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. 2012 Nov;136(2):521-33.
doi: 10.1007/s10549-012-2276-1. Epub 2012 Sep 29.

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

Dejana Braithwaite  1 , 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
Affiliations

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

Dejana Braithwaite et al. Breast Cancer Res Treat. 2012 Nov.

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.

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Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram* of literature search for the association between smoking status and breast cancer mortality *The PRISMA flow diagram depicts the flow of information throughout the different phases of this systematic review. It includes the number of records identified, included, and excluded and the reason for exclusions.
FIGURE 2
FIGURE 2
Kaplan-Meier plots of survival, by smoking status (a) All-cause survival (b) Other cause survival (c) Breast cancer survival
FIGURE 2
FIGURE 2
Kaplan-Meier plots of survival, by smoking status (a) All-cause survival (b) Other cause survival (c) Breast cancer survival
FIGURE 2
FIGURE 2
Kaplan-Meier plots of survival, by smoking status (a) All-cause survival (b) Other cause survival (c) Breast cancer survival
See this image and copyright information in PMC

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