Breast Cancer Research and Treatment

, Volume 136, Issue 2, pp 521–533 | Cite as

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

  • Dejana Braithwaite
  • Monika Izano
  • Dan H. Moore
  • Marilyn L. Kwan
  • Martin C. Tammemagi
  • Robert A. Hiatt
  • Karla Kerlikowske
  • Candyce H. Kroenke
  • Carol Sweeney
  • Laurel Habel
  • Adrienne Castillo
  • Erin Weltzien
  • Bette Caan


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.


Cigarette smoking Breast cancer Survival Cohort study Systematic review 



This research was supported by Grant# KG110940 from Susan G. Komen for the Cure and by Grant# 121891-MRSG-12-007-01-CPHPS from the American Cancer Society. Additional support was obtained from the National Institutes of Health, National Cancer Institute, Bay Area Breast Cancer SPORE (P50 CA 58207). The data were derived from the Life after Cancer Epidemiology (LACE) study, which is supported by the National Cancer Institute (RO1 CA129059-05 to B. J. Caan). We thank Dr. Stanton Glantz for helpful comments on an earlier draft of this manuscript.

Conflict of interest

The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The authors have no further financial relationship with the funders. The authors have full control of all primary data and the Journal may review the data if requested.

Supplementary material

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


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Dejana Braithwaite
    • 1
    • 2
  • Monika Izano
    • 2
  • Dan H. Moore
    • 2
  • Marilyn L. Kwan
    • 4
  • Martin C. Tammemagi
    • 3
  • Robert A. Hiatt
    • 1
    • 2
  • Karla Kerlikowske
    • 1
    • 2
  • Candyce H. Kroenke
    • 4
  • Carol Sweeney
    • 5
  • Laurel Habel
    • 4
  • Adrienne Castillo
    • 4
  • Erin Weltzien
    • 4
  • Bette Caan
    • 4
  1. 1.Helen Diller Family Comprehensive Cancer CenterUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of Community Health SciencesBrock UniversitySt. CatharinesCanada
  4. 4.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA
  5. 5.Department of MedicineUniversity of UtahSalt Lake CityUSA

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