway K, Edmiston SN, Cui L, Drouin SS, Pang J, He M, Tse CK, Geradts J, Dressler L, Liu ET, Millikan R, Newman B (2002) Prevalence and spectrum of p53 mutations associated with smoking in breast cancer. Cancer Res 62(7):1987–1995PubMedGoogle Scholar
  2. 2.
    Yamasaki E, Ames BN (1977) Concentration of mutagens from urine by absorption with the nonpolar resin XAD-2: cigarette smokers have mutagenic urine. Proc Natl Acad Sci USA 74(8):3555–3559PubMedCrossRefGoogle Scholar
  3. 3.
    Shu HP, Bymun EN (1983) Systemic excretion of benzo(a)pyrene in the control and microsomally induced rat: the influence of plasma lipoproteins and albumin as carrier molecules. Cancer Res 43(2):485–490PubMedGoogle Scholar
  4. 4.
    MacNicoll AD, Easty GC, Neville AM, Grover PL, Sims P (1980) Metabolism and activation of carcinogenic polycyclic hydrocarbons by human mammary cells. Biochem Biophys Res Commun 95(4):1599–1606PubMedCrossRefGoogle Scholar
  5. 5.
    Faraglia B, Chen SY, Gammon MD, Zhang Y, Teitelbaum SL, Neugut AI, Ahsan H, Garbowski GC, Hibshoosh H, Lin D, Kadlubar FF, Santella RM (2003) Evaluation of 4-aminobiphenyl-DNA adducts in human breast cancer: the influence of tobacco smoke. Carcinogenesis 24(4):719–725PubMedCrossRefGoogle Scholar
  6. 6.
    Firozi PF, Bondy ML, Sahin AA, Chang P, Lukmanji F, Singletary ES, Hassan MM, Li D (2002) Aromatic DNA adducts and polymorphisms of CYP1A1, NAT2, and GSTM1 in breast cancer. Carcinogenesis 23(2):301–306PubMedCrossRefGoogle Scholar
  7. 7.
    Perera FP, Estabrook A, Hewer A, Channing K, Rundle A, Mooney LA, Whyatt R, Phillips DH (1995) Carcinogen-DNA adducts in human breast tissue. Cancer Epidemiol Biomarkers Prev 4(3):233–238PubMedGoogle Scholar
  8. 8.
    Jensen J, Christiansen C, Rodbro P (1985) Cigarette smoking, serum estrogens, and bone loss during hormone-replacement therapy early after menopause. N Engl J Med 313(16):973–975PubMedCrossRefGoogle Scholar
  9. 9.
    Jensen J, Christiansen C (1988) Effects of smoking on serum lipoproteins and bone mineral content during postmenopausal hormone replacement therapy. Am J Obstet Gynecol 159(4):820–825PubMedGoogle Scholar
  10. 10.
    Baron JA, La Vecchia C, Levi F (1990) The antiestrogenic effect of cigarette smoking in women. Am J Obstet Gynecol 162(2):502–514PubMedGoogle Scholar
  11. 11.
    MacMahon B, Trichopoulos D, Cole P, Brown J (1982) Cigarette smoking and urinary estrogens. N Engl J Med 307(17):1062–1065PubMedCrossRefGoogle Scholar
  12. 12.
    Clemons M, Goss P (2001) Estrogen and the risk of breast cancer. N Engl J Med 344(4):276–285PubMedCrossRefGoogle Scholar
  13. 13.
    Terry PD, Rohan TE (2002) Cigarette smoking and the risk of breast cancer in women: a review of the literature. Cancer Epidemiol Biomarkers Prev 11(10 Pt 1):953–971PubMedGoogle Scholar
  14. 14.
    Terry PD, Miller AB, Rohan TE (2002) Cigarette smoking and breast cancer risk: a long latency period? Int J Cancer 100(6):723–728PubMedCrossRefGoogle Scholar
  15. 15.
    Olson JE, Vachon CM, Vierkant RA, Sweeney C, Limburg PJ, Cerhan JR, Sellers TA (2005) Prepregnancy exposure to cigarette smoking and subsequent risk of postmenopausal breast cancer. Mayo Clin Proc 80(11):1423–1428PubMedCrossRefGoogle Scholar
  16. 16.
    Li CI, Malone KE, Daling JR (2005) The relationship between various measures of cigarette smoking and risk of breast cancer among older women 65–79 years of age (United States). Cancer Causes Control 16(8):975–985PubMedCrossRefGoogle Scholar
  17. 17.
    Band PR, Le ND, Fang R, Deschamps M (2002): Carcinogenic and endocrine disrupting effects of cigarette smoke and risk of breast cancer. Lancet 360(9339):1044–1049PubMedCrossRefGoogle Scholar
  18. 18.
    Gram IT, Braaten T, Terry PD, Sasco AJ, Adami HO, Lund E, Weiderpass E (2005) Breast cancer risk among women␣who start smoking as teenagers. Cancer Epidemiol Biomarkers Prev 14(1):61–66PubMedGoogle Scholar
  19. 19.
    Miller AB, Baines CJ, To T, Wall C (1992) Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. CMAJ 147(10):1477–1488PubMedGoogle Scholar
  20. 20.
    Miller AB, Baines CJ, To T, Wall C (1992) Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years. CMAJ 147(10): 1459–1476PubMedGoogle Scholar
  21. 21.
    Manjer J, Johansson R, Lenner P (2004) Smoking is associated with postmenopausal breast cancer in women with high levels of estrogens. Int J Cancer 112(2):324–328PubMedCrossRefGoogle Scholar
  22. 22.
    Lash TL, Aschengrau A (2002) A null association between active or passive cigarette smoking and breast cancer risk. Breast Cancer Res Treat 75(2):181–184PubMedCrossRefGoogle Scholar
  23. 23.
    Kropp S, Chang-Claude J (2002) Active and passive smoking and risk of breast cancer by age 50 years among German women. Am J Epidemiol 156(7):616–626PubMedCrossRefGoogle Scholar
  24. 24.
    Al-Delaimy WK, Cho E, Chen WY, Colditz G, Willet WC (2004) A prospective study of smoking and risk of breast cancer in young adult women. Cancer Epidemiol Biomarkers Prev 13(3):398–404PubMedGoogle Scholar
  25. 25.
    Reynolds P, Hurley S, Goldberg DE, Anton-Culver H, Bernstein L, Deapen D, Horn-Ross PL, Peel D, Pinder R, Ross RK, West D, Wright WE, Ziogas A (2004) Active smoking, household passive smoking, and breast cancer: evidence from the California Teachers Study. J Natl Cancer Inst 96(1):29–37PubMedCrossRefGoogle Scholar
  26. 26.
    Lawlor DA, Ebrahim S, Smith GD (2004) Smoking before the birth of a first child is not associated with increased risk of breast cancer: findings from the British Womenȁ9s Heart and Health Cohort Study and a meta-analysis. Br J Cancer 91(3):512–518PubMedCrossRefGoogle Scholar
  27. 27.
    Russo J, Russo IH (1995) The etiopathogenesis of breast cancer prevention. Cancer Lett 90(1):81–89PubMedCrossRefGoogle Scholar
  28. 28.
    Russo J, Rivera R, Russo IH (1992) Influence of age and parity on the development of the human breast. Breast Cancer Res Treat 23(3):211–218PubMedCrossRefGoogle Scholar
  29. 29.
    Russo J, Hu YF, Yang X, Russo IH (2000) Developmental, cellular, and molecular basis of human breast cancer. J Natl Cancer Inst Monogr 27:17–37Google Scholar
  30. 30.
    Friedenreich CM (2001) Physical activity and cancer prevention: from observational to intervention research. Cancer Epidemiol Biomarkers Prev 10(4):287–301PubMedGoogle Scholar
  31. 31.
    McTiernan A, Kooperberg C, White E, Wilcox S, Coates R, Adams-Campbell LL, Woods N, Ockene J (2003) Recreational physical activity and the risk of breast cancer in postmenopausal women: the Womenȁ9s Health Initiative Cohort Study. JAMA 290(10):1331–1336PubMedCrossRefGoogle Scholar
  32. 32.
    Johnson KC (2005) Accumulating evidence on passive and active smoking and breast cancer risk. Int J Cancer 117(4):619–628PubMedCrossRefGoogle Scholar
  33. 33.
    Wartenberg D, Calle EE, Thun MJ, Heath CW Jr, Lally C, Woodruff T (2000) Passive smoking exposure and female breast cancer mortality. J Natl Cancer Inst 92(20):1666–1673PubMedCrossRefGoogle Scholar
  34. 34.
    Egan KM, Stampfer MJ, Hunter D, Hankinson S, Rosner BA, Holmes M, Willett WC, Colditz GA (2002) Active and passive smoking in breast cancer: prospective results from the Nursesȁ9 Health Study. Epidemiology 13(2):138–145PubMedCrossRefGoogle Scholar
  35. 35.
    Hanaoka T, Yamamoto S, Sobue T, Sasaki S, Tsugane S (2005) Active and passive smoking and breast cancer risk in middle-aged Japanese women. Int J Cancer 114(2):317–322PubMedCrossRefGoogle Scholar
  36. 36.
    Johnson KC, Hu J, Mao Y (2000) Passive and active smoking and breast cancer risk in Canada, 1994–97. The Canadian Cancer Registries Epidemiology Research Group. Cancer Cause Control 11(3):211–221CrossRefGoogle Scholar
  37. 37.
    Rothman KL, Greenland S (1998) Modern epidemiology, 2nd edn. Lippincott-Raven, PhiladelphiaGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  1. 1.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA
  2. 2.Department of Public Health SciencesUniversity of TorontoTorontoCanada

Personalised recommendations