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. 2017 Aug 22;17(1):556.
doi: 10.1186/s12885-017-3546-4.

Active smoking and risk of breast cancer in a Danish nurse cohort study

Zorana Jovanovic Andersen  1 , Jeanette Therming Jørgensen  2 , Randi Grøn  2 , Elvira Vaclavik Brauner  3   4 , Elsebeth Lynge  2
Affiliations

Active smoking and risk of breast cancer in a Danish nurse cohort study

Zorana Jovanovic Andersen et al. BMC Cancer. .

Abstract

Background: No scientific consensus has been reached on whether active tobacco smoking causes breast cancer. We examine the association between active smoking and breast cancer risk in Denmark, which has some of the highest smoking and breast cancer rates in women worldwide.

Methods: We used the data from a nationwide Danish Nurse Cohort on 21,867 female nurses (age > 44 years) who at recruitment in 1993 or 1999 reported information on smoking status, onset, duration, and intensity, as well as breast cancer risk factors. We obtained data on incidence of breast cancer from Danish Cancer Registry until 2013, and used Cox regression models to analyze the association between smoking and breast cancer.

Results: Of 21,831 women (mean age 53.2 years) 1162 developed breast cancer during 15.7 years of follow-up. 33.7% of nurses were current and 30.0% former smokers at cohort baseline. Compared to never smokers, we found increased risk of breast cancer of 18% in ever (hazard ratio and 95% confidence interval: 1.18; 1.04-1.34) and 27% in current (1.27; 1.11-1.46) smokers. We detected a dose-response relationship with smoking intensity with the highest breast cancer risk in women smoking >15 g/day (1.31; 1.11-1.56) or >20 pack-years (1.32; 1.12-1.55). Parous women who smoked heavily (>10 pack-years) before first childbirth had the highest risk of breast cancer (1.58; 1.20-2.10). Association between smoking and breast cancer was not modified by menopausal status, obesity, alcohol or hormone therapy use, and seemed to be limited to the estrogen receptor positive breast cancer subtype.

Conclusions: Active smoking increases risk of breast cancer, with smoking before first birth being the most relevant exposure window.

Keywords: Active smoking; Breast cancer; Cohort; Tobacco smoking.

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Conflict of interest statement

Ethics approval and consent to participate

The study was entirely based on register data and was approved by the Danish Data Protection Agency (2014–41-2750). Danish law regarding ethical approval of register-based research does not require informed consent from study participants, thus no contact was made with the participating women or their relatives and general practitioners.

Consent for publication

Danish law regarding ethical approval of register-based research does not require consent from study participants to publish.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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