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Impact of smoking history on the outcomes of women with early-stage breast cancer: a secondary analysis of a randomized study

Abstract

To assess the impact of smoking history on the outcomes of early-stage breast cancer patients treated with sequential anthracyclines–taxanes in a randomized study. This is a secondary analysis of patient-level data of 1242 breast cancer patients referred for adjuvant chemotherapy in the BCIRG005 clinical trial. Overall survival was assessed according to smoking history through Kaplan–Meier analysis. Univariate and multivariate Cox regression analyses of factors affecting overall and relapse-free survival were subsequently conducted. Factors that were evaluated included: age, performance status, number of chemotherapy cycles, T stage, lymph node ratio, estrogen receptor status, adjuvant radiotherapy and smoking history. Kaplan–Meier analysis of overall survival according to smoking status (ever smoker vs. never smoker) was conducted. There was a trend toward a better overall survival among never smokers compared to ever smokers; however, it was not statistically significant (P = 0.098). The following factors were associated with better overall survival in multivariate analysis: older age (P = 0.011), complete chemotherapy course (P = 0.002), lower T stage (P < 0.0001), lower lymph node ratio (P < 0.0001) and positive estrogen receptor status (P = 0.006). Otherwise, the following factors were associated with better relapse-free survival in multivariate analysis: older age (P = 0.001), never smoking status (P = 0.021), lower T stage (P = 0.028), lower lymph node ratio (P < 0.0001) and positive estrogen receptor status (P < 0.0001). Early-stage breast cancer patients with a positive smoking history experienced worse relapse-free survival compared to never smokers. Physicians managing breast cancer patients should prioritize discussion about the benefits of smoking cessation when counseling their patients.

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References

  1. Gil-Lacruz AI, Gil-Lacruz M, Leeder S. Women and smoking-prices and health warning messages: evidence from Spain. Addict Behav. 2015;45:294–300.

    Article  PubMed  Google Scholar 

  2. Bjerkaas E, Parajuli R, Engeland A, Maskarinec G, Weiderpass E, Gram IT. The association between lifetime smoking exposure and breast cancer mortality–results from a Norwegian cohort. Cancer Med. 2014;3(5):1448–57.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Berube S, Lemieux J, Moore L, Maunsell E, Brisson J. Smoking at time of diagnosis and breast cancer-specific survival: new findings and systematic review with meta-analysis. Breast Cancer Res. 2014;16(2):R42.

    Article  PubMed  PubMed Central  Google Scholar 

  4. https://www.projectdatasphere.org/projectdatasphere/html/home. Accessed 7 Oct 2017.

  5. http://globocan.iarc.fr. Accessed 27 Nov 2016.

  6. Abdoli G, Bottai M, Sandelin K, Moradi T. Breast cancer diagnosis and mortality by tumor stage and migration background in a nationwide cohort study in Sweden. Breast. 2017;31:57–65.

    Article  PubMed  Google Scholar 

  7. Eiermann W, Pienkowski T, Crown J, Sadeghi S, Martin M, Chan A, et al. Phase III study of doxorubicin/cyclophosphamide with concomitant versus sequential docetaxel as adjuvant treatment in patients with human epidermal growth factor receptor 2-normal, node-positive breast cancer: BCIRG-005 trial. J Clin Oncol. 2011;29(29):3877–84.

    CAS  Article  PubMed  Google Scholar 

  8. Dossus L, Boutron-Ruault MC, Kaaks R, Gram IT, Vilier A, Fervers B, et al. Active and passive cigarette smoking and breast cancer risk: results from the EPIC cohort. Int J Cancer. 2014;134(8):1871–88.

    CAS  Article  PubMed  Google Scholar 

  9. Catsburg C, Miller AB, Rohan TE. Active cigarette smoking and risk of breast cancer. Int J Cancer. 2015;136(9):2204–9.

    CAS  Article  PubMed  Google Scholar 

  10. Izano M, Satariano WA, Hiatt RA, Braithwaite D. Smoking and mortality after breast cancer diagnosis: the health and functioning in women study. Cancer Med. 2015;4(2):315–24.

    Article  PubMed  Google Scholar 

  11. Pierce JP, Patterson RE, Senger CM, Flatt SW, Caan BJ, Natarajan L, et al. Lifetime cigarette smoking and breast cancer prognosis in the After Breast Cancer Pooling Project. J Natl Cancer Inst. 2014;106(1):359.

    Article  Google Scholar 

  12. Padron-Monedero A, Tannenbaum SL, Koru-Sengul T, Miao F, Hansra D, Lee DJ, et al. Smoking and survival in female breast cancer patients. Breast Cancer Res Treat. 2015;150(2):395–403.

    Article  PubMed  Google Scholar 

  13. Andres SA, Bickett KE, Alatoum MA, Kalbfleisch TS, Brock GN, Wittliff JL. Interaction between smoking history and gene expression levels impacts survival of breast cancer patients. Breast Cancer Res Treat. 2015;152(3):545–56.

    CAS  Article  PubMed  Google Scholar 

  14. Larsen SB, Kroman N, Ibfelt EH, Christensen J, Tjonneland A, Dalton SO. Influence of metabolic indicators, smoking, alcohol and socioeconomic position on mortality after breast cancer. Acta Oncol. 2015;54(5):780–8.

    Article  PubMed  Google Scholar 

  15. Huisman M, Kunst AE, Mackenbach JP. Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control. 2005;14(2):106–13.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. Boone SD, Baumgartner KB, Baumgartner RN, Connor AE, John EM, Giuliano AR, et al. Active and passive cigarette smoking and mortality among Hispanic and non-Hispanic white women diagnosed with invasive breast cancer. Ann Epidemiol. 2015;25(11):824–31.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This publication is based on research using information obtained from www.projectdatasphere.org, which is maintained by Project Data Sphere, LLC. Neither Project Data Sphere, LLC nor the owner(s) of any information from the web site have contributed to, approved or are in any way responsible for the contents of this publication.

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Correspondence to Winson Y. Cheung.

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This article does not contain any studies with human participants or animals performed by the authors.

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As this study is based on a publicly available dataset without identifying patient information, informed consent was not needed.

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Abdel-Rahman, O., Cheung, W.Y. Impact of smoking history on the outcomes of women with early-stage breast cancer: a secondary analysis of a randomized study. Med Oncol 35, 68 (2018). https://doi.org/10.1007/s12032-018-1129-0

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  • DOI: https://doi.org/10.1007/s12032-018-1129-0

Keywords

  • Smoking
  • Chemotherapy
  • Breast cancer
  • Outcomes