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Kim J, Keegan TH. Characterizing risky alcohol use, cigarette smoking, e-cigarette use, and physical inactivity among cancer survivors in the USA-a cross-sectional study. J Cancer Surviv 2023; 17:1799-1812. [PMID: 35963976 PMCID: PMC10539414 DOI: 10.1007/s11764-022-01245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Unhealthy lifestyle behaviors are associated with inferior health outcomes among cancer survivors, including increased mortality. It is crucial to identify vulnerable subgroups, yet investigations have been limited. Thus, this study aimed to examine sociodemographic and clinical characteristics associated with risky health behaviors among cancer survivors. METHODS We used national, cross-sectional survey data (Health Information National Trends Survey, HINTS 2017-2020) for 2579 cancer survivors. We calculated the prevalence of risky alcohol use, current cigarette smoking, e-cigarette use, and not meeting physical activity guidelines. We performed weighted logistic regression to obtain multivariable-adjusted odds ratios (OR) for the association between each unhealthy behavior with sociodemographic and clinical characteristics. RESULTS Overall, 25% showed risky alcohol use, 12% were current cigarette smokers, 3% were current e-cigarette users, and 68% did not meet physical activity guidelines. Cancer survivors who were males, non-Hispanic Whites or African Americans, without a college education, not married and with comorbidities or psychological distress were more likely to have unhealthy behaviors. Those with lung disease or depression were 2 times as likely to smoke cigarette or e-cigarettes and those with psychological distress were 1.6 times as likely to be physically inactive. Moreover, risky drinkers (OR = 1.75, 95% CI = 1.22-2.52) and e-cigarette smokers (OR = 16.40, 95% CI 3.29-81.89) were more likely to be current cigarette smokers. CONCLUSIONS We identified vulnerable subpopulations of cancer survivors with multiple unhealthy lifestyle behaviors. IMPLICATIONS FOR CANCER SURVIVORS Our findings inform clinicians and program and policy makers of the subgroups of cancer survivors to target for multiple health behavior interventions.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, University of California, Davis, 1 Shields Avenue, Davis, CA, 95616, USA.
| | - Theresa H Keegan
- Division of Hematology and Oncology, UC Davis Comprehensive Cancer Center, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA
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Hughes RT, Ip EH, Urbanic JJ, Hu JJ, Weaver KE, Lively MO, Winkfield KM, Shaw EG, Diaz LB, Brown DR, Strasser J, Sears JD, Lesser GJ. Smoking and Radiation-induced Skin Injury: Analysis of a Multiracial, Multiethnic Prospective Clinical Trial. Clin Breast Cancer 2022; 22:762-770. [PMID: 36216768 PMCID: PMC10003823 DOI: 10.1016/j.clbc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Smoking during breast radiotherapy (RT) may be associated with radiation-induced skin injury (RISI). We aimed to determine if a urinary biomarker of tobacco smoke exposure is associated with increased rates of RISI during and after breast RT. PATIENTS AND METHODS Women with Stage 0-IIIA breast cancer treated with breast-conserving surgery or mastectomy followed by RT to the breast or chest wall with or without regional nodal irradiation were prospectively enrolled on a multicenter study assessing acute/late RISI. 980 patients with urinary cotinine (UCot) measurements (baseline and end-RT) were categorized into three groups. Acute and late RISI was assessed using the ONS Acute Skin Reaction scale and the LENT-SOMA Criteria. RESULTS Late Grade 2+ and Grade 3+ RISI occurred in 18.2% and 1.9% of patients, respectively-primarily fibrosis, pain, edema, and hyperpigmentation. Grade 2+ late RISI was associated with UCot group (P= 006). Multivariable analysis identified UCot-based light smoker/secondhand smoke exposure (HR 1.79, P= .10) and smoking (HR 1.60, p = .06) as non-significantly associated with an increased risk of late RISI. Hypofractionated breast RT was associated with decreased risk of late RISI (HR 0.51, P=.03). UCot was not associated with acute RISI, multivariable analysis identified race, obesity, RT site/fractionation, and bra size to be associated with acute RISI. CONCLUSIONS Tobacco exposure during breast RT may be associated with an increased risk of late RISI without an effect on acute toxicity. Smoking cessation should be encouraged prior to radiotherapy to minimize these and other ill effects of smoking.
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Affiliation(s)
- Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Edward H Ip
- Department of Biostatistics & Data Science, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States; Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - James J Urbanic
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, United States.
| | - Jennifer J Hu
- Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136.
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | | | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, 1005 Dr DB Todd Jr Blvd, Nashville, TN 37208, United States.
| | | | - Luis Baez Diaz
- Puerto Rico Minority Underserved NCI Community Oncology Research Program, 89 De Diego Avenue, PMB #711, Suite 105, San Juan, Puerto Rico 00927.
| | - Doris R Brown
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Jon Strasser
- Helen F Graham Cancer Center, 4701 Ogletown Stanton Rd, Newark, DE 19713, United States.
| | - Judith D Sears
- Piedmont Radiation Oncology, 1010 Bethesda Court, Winston-Salem, NC 27103, United States.
| | - Glenn J Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine.
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An D, Choi J, Lee J, Kim JY, Kwon S, Kim J, Lee S, Jeon S, Lee C, Lee S, Woo H. Time to surgery and survival in breast cancer. BMC Surg 2022; 22:388. [PMID: 36369022 PMCID: PMC9652796 DOI: 10.1186/s12893-022-01835-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to investigate the effect of the time from diagnosis to breast cancer surgery on breast cancer patients’ prognosis.
Methods Of the 1900 patients diagnosed with invasive (stage 1–3) breast cancer who underwent surgery in KUH between 2012 and 2019, 279 patients were enrolled in this study. All patients, including those who received neoadjuvant chemotherapy, were classified as Model 1 subjects, and those who received immediate surgical treatment were classified as Model 2 subjects. We conducted a Cox regression analysis to identify prognostic factors of breast cancer associated with the time from diagnosis to surgery. Results The univariate results indicated a sharp drop in both groups’ survival rates when the time to surgery was delayed for more than 8 weeks (Model 1 p = 0.000; Model 2 p = 0.001). In the multivariate analysis, the hazard ratio (HR) of Model 1increased (HR = 6.84, 95% CI 1.06–44.25) in response to a delay in surgery of more than 8 weeks. Smoking and the American Joint Committee on Cancer (AJCC) staging system had a negative effect on breast cancer prognosis, while hormone therapy had a positive effect. Conclusion For all patients, a delay in breast cancer surgery of more than 8 weeks was inversely associated with survival.
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Rosner B, Glynn RJ, Eliassen AH, Hankinson SE, Tamimi RM, Chen WY, Holmes MD, Mu Y, Peng C, Colditz GA, Willett WC, Tworoger SS. A Multi-State Survival Model for Time to Breast Cancer Mortality among a Cohort of Initially Disease-Free Women. Cancer Epidemiol Biomarkers Prev 2022; 31:1582-1592. [PMID: 35654356 PMCID: PMC9348829 DOI: 10.1158/1055-9965.epi-21-1471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/12/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Identifying risk factors for aggressive forms of breast cancer is important. Tumor factors (e.g., stage) are important predictors of prognosis, but may be intermediates between prediagnosis risk factors and mortality. Typically, separate models are fit for incidence and mortality postdiagnosis. These models have not been previously integrated to identify risk factors for lethal breast cancer in cancer-free women. METHODS We combined models for breast cancer incidence and breast cancer-specific mortality among cases into a multi-state survival model for lethal breast cancer. We derived the model from cancer-free postmenopausal Nurses' Health Study women in 1990 using baseline risk factors. A total of 4,391 invasive breast cancer cases were diagnosed from 1990 to 2014 of which 549 died because of breast cancer over the same period. RESULTS Some established risk factors (e.g., family history, estrogen plus progestin therapy) were not associated with lethal breast cancer. Controlling for age, the strongest risk factors for lethal breast cancer were weight gain since age 18: > 30 kg versus ± 5 kg, RR = 1.94 [95% confidence interval (CI) = 1.38-2.74], nulliparity versus age at first birth (AAFB) < 25, RR = 1.60 (95% CI = 1.16-2.22), and current smoking ≥ 15 cigarettes/day versus never, RR = 1.42 (95% CI = 1.07-1.89). CONCLUSIONS Some breast cancer incidence risk factors are not associated with lethal breast cancer; other risk factors for lethal breast cancer are not associated with disease incidence. IMPACT This multi-state survival model may be useful for identifying prediagnosis factors that lead to more aggressive and ultimately lethal breast cancer.
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Affiliation(s)
- Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Robert J. Glynn
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - A. Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Susan E. Hankinson
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Rulla M. Tamimi
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Wendy Y. Chen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michelle D. Holmes
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yi Mu
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cheng Peng
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Graham A. Colditz
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Siteman Cancer Center and Washington University School of Medicine, Saint Louis, Missouri
| | - Walter C. Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shelley S. Tworoger
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
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Chan JE, Caesar MA, Mann AK, Koh-Bell A, Richardson MT, Johnson CR, Kapp DS, Chan JK. The Role of Diet Compared to Physical Activity on Women's Cancer Mortality: Results From the Third National Health and Nutrition Examination Survey. Front Public Health 2022; 10:853636. [PMID: 35979450 PMCID: PMC9376675 DOI: 10.3389/fpubh.2022.853636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background Among women in the United States, cancer is the second leading cause of death. Prior studies have examined how lifestyle factors, such as diet and physical activity, influence cancer mortality. However, few have evaluated if diet or physical activity has a stronger protective effect for cancer mortality. Therefore, this study aims to evaluate and compare the impacts of diet and physical activity on women's cancer mortality. Methods Prospective, cross-sectional data were abstracted from the Third US National Health and Nutrition Examination Survey (NHANES III) on female respondents from 1988 to 1994. Physical activity was derived from the CDC's metabolic equivalent (MET) intensity levels. Dietary classifications were derived from the USDA's healthy eating index (HEI). We utilized the National Death Index to obtain mortality follow-up information on our cohort until December 31, 2015. Chi-squared, multivariable Cox regression, and Kaplan–Meier estimates were employed for statistical analyses. Results Of 3,590 women (median age: 57, range: 40–89), 30% had an obese BMI (BMI≥30 kg/m2). Additionally, 22% of participants self-reported a healthy diet, 69% needed dietary improvement, and 9% had a poor diet. Furthermore, 21% reported physical inactivity, 44% did not meet physical activity guidelines, and 35% met guidelines. On multivariate analysis, healthy diet (HR: 0.70; 95% CI: 0.51–0.98; p = 0.04), but not physical activity (HR: 0.87; 95% CI: 0.55–1.38; p = 0.55), independently predicted for lower cancer mortality. Participants with a healthy diet but low exercise had decreased cancer mortality compared to participants with an unhealthy diet but high exercise (p = 0.01). Conclusions A healthful diet was associated with lower cancer mortality in women, even after adjusting for obesity, inflammation, and other covariates. In addition, diet may play a stronger role in reducing cancer mortality in women than physical activity.
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Affiliation(s)
- Joshua E. Chan
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Michelle Ann Caesar
- Department of Obstetrics and Gynecology, California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Amandeep K. Mann
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Alex Koh-Bell
- California Pacific Medical Center, San Francisco, CA, United States
| | - Michael T. Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Caitlin R. Johnson
- Department of Obstetrics and Gynecology, California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States
| | - John K. Chan
- California Pacific Medical Center, San Francisco, CA, United States
- *Correspondence: John K. Chan
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Khobrani A, Alatawi Y, Bajnaid E, Alemam O, Osman A, Bin Attash L, Jaffal M, AlGhanmi M, Alharbi A, Alnuhait M. Adherence to Hormonal Therapy in Breast Cancer Patients in Saudi Arabia: A Single-Center Study. Cureus 2022; 14:e24780. [PMID: 35677000 PMCID: PMC9167632 DOI: 10.7759/cureus.24780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Breast cancer is one of the most common types of cancer in women. Approximately three-quarters of all breast cancer patients have estrogen and/or progesterone receptor positivity. As a result, the majority of patients receive hormonal treatment for between five and 10 years. Long-term use of hormonal therapy reduces the recurrence rate and the risk of death. In Saudi patients, adherence to hormonal therapy is not adequately assessed. The primary objective of this study is to determine the clinical outcomes associated with hormonal therapy adherence in breast cancer patients. This is a retrospective cohort study of patients who received adjuvant hormonal therapy for hormone-receptor-positive breast cancer. Patients were included if they had received at least two prescription refills following their breast cancer diagnosis. The primary outcome measure was mortality and disease progression in relation to hormonal therapy adherence. Progression of disease is defined as local recurrence or radiographic evidence of metastatic disease. The secondary outcome measure was the study population's adherence to hormonal therapy. The proportion of days covered during hormonal therapy was used to assess adherence (PDC). PDC was calculated as the number of days in the prescription period divided by the total number of days in the prescription period. Patients are considered adherent if their PDC value is greater than 0.8. The mortality and disease progression curves were generated using the Kaplan-Meier method. The proportion of patients adhering to hormonal therapy was determined using descriptive analysis. The IRB granted approval. A total of 121 patients were included in the study from the 380 patients screened. Tamoxifen, letrozole, and anastrozole were administered to 58%, 27%, and 14% of patients, respectively. The median age was 53 years. Women who were postmenopausal constituted 52.3% of the study population. The majority of patients were in Stages II and I (56.2% and 16.53%, respectively). The majority of the tumors were Grade II (58.68 %). Adherence was not associated with disease progression (HR, 0.66; 95% CI, 0.25-1.72) or mortality (HR, 1.391; 95 percent CI, 0.33-5.82). Disease progression and mortality were not found to be significantly associated with hormonal therapy adherence in this study. A larger study is required to confirm the findings of our study.
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Darmon S, Park A, Lovejoy LA, Shriver CD, Zhu K, Ellsworth RE. Relationship between Cigarette Smoking and Cancer Characteristics and Survival among Breast Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4084. [PMID: 35409765 PMCID: PMC8997894 DOI: 10.3390/ijerph19074084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 02/04/2023]
Abstract
Carcinogenic effects of tobacco smoke may affect breast tumorigenesis. To assess whether cigarette smoking is associated with breast cancer characteristics, we investigated the relationships between smoking, pathological characteristics, and outcomes in 2153 women diagnosed with breast cancer 2001-2016. Patients were classified as never, former, or current smokers at the time of diagnosis. Logistic regression and multivariable Cox proportional hazards analysis were performed to determine whether smoking was associated with tumor characteristics. Multivariable Cox proportional hazards analysis was conducted to compare former or current smokers to never smokers in survival with adjustment for the potential confounders. The majority of women (61.8%) never smoked, followed by former smokers (26.2%) and current smokers (12.0%). After adjustment for demographic variables, body mass index, and comorbidities, tumor characteristics were not significantly associated with smoking status or pack-years smoked. Ten-year overall survival was significantly lower for former and current smokers compared to never smokers (p = 0.0105). However, breast cancer specific survival did not differ significantly between groups (p = 0.1606). Although cigarette smoking did not alter the underlying biology of breast tumors or breast cancer-specific survival, overall survival was significantly worse in smokers, highlighting the importance of smoking cessation in the recently diagnosed breast cancer patient.
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Affiliation(s)
- Sarah Darmon
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; (S.D.); (A.P.); (C.D.S.); (K.Z.)
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Amie Park
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; (S.D.); (A.P.); (C.D.S.); (K.Z.)
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Leann A. Lovejoy
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA 15963, USA;
| | - Craig D. Shriver
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; (S.D.); (A.P.); (C.D.S.); (K.Z.)
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Kangmin Zhu
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; (S.D.); (A.P.); (C.D.S.); (K.Z.)
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
- Department of Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Rachel E. Ellsworth
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; (S.D.); (A.P.); (C.D.S.); (K.Z.)
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
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Nicolas M, Grandal B, Dubost E, Kassara A, Guerin J, Toussaint A, Laas E, Feron JG, Fourchotte V, Lecuru F, Girard N, Coussy F, Lavielle B, Kriegel I, Kirova Y, Pierga JY, Reyal F, Hamy AS. Breast Cancer (BC) Is a Window of Opportunity for Smoking Cessation: Results of a Retrospective Analysis of 1234 BC Survivors in Follow-Up Consultation. Cancers (Basel) 2021; 13:2423. [PMID: 34067742 PMCID: PMC8156674 DOI: 10.3390/cancers13102423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is the most commonly diagnosed type of cancer and the leading cause of cancer deaths in women. Smoking is the principal modifiable risk factor for cancers and has a negative influence on long-term survival. We conducted a retrospective study on consecutive BC survivors seen at follow-up consultations between 3 June and 30 October 2019 at Institut Curie, Paris, France. Smoking behaviors were evaluated prospectively via interviewer-administered questionnaires. The aim of this study was to describe smoking-related patient care at diagnosis and smoking cessation patterns in women with a history of BC. A total of 1234 patients were included in the study. Smoking status at diagnosis was missing from electronic health records in 32% of cases, including 13% of patients who smoke. Only 20% of the 197 patients currently smoking at diagnosis recalled having a discussion about smoking with a healthcare professional. Radiotherapists and surgeons were more likely to talk about complications than other practitioners. The main type of information provided was general advice to stop smoking (n = 110), followed by treatment complications (n = 48), while only five patients were referred to tobaccologists. Since diagnosis, 33% (n = 65) of the patients currently smoking had quit. Patients who quit had a lower alcohol consumption, but no other factor was associated with smoking cessation. The main motivation for tobacco withdrawal was the fear of BC relapse (63%). This study highlights room for improvement in the assessment of smoking behavior. Our data raise important perspectives for considering BC treatment and follow-up as a window of opportunity for smoking cessation.
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Affiliation(s)
- Marion Nicolas
- Faculty of Medicine, Sorbonne Université, 75006 Paris, France;
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Beatriz Grandal
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Emma Dubost
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Amyn Kassara
- Data Factory, Institut Curie, Université Paris, 75005 Paris, France; (A.K.); (J.G.)
| | - Julien Guerin
- Data Factory, Institut Curie, Université Paris, 75005 Paris, France; (A.K.); (J.G.)
| | - Aullene Toussaint
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Enora Laas
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Jean-Guillaume Feron
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Virginie Fourchotte
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Fabrice Lecuru
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Noemie Girard
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
| | - Beatrice Lavielle
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
| | - Irene Kriegel
- Department of Anesthesiology, Institut Curie, Université Paris, 75005 Paris, France;
| | - Youlia Kirova
- Department of Radiotherapy, Institut Curie, Université Paris, 75005 Paris, France;
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
| | - Fabien Reyal
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, 75005 Paris, France
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, 75005 Paris, France
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Jha P. The hazards of smoking and the benefits of cessation: a critical summation of the epidemiological evidence in high-income countries. eLife 2020; 9:49979. [PMID: 32207405 PMCID: PMC7093109 DOI: 10.7554/elife.49979] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
In high-income countries, the biggest cause of premature death, defined as death before 70 years, is smoking of manufactured cigarettes. Smoking-related disease was responsible for about 41 million deaths in the United States, United Kingdom and Canada, cumulatively, from 1960 to 2020. Every million cigarettes smoked leads to one death in the US and Canada, but slightly more than one death in the UK. The 21st century hazards reveal that smokers who start smoking early in adult life and do not quit lose a decade of life expectancy versus non-smokers. Cessation, particularly before age 40 years, yields large reductions in mortality risk. Up to two-thirds of deaths among smokers are avoidable at non-smoking death rates, and former smokers have about only a quarter of the excess risk of death compared to current smokers. The gap between scientific and popular understanding of smoking hazards is surprisingly large.
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Affiliation(s)
- Prabhat Jha
- Centre for Global Health Research, Dalla Lana School of Public Health and Unity Health, Toronto, University of Toronto, Ontario, Canada
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10
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Bea VJ, Cunningham JE, Alberg AJ, Burshell D, Bauza CE, Knight KD, Hazelton TR, Varner H, Kramer R, Bolick S, Hurley D, Mosley C, Ford ME. Alcohol and Tobacco Use in an Ethnically Diverse Sample of Breast Cancer Patients, Including Sea Island African Americans: Implications for Survivorship. Front Oncol 2018; 8:392. [PMID: 30319964 PMCID: PMC6170649 DOI: 10.3389/fonc.2018.00392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/31/2018] [Indexed: 11/13/2022] Open
Abstract
Background/Objective: Data suggest that modifiable risk factors such as alcohol and tobacco use may increase the risk of breast cancer (BC) recurrence and reduce survival. Female BC mortality in South Carolina is 40% higher among African Americans (AAs) than European Americans (EAs). Given this substantial racial disparity, using a cross-sectional survey design we examined alcohol and tobacco use in an ethnically diverse statewide study of women with recently diagnosed invasive breast cancer. This included a unique South Carolina AA subpopulation, the Sea Islanders (SI), culturally isolated and with the lowest European American genetic admixture of any AA group. Methods: Participants (42 EAs, 66 non-SI AAs, 29 SIs), diagnosed between August 2011 and December 2012, were identified through the South Carolina Central Cancer Registry and interviewed by telephone within 21 months of diagnosis. Self-reported educational status, alcohol consumption and tobacco use were obtained using elements of the Behavior and Risk Factor Surveillance System questionnaire. Results:Alcohol: EAs were approximately twice as likely to consume alcohol (40%) and to be moderate drinkers (29%) than either AA group (consumers: 24% of non-SI AAs, 21% of SIs; moderate drinkers 15 and 10% respectively). Users tended to be younger, significantly among EAs and non-SI AAs, but not SIs, and to have attained more education. Heavy drinking was rare (≤1%) and binge drinking uncommon (≤10%) with no differences by race/ethnicity. Among both AA subgroups but not EAs, alcohol users were six to nine times more likely to have late stage disease (Regional or Distant), statistically significant but with wide confidence intervals. Tobacco: Current cigarette smoking (daily or occasional) was reported by 14% of EAs, 14% of non-SI AAs and 7% of SIs. Smoking was inversely associated with educational attainment. Use of both alcohol and cigarettes was reported by 3–6% of cases. Conclusions: Prevalences of alcohol and cigarette use were similar to those in the general population, with alcohol consumption more common among EAs. Up to half of cases used alcohol and/or tobacco. Given the risks from alcohol for disease recurrence, and implications of smoking for various health outcomes, these utilization rates are of concern.
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Affiliation(s)
- Vivian J Bea
- Department of Breast Surgical Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ, United States
| | - Joan E Cunningham
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.,National Coalition of Independent Scholars, San Antonio, TX, United States
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
| | - Dana Burshell
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Colleen E Bauza
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Kendrea D Knight
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Tonya R Hazelton
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Heidi Varner
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Rita Kramer
- Department of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Susan Bolick
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Deborah Hurley
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Catishia Mosley
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Marvella E Ford
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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11
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Kroenke CH. A conceptual model of social networks and mechanisms of cancer mortality, and potential strategies to improve survival. Transl Behav Med 2018; 8:629-642. [PMID: 30016520 PMCID: PMC6065533 DOI: 10.1093/tbm/ibx061] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Women with larger personal social networks have better breast cancer survival and a lower risk of mortality. However, little work has examined the mechanisms through which social networks influence breast cancer outcomes and cancer outcomes more generally, potentially limiting the development of feasible, clinically effective interventions. In fact, much of the emphasis in cancer research regarding the influence of social relationships on cancer outcomes has focused on the benefits of the provision of social support to patients, especially through peer support groups, and only more recently through patient navigation. Though critically important, there are other ways through which social relationships might influence outcomes, around which interventions might be developed. In addition to social support, these include social resources, social norms, social contagion, social roles, and social burdens and obligations. This narrative review addresses how social networks may influence cancer outcomes and discusses potential strategies for improving outcomes given these relationships. The paper (a) describes background and limitations of previous research, (b) outlines terms and provides a conceptual model that describes interrelationships between social networks and relevant variables and their hypothesized influence on cancer outcomes, (c) clarifies social and psychosocial mechanisms through which social networks affect downstream factors, (d) describes downstream behavioral, treatment, and physiological factors through which these subsequently influence recurrence and mortality, and (e) describes needed research and potential opportunities to enhance translation. Though most literature in this area pertains to breast cancer, this review has substantial relevance for cancer outcomes generally. Further clarification and research regarding potential mechanisms are needed to translate epidemiological findings on social networks into clinical and community strategies to improve cancer outcomes.
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Affiliation(s)
- Candyce H Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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12
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Goldvaser H, Gal O, Rizel S, Hendler D, Neiman V, Shochat T, Sulkes A, Brenner B, Yerushalmi R. The association between smoking and breast cancer characteristics and outcome. BMC Cancer 2017; 17:624. [PMID: 28874120 PMCID: PMC5585941 DOI: 10.1186/s12885-017-3611-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/23/2017] [Indexed: 12/14/2022] Open
Abstract
Background Smoking is associated with an increased incidence of hormone receptor positive breast cancer. Data regarding worse breast cancer outcome in smokers are accumulating. Current literature regarding the impact of smoking on breast cancer characteristics is limited. We evaluated the impact of smoking on breast cancer characteristics and outcome. Methods This was a retrospective single center study. All women diagnosed from 4/2005 through 3/2012 and treated in our institute for early, estrogen receptor positive, human epidermal growth factor receptor 2 (HER2) negative breast cancer, whose tumors were sent for Oncotype DX analysis were included. Medical records were reviewed for demographics, clinico-pathological parameters, treatment and outcome. Data regarding smoking were retrieved according to patients’ history at the first visit in the oncology clinic. Patients were grouped and compared according to smoking history (ever smokers vs. never smokers), smoking status (current vs. former and never smokers) and smoking intensity (pack years ≥30 vs. the rest of the cohort). Outcomes were adjusted in multivariate analyses and included age, menopausal status, ethnicity, tumor size, nodal status and grade. Results A total of 662 women were included. 28.2% had a history of smoking, 16.6% were current smokers and 11.3% were heavy smokers. Smoking had no impact on tumor size, nodal involvement and Oncotype DX recurrence score. Angiolymphatic and perineural invasion rates were higher in current smokers than in the rest of the cohort (10.4% vs. 5.1%, p = 0.045, 8.3% vs. 3.5%, p = 0.031, respectively). Smoking had no other impact on histological characteristics. Five-year disease free survival and overall survival rates were 95.7% and 98.5%, respectively. Smoking had no impact on outcomes. Adjusted disease free survival and overall survival did not influence the results. Conclusions Smoking had no clinically significant influence on tumor characteristics and outcome among women with estrogen receptor positive, HER2 negative, early breast cancer. As the study was limited to a specific subgroup of the breast cancer population in this heterogeneous disease and since smoking is a modifiable risk factor for the disease, further research is required to clarify the possible impact of smoking on breast cancer.
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Affiliation(s)
- Hadar Goldvaser
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Tel Aviv, Israel.
| | - Omer Gal
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petach Tikva, Israel
| | - Shulamith Rizel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Tel Aviv, Israel
| | - Daniel Hendler
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petach Tikva, Israel
| | - Victoria Neiman
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petach Tikva, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petach Tikva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Tel Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Tel Aviv, Israel
| | - Rinat Yerushalmi
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Tel Aviv, Israel
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13
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Parada H, Bradshaw PT, Steck SE, Engel LS, Conway K, Teitelbaum SL, Neugut AI, Santella RM, Gammon MD. Postdiagnosis Changes in Cigarette Smoking and Survival Following Breast Cancer. JNCI Cancer Spectr 2017; 1:pkx001. [PMID: 29608187 PMCID: PMC5875926 DOI: 10.1093/jncics/pkx001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/14/2017] [Accepted: 07/06/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine whether at-diagnosis smoking and postdiagnosis changes in smoking within five years after breast cancer were associated with long-term all-cause and breast cancer-specific mortality. METHODS A population-based cohort of 1508 women diagnosed with first primary in situ or invasive breast cancer in 1996 to 1997 were interviewed shortly after diagnosis and again approximately five years later to assess smoking history. Participants were followed for vital status through December 31, 2014. After 18+ years of follow-up, 597 deaths were identified, 237 of which were breast cancer related. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Compared with never smokers, risk of all-cause mortality was elevated among the 19% of at-diagnosis smokers (HR=1.69, 95% CI=1.36 to 2.11), those who smoked 20 or more cigarettes per day (HR=1.85, 95% CI=1.42 to 2.40), women who had smoked for 30 or more years (HR=1.62, 95% CI=1.28 to 2.05), and women who had smoked 30 or more pack-years (HR=1.82, 95% CI=1.39 to 2.37). Risk of all-cause mortality was further increased among the 8% of women who were at-/post-diagnosis smokers (HR=2.30, 95% CI=1.56 to 3.39) but was attenuated among the 11% women who quit smoking after diagnosis (HR=1.83, 95% CI=1.32 to 2.52). Compared with never smokers, breast cancer-specific mortality risk was elevated 60% (HR=1.60, 95% CI=0.79 to 3.23) among at-/postdiagnosis current smokers, but the confidence interval included the null value and elevated 175% (HR=2.75, 95% CI=1.26 to 5.99) when we considered postdiagnosis cumulative pack-years. Conclusions: Smoking negatively impacts long-term survival after breast cancer. Postdiagnosis cessation of smoking may reduce the risk of all-cause mortality. Breast cancer survivors may benefit from aggressive smoking cessation programs starting as early as the time of diagnosis.
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Affiliation(s)
- Humberto Parada
- Affiliations of authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (HPJr, LSE, KC, MDG); Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (PTB); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (SES); Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY (SLT); Department of Epidemiology (AIN), Department of Medicine (AIN), and Department of Environmental Health Sciences (RMS), Columbia University, New York, NY
| | - Patrick T. Bradshaw
- Affiliations of authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (HPJr, LSE, KC, MDG); Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (PTB); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (SES); Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY (SLT); Department of Epidemiology (AIN), Department of Medicine (AIN), and Department of Environmental Health Sciences (RMS), Columbia University, New York, NY
| | - Susan E. Steck
- Affiliations of authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (HPJr, LSE, KC, MDG); Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (PTB); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (SES); Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY (SLT); Department of Epidemiology (AIN), Department of Medicine (AIN), and Department of Environmental Health Sciences (RMS), Columbia University, New York, NY
| | - Lawrence S. Engel
- Affiliations of authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (HPJr, LSE, KC, MDG); Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (PTB); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (SES); Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY (SLT); Department of Epidemiology (AIN), Department of Medicine (AIN), and Department of Environmental Health Sciences (RMS), Columbia University, New York, NY
| | - Kathleen Conway
- Affiliations of authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (HPJr, LSE, KC, MDG); Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (PTB); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (SES); Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY (SLT); Department of Epidemiology (AIN), Department of Medicine (AIN), and Department of Environmental Health Sciences (RMS), Columbia University, New York, NY
| | - Susan L. Teitelbaum
- Affiliations of authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (HPJr, LSE, KC, MDG); Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (PTB); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (SES); Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY (SLT); Department of Epidemiology (AIN), Department of Medicine (AIN), and Department of Environmental Health Sciences (RMS), Columbia University, New York, NY
| | - Alfred I. Neugut
- Affiliations of authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (HPJr, LSE, KC, MDG); Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (PTB); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (SES); Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY (SLT); Department of Epidemiology (AIN), Department of Medicine (AIN), and Department of Environmental Health Sciences (RMS), Columbia University, New York, NY
| | - Regina M. Santella
- Affiliations of authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (HPJr, LSE, KC, MDG); Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (PTB); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (SES); Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY (SLT); Department of Epidemiology (AIN), Department of Medicine (AIN), and Department of Environmental Health Sciences (RMS), Columbia University, New York, NY
| | - Marilie D. Gammon
- Affiliations of authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (HPJr, LSE, KC, MDG); Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (PTB); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (SES); Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY (SLT); Department of Epidemiology (AIN), Department of Medicine (AIN), and Department of Environmental Health Sciences (RMS), Columbia University, New York, NY
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14
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Parada H, Sun X, Tse CK, Olshan AF, Troester MA, Conway K. Active smoking and survival following breast cancer among African American and non-African American women in the Carolina Breast Cancer Study. Cancer Causes Control 2017; 28:929-938. [PMID: 28695396 PMCID: PMC5709174 DOI: 10.1007/s10552-017-0923-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/04/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE To examine racial differences in smoking rates at the time of breast cancer diagnosis and subsequent survival among African American and non-African American women in the Carolina Breast Cancer Study (Phases I/II), a large population-based North Carolina study. METHODS We interviewed 788 African American and 1,020 Caucasian/non-African American women diagnosed with invasive breast cancer from 1993 to 2000, to assess smoking history. After a median follow-up of 13.56 years, we identified 717 deaths using the National Death Index; 427 were breast cancer-related. We used Cox regression to examine associations between self-reported measures of smoking and breast cancer-specific survival within 5 years and up to 18 years after diagnosis conditional on 5-year survival. We examined race and estrogen receptor status as potential modifiers. RESULTS Current (vs never) smoking was not associated with 5-year survival; however, risk of 13 year conditional breast cancer-specific mortality was elevated among women who were current smokers at diagnosis (HR 1.54, 95% CI 1.06-2.25), compared to never smokers. Although smoking rates were similar among African American (22.0%) and non-African American (22.1%) women, risk of breast cancer-specific mortality was elevated among African American (HR 1.69, 95% CI 1.00-2.85), but only weakly elevated among non-African American (HR 1.22, 95% CI 0.70-2.14) current (vs. never) smokers (P Interaction = 0.30). Risk of breast cancer-specific mortality was also elevated among current (vs never) smokers diagnosed with ER- (HR 2.58, 95% CI 1.35-4.93), but not ER+ (HR 1.11, 95% CI 0.69-1.78) tumors (P Interaction = 0.17). CONCLUSIONS Smoking may negatively impact long-term survival following breast cancer. Racial differences in long-term survival, as related to smoking, may be driven by ER status, rather than by differences in smoking patterns.
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Affiliation(s)
- Humberto Parada
- Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Xuezheng Sun
- Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA
| | - Chiu-Kit Tse
- Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen Conway
- Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Duan W, Li S, Meng X, Sun Y, Jia C. Smoking and survival of breast cancer patients: A meta-analysis of cohort studies. Breast 2017; 33:117-124. [DOI: 10.1016/j.breast.2017.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 02/07/2023] Open
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16
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Veal CT, Hart V, Lakoski SG, Hampton JM, Gangnon RE, Newcomb PA, Higgins ST, Trentham-Dietz A, Sprague BL. Health-related behaviors and mortality outcomes in women diagnosed with ductal carcinoma in situ. J Cancer Surviv 2017; 11:320-328. [PMID: 28058695 PMCID: PMC5419859 DOI: 10.1007/s11764-016-0590-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/16/2016] [Indexed: 01/19/2023]
Abstract
PURPOSE Women diagnosed with ductal carcinoma in situ (DCIS) of the breast are at greater risk of dying from cardiovascular disease and other causes than from breast cancer, yet associations between health-related behaviors and mortality outcomes after DCIS have not been well studied. METHODS We examined the association of body mass index, physical activity, alcohol consumption, and smoking with mortality among 1925 women with DCIS in the Wisconsin In Situ Cohort study. Behaviors were self-reported through baseline interviews and up to three follow-up questionnaires. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality after DCIS, with adjustment for patient sociodemographic, comorbidity, and treatment factors. RESULTS Over a mean of 6.7 years of follow-up, 196 deaths occurred. All-cause mortality was elevated among women who were current smokers 1 year prior to diagnosis (HR = 2.17 [95% CI 1.48, 3.18] vs. never smokers) and reduced among women with greater physical activity levels prior to diagnosis (HR = 0.55 [95% CI: 0.35, 0.87] for ≥5 h per week vs. no activity). Moderate levels of post-diagnosis physical activity were associated with reduced all-cause mortality (HR = 0.31 [95% CI 0.14, 0.68] for 2-5 h per week vs. no activity). Cancer-specific mortality was elevated among smokers and cardiovascular disease mortality decreased with increasing physical activity levels. CONCLUSIONS There are numerous associations between health-related behaviors and mortality outcomes after a DCIS diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Women diagnosed with DCIS should be aware that their health-related behaviors are associated with mortality outcomes.
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Affiliation(s)
- Christopher Thomas Veal
- Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Vicki Hart
- Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Susan G Lakoski
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
- Department of Clinical Cancer Prevention & Cardiology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Ronald E Gangnon
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Polly A Newcomb
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephen T Higgins
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
- Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, USA
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
| | - Amy Trentham-Dietz
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Brian L Sprague
- Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA.
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA.
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.
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17
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Mustafa Ali M, Moeller M, Rybicki L, Moore HCF. Prevalence and correlates of patient-reported symptoms and comorbidities in breast cancer survivors at a tertiary center. J Cancer Surviv 2017; 11:743-750. [DOI: 10.1007/s11764-017-0612-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/27/2017] [Indexed: 12/28/2022]
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18
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Holmes MD, Wang J, Hankinson SE, Tamimi RM, Chen WY. Protein Intake and Breast Cancer Survival in the Nurses' Health Study. J Clin Oncol 2016; 35:325-333. [PMID: 28095274 DOI: 10.1200/jco.2016.68.3292] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Greater protein intake has been associated with better breast cancer survival in several prospective studies, including among 1,982 women in the Nurses' Health Study. We proposed to extend this previous finding. We hypothesized that protein, essential amino acid, branched-chain amino acid, and leucine intakes are associated with improved survival and that these associations are stronger in tumors expressing insulin receptor (IR). Patients and Methods We included 6,348 women diagnosed with stage I to III breast cancer between 1976 and 2004. There were 1,046 distant recurrences. Relative risks (RRs) and 95% CIs were calculated according to quintiles of updated postdiagnostic diet using adjusted Cox proportional hazards models based on follow-up until 2010. Results There was an inverse association between energy-adjusted protein intake and recurrence. Multivariable RRs for increasing quintiles of intake compared with the lowest were 0.95 (95% CI, 0.79 to 1.15), 0.92 (95% CI, 0.76 to 1.11), 0.75 (95% CI, 0.61 to 0.91), and 0.84 (95% CI, 0.69 to 1.03; trend P = .02). For animal protein intake, the RRs were 0.88 (95% CI, 0.73 to 1.06), 0.85 (95% CI, 0.70 to 1.02), 0.75 (95% CI, 0.62 to 0.92), and 0.78 (95% CI, 0.63 to 0.95; trend P = .003). Neither essential amino acids, branched-chain amino acids, nor any individual amino acid stood out as being the source of the association. The association also did not differ by IR status. There was no clear association with any protein-containing foods. Conclusion We found a modest survival advantage with higher intake of protein, regardless of IR status. There was no clear mechanism for this association, although it is consistent with prior studies. Our data suggest that there is likely no advantage for women with a history of breast cancer in restricting protein intake or protein-containing foods.
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Affiliation(s)
- Michelle D Holmes
- Michelle D. Holmes, Susan E. Hankinson, Rulla M. Tamimi, and Wendy E. Chen, Brigham and Women's Hospital; Michelle D. Holmes and Rulla M. Tamimi, Harvard T.H. Chan School of Public Health; Wendy E. Chen, Dana-Farber Cancer Institute, Boston; and Jun Wang and Susan E. Hankinson, University of Massachusetts Amherst, Amherst, MA
| | - Jun Wang
- Michelle D. Holmes, Susan E. Hankinson, Rulla M. Tamimi, and Wendy E. Chen, Brigham and Women's Hospital; Michelle D. Holmes and Rulla M. Tamimi, Harvard T.H. Chan School of Public Health; Wendy E. Chen, Dana-Farber Cancer Institute, Boston; and Jun Wang and Susan E. Hankinson, University of Massachusetts Amherst, Amherst, MA
| | - Susan E Hankinson
- Michelle D. Holmes, Susan E. Hankinson, Rulla M. Tamimi, and Wendy E. Chen, Brigham and Women's Hospital; Michelle D. Holmes and Rulla M. Tamimi, Harvard T.H. Chan School of Public Health; Wendy E. Chen, Dana-Farber Cancer Institute, Boston; and Jun Wang and Susan E. Hankinson, University of Massachusetts Amherst, Amherst, MA
| | - Rulla M Tamimi
- Michelle D. Holmes, Susan E. Hankinson, Rulla M. Tamimi, and Wendy E. Chen, Brigham and Women's Hospital; Michelle D. Holmes and Rulla M. Tamimi, Harvard T.H. Chan School of Public Health; Wendy E. Chen, Dana-Farber Cancer Institute, Boston; and Jun Wang and Susan E. Hankinson, University of Massachusetts Amherst, Amherst, MA
| | - Wendy Y Chen
- Michelle D. Holmes, Susan E. Hankinson, Rulla M. Tamimi, and Wendy E. Chen, Brigham and Women's Hospital; Michelle D. Holmes and Rulla M. Tamimi, Harvard T.H. Chan School of Public Health; Wendy E. Chen, Dana-Farber Cancer Institute, Boston; and Jun Wang and Susan E. Hankinson, University of Massachusetts Amherst, Amherst, MA
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Choi SH, Terrell JE, Bradford CR, Ghanem T, Spector ME, Wolf GT, Lipkus IM, Duffy SA. Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients? Nicotine Tob Res 2016; 18:2216-2224. [PMID: 27613928 DOI: 10.1093/ntr/ntw189] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To determine if smoking after a cancer diagnosis makes a difference in mortality among newly diagnosed head and neck cancer patients. METHODS Longitudinal data were collected from newly diagnosed head and neck cancer patients with a median follow-up time of 1627 days (N = 590). Mortality was censored at 8 years or September 1, 2011, whichever came first. Based on smoking status, all patients were categorized into four groups: continuing smokers, quitters, former smokers, or never-smokers. A broad range of covariates were included in the analyses. Kaplan-Meier curves, bivariate and multivariate Cox proportional hazards models were constructed. RESULTS Eight-year overall mortality and cancer-specific mortality were 40.5% (239/590) and 25.4% (150/590), respectively. Smoking status after a cancer diagnosis predicted overall mortality and cancer-specific mortality. Compared to never-smokers, continuing smokers had the highest hazard ratio (HR) of dying from all causes (HR = 2.71, 95% confidence interval [CI] = 1.48-4.98). Those who smoked at diagnosis, but quit and did not relapse-quitters-had an improved hazard ratio of dying (HR = 2.38, 95% CI = 1.29-4.36) and former smokers at diagnosis with no relapse after diagnosis-former smokers-had the lowest hazard ratio of dying from all causes (HR = 1.68, 95% CI = 1.12-2.56). Similarly, quitters had a slightly higher hazard ratio of dying from cancer-specific reasons (HR = 2.38, 95% CI = 1.13-5.01) than never-smokers, which was similar to current smokers (HR = 2.07, 95% CI = 0.96-4.47), followed by former smokers (HR = 1.70, 95% CI = 1.00-2.89). CONCLUSIONS Compared to never-smokers, continuing smokers have the highest HR of overall mortality followed by quitters and former smokers, which indicates that smoking cessation, even after a cancer diagnosis, may improve overall mortality among newly diagnosed head and neck cancer patients. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population. IMPLICATIONS Using prospective observational longitudinal data from 590 head and neck cancer patients, this study showed that continuing smokers have the highest overall mortality relative to never-smokers, which indicates that smoking cessation, even after a cancer diagnosis, may have beneficial effects on long-term overall mortality. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population.
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Affiliation(s)
- Seung Hee Choi
- College of Nursing, Michigan State University, East Lansing, MI
| | | | | | | | | | | | | | - Sonia A Duffy
- College of Nursing, Ohio State University, Columbus, OH; .,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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Impacts of smoking on endocrine treatment response in a prospective breast cancer cohort. Br J Cancer 2016; 115:382-90. [PMID: 27280635 PMCID: PMC4973149 DOI: 10.1038/bjc.2016.174] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 05/11/2016] [Accepted: 05/16/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The association between smoking and breast cancer prognosis remains unclear. The purpose of this study was to investigate whether preoperative smoking was associated with prognosis in different treatment groups. METHODS This population-based cohort consisted of 1065 breast cancer patients without preoperative treatment included between 2002 and 2012 in Lund, Sweden. Smoking status was examined in relation to patient and tumour characteristics, and prognosis in different treatment groups. RESULTS At the preoperative visit, 21.0% smoked. Median follow-up time was 5.1 years. Overall, in the 1016 patients included in the survival analyses, there was no significant association between smoking and risk of breast cancer events (adjusted hazard ratio (adjHR): 1.45; 95% confidence interval (CI): 0.95-2.20). For the 309 aromatase inhibitor (AI)-treated patients ⩾50 years with oestrogen receptor-positive (ER+) tumours, smoking was associated with risk of breast cancer events (adjHR: 2.97; 95% CI: 1.44-6.13), distant metastasis (adjHR: 4.19; 95% CI: 1.81-9.72), and death (adjHR: 3.52; 95% CI: 1.59-7.81). Smoking was not associated with breast cancer events or distant metastasis in other treatment groups. CONCLUSIONS Preoperative smoking was only associated with an increased risk for breast cancer events and distant metastasis in AI-treated patients. If confirmed, smoking status should be taken into consideration when selecting an endocrine therapy.
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21
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Gaillot-de-Saintignon J, Deutsch A. [Systematizing support in cessation smoking to improve care for cancer patients]. Bull Cancer 2016; 103:584-93. [PMID: 27233368 DOI: 10.1016/j.bulcan.2016.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 01/18/2023]
Abstract
Approximately 20% of cancer patients smoke at diagnosis (all localizations included), and over two thirds continue despite the therapeutic management of their cancer, especially when cancer is not associated with tobacco. The impact of smoking on quality of care for patients is actually not enough considered. A literature review conducted by the French National Cancer Institute emphasizes the importance of tobacco cessation to improve the prognosis (decreased mortality from all causes and specific); to reduce the risk of second primary cancers; to reduce per- and post-surgical risks as long as some toxicities related to treatments and to improve the quality of physical and mental life of patients. It is important that a communication with the patient takes place at the beginning of the treatment to impact the smoking behavior. All oncology health professionals should deliver a clearly and personalized cessation advice in the light of scientific data and ensure that smoking cessation help will be offered to the patient.
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Affiliation(s)
- Julie Gaillot-de-Saintignon
- Institut national du cancer, département prévention, 52, avenue André-Morizet, 92513 Boulogne-Billancourt cedex, France.
| | - Antoine Deutsch
- Institut national du cancer, département prévention, 52, avenue André-Morizet, 92513 Boulogne-Billancourt cedex, France
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22
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Passarelli MN, Newcomb PA, Hampton JM, Trentham-Dietz A, Titus LJ, Egan KM, Baron JA, Willett WC. Cigarette Smoking Before and After Breast Cancer Diagnosis: Mortality From Breast Cancer and Smoking-Related Diseases. J Clin Oncol 2016; 34:1315-22. [PMID: 26811527 DOI: 10.1200/jco.2015.63.9328] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cigarette smoking increases overall mortality, but it is not established whether smoking is associated with breast cancer prognosis. METHODS We evaluated the association between smoking status before and after breast cancer diagnosis and mortality in the Collaborative Breast Cancer and Women's Longevity Study, a population-based prospective observational study conducted in Wisconsin, New Hampshire, and Massachusetts. Participants included 20,691 women, ages 20 to 79 years, diagnosed with incident localized or regional invasive breast cancer between 1988 and 2008; a subset of 4,562 of these women were recontacted a median of 6 years after diagnosis. Hazard ratios (HRs) with 95% CIs were calculated according to smoking status for death as a result of breast cancer; cancers of the lung, pharynx, or intrathoracic organs; other cancer; respiratory disease; and cardiovascular disease. RESULTS During a median of 12 years, 6,778 women died, including 2,894 who died as a result of breast cancer. Active smokers 1 year before breast cancer diagnosis were more likely than never smokers to die of breast cancer (HR, 1.25; 95% CI, 1.13 to 1.37), respiratory cancer (HR, 14.48; 95% CI, 9.89 to 21.21), other respiratory disease (HR, 6.02; 95% CI, 4.55 to 7.97), and cardiovascular disease (HR, 2.08; 95% CI, 1.80 to 2.41). The 10% of women who continued to smoke after diagnosis were more likely than never smokers to die of breast cancer (HR, 1.72; 95% CI, 1.13 to 2.60). When compared with women who continued to smoke after diagnosis, those who quit smoking after diagnosis had lower mortality from breast cancer (HR, 0.67; 95% CI, 0.38 to 1.19) and respiratory cancer (HR, 0.39; 95% CI, 0.16 to 0.95). CONCLUSION Smoking before or after diagnosis was associated with a higher mortality from breast cancer and several other causes.
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Affiliation(s)
- Michael N Passarelli
- Michael N. Passarelli, University of California, San Francisco, San Francisco, CA; Polly A. Newcomb, Fred Hutchinson Cancer Research Center, Seattle, WA; Polly A. Newcomb, John M. Hampton, and Amy Trentham-Dietz, University of Wisconsin School of Medicine and Public Health, Madison, WI; Linda J. Titus, Geisel School of Medicine at Dartmouth, Lebanon, NH; Kathleen M. Egan, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; John A. Baron, University of North Carolina School of Medicine, Chapel Hill, NC; and Walter C. Willett, Harvard Medical School and Brigham and Women's Hospital, Boston, MA.
| | - Polly A Newcomb
- Michael N. Passarelli, University of California, San Francisco, San Francisco, CA; Polly A. Newcomb, Fred Hutchinson Cancer Research Center, Seattle, WA; Polly A. Newcomb, John M. Hampton, and Amy Trentham-Dietz, University of Wisconsin School of Medicine and Public Health, Madison, WI; Linda J. Titus, Geisel School of Medicine at Dartmouth, Lebanon, NH; Kathleen M. Egan, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; John A. Baron, University of North Carolina School of Medicine, Chapel Hill, NC; and Walter C. Willett, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - John M Hampton
- Michael N. Passarelli, University of California, San Francisco, San Francisco, CA; Polly A. Newcomb, Fred Hutchinson Cancer Research Center, Seattle, WA; Polly A. Newcomb, John M. Hampton, and Amy Trentham-Dietz, University of Wisconsin School of Medicine and Public Health, Madison, WI; Linda J. Titus, Geisel School of Medicine at Dartmouth, Lebanon, NH; Kathleen M. Egan, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; John A. Baron, University of North Carolina School of Medicine, Chapel Hill, NC; and Walter C. Willett, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - Amy Trentham-Dietz
- Michael N. Passarelli, University of California, San Francisco, San Francisco, CA; Polly A. Newcomb, Fred Hutchinson Cancer Research Center, Seattle, WA; Polly A. Newcomb, John M. Hampton, and Amy Trentham-Dietz, University of Wisconsin School of Medicine and Public Health, Madison, WI; Linda J. Titus, Geisel School of Medicine at Dartmouth, Lebanon, NH; Kathleen M. Egan, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; John A. Baron, University of North Carolina School of Medicine, Chapel Hill, NC; and Walter C. Willett, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - Linda J Titus
- Michael N. Passarelli, University of California, San Francisco, San Francisco, CA; Polly A. Newcomb, Fred Hutchinson Cancer Research Center, Seattle, WA; Polly A. Newcomb, John M. Hampton, and Amy Trentham-Dietz, University of Wisconsin School of Medicine and Public Health, Madison, WI; Linda J. Titus, Geisel School of Medicine at Dartmouth, Lebanon, NH; Kathleen M. Egan, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; John A. Baron, University of North Carolina School of Medicine, Chapel Hill, NC; and Walter C. Willett, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - Kathleen M Egan
- Michael N. Passarelli, University of California, San Francisco, San Francisco, CA; Polly A. Newcomb, Fred Hutchinson Cancer Research Center, Seattle, WA; Polly A. Newcomb, John M. Hampton, and Amy Trentham-Dietz, University of Wisconsin School of Medicine and Public Health, Madison, WI; Linda J. Titus, Geisel School of Medicine at Dartmouth, Lebanon, NH; Kathleen M. Egan, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; John A. Baron, University of North Carolina School of Medicine, Chapel Hill, NC; and Walter C. Willett, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - John A Baron
- Michael N. Passarelli, University of California, San Francisco, San Francisco, CA; Polly A. Newcomb, Fred Hutchinson Cancer Research Center, Seattle, WA; Polly A. Newcomb, John M. Hampton, and Amy Trentham-Dietz, University of Wisconsin School of Medicine and Public Health, Madison, WI; Linda J. Titus, Geisel School of Medicine at Dartmouth, Lebanon, NH; Kathleen M. Egan, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; John A. Baron, University of North Carolina School of Medicine, Chapel Hill, NC; and Walter C. Willett, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - Walter C Willett
- Michael N. Passarelli, University of California, San Francisco, San Francisco, CA; Polly A. Newcomb, Fred Hutchinson Cancer Research Center, Seattle, WA; Polly A. Newcomb, John M. Hampton, and Amy Trentham-Dietz, University of Wisconsin School of Medicine and Public Health, Madison, WI; Linda J. Titus, Geisel School of Medicine at Dartmouth, Lebanon, NH; Kathleen M. Egan, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; John A. Baron, University of North Carolina School of Medicine, Chapel Hill, NC; and Walter C. Willett, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
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23
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Kroenke CH, Michael YL, Shu XO, Poole EM, Kwan ML, Nechuta S, Caan BJ, Pierce JP, Chen WY. Post-diagnosis social networks, and lifestyle and treatment factors in the After Breast Cancer Pooling Project. Psychooncology 2016; 26:544-552. [PMID: 26749519 DOI: 10.1002/pon.4059] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 11/12/2015] [Accepted: 12/05/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Larger social networks have been associated with better breast cancer survival. To investigate potential mediators, we evaluated associations of social network size and diversity with lifestyle and treatment factors associated with prognosis. METHODS We included 9331 women from the After Breast Cancer Pooling Project who provided data on social networks within approximately two years following diagnosis. A social network index was derived from information about the presence of a spouse or intimate partner, religious ties, community participation, friendship ties, and numbers of living relatives. Diversity was assessed as variety of ties, independent of size. We used logistic regression to evaluate associations with outcomes and evaluated whether effect estimates differed using meta-analytic techniques. RESULTS Associations were similar across cohorts though analyses of smoking and alcohol included US cohorts only because of low prevalence of these behaviors in the Shanghai cohort. Socially isolated women were more likely to be obese (OR = 1.21, 95% CI:1.03-1.42), have low physical activity (<10 MET-hours/week, OR = 1.55, 95% CI:1.36-1.78), be current smokers (OR = 2.77, 95% CI:2.09-3.68), and have high alcohol intake (≥15 g/d, OR = 1.23, 95% CI:1.00-1.51), compared with socially integrated women. Among node positive cases from three cohorts, socially isolated women were more likely not to receive chemotherapy (OR = 2.10, 95% CI:1.30-3.39); associations differed in a fourth cohort. Other associations (nonsignificant) were consistent with less intensive treatment in socially isolated women. Low social network diversity was independently associated with more adverse lifestyle, but not clinical, factors. CONCLUSIONS Small, less diverse social networks measured post-diagnosis were associated with more adverse lifestyle factors and less intensive cancer treatment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Candyce H Kroenke
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - Yvonne L Michael
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Xiao-Ou Shu
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Elizabeth M Poole
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marilyn L Kwan
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - Sarah Nechuta
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bette J Caan
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - John P Pierce
- San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Wendy Y Chen
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Dana Farber Cancer Institute, Department of Medical Oncology, Boston, MA, USA
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24
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Seifart U. [Cancer and life style: What really helps?]. Internist (Berl) 2015; 57:55-62; quiz 63-4. [PMID: 26678284 DOI: 10.1007/s00108-015-3772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The continuously growing number of patients who survive cancer (long-term survivors) and their special life situations necessitate an increasing need for consultation on the topics of quality of life and recurrence prophylaxis. This consultation is often associated with aspects of complementary medicine and also social medicine, which are becoming increasingly more important in the long-term care of patients. This article presents the scientifically proven knowledge on the aspects of nutrition, sport, nicotine abuse and professional rehabilitation and their importance for the course of cancer diseases.
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Affiliation(s)
- U Seifart
- Klinik Sonnenblick, Akademisches Lehrkrankenhaus der Universität Marburg, Baldinger Str. 1-6, 35043, Marburg, Deutschland.
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25
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Smoking and survival in male breast cancer patients. Breast Cancer Res Treat 2015; 153:679-87. [DOI: 10.1007/s10549-015-3582-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/19/2015] [Indexed: 10/23/2022]
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26
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Active and passive cigarette smoking and mortality among Hispanic and non-Hispanic white women diagnosed with invasive breast cancer. Ann Epidemiol 2015; 25:824-31. [PMID: 26387598 DOI: 10.1016/j.annepidem.2015.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/06/2015] [Accepted: 08/17/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE Women who smoke at breast cancer diagnosis have higher risk of breast cancer-specific and all-cause mortality than nonsmokers; however, differences by ethnicity or prognostic factors and risk for noncancer mortality have not been evaluated. METHODS We examined associations of active and passive smoke exposure with mortality among Hispanic (n = 1020) and non-Hispanic white (n = 1198) women with invasive breast cancer in the Breast Cancer Health Disparities Study (median follow-up of 10.6 years). RESULTS Risk of breast cancer-specific (HR = 1.55, 95% CI = 1.11-2.16) and all-cause (HR = 1.68, 95% CI = 1.30-2.17) mortality was increased for current smokers, with similar results stratified by ethnicity. Ever smokers had an increased risk of noncancer mortality (HR = 1.68, 95% CI = 1.12-2.51). Associations were strongest for current smokers who smoked for 20 years or more were postmenopausal, overweight and/or obese, or reported moderate and/or high alcohol consumption; however, interactions were not significant. Breast cancer-specific mortality was increased two fold for moderate and/or high recent passive smoke exposure among never smokers (HR = 2.12, 95% CI = 1.24-3.63). CONCLUSIONS Findings support associations of active-smoking and passive-smoking diagnosis with risk of breast cancer-specific and all-cause mortality and ever smoking with noncancer mortality, regardless of ethnicity, and other factors. Smoking is a modifiable lifestyle factor and effective smoking cessation, and maintenance programs should be routinely recommended for women with breast cancer.
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27
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Kakugawa Y, Kawai M, Nishino Y, Fukamachi K, Ishida T, Ohuchi N, Minami Y. Smoking and survival after breast cancer diagnosis in Japanese women: A prospective cohort study. Cancer Sci 2015; 106:1066-74. [PMID: 26052951 PMCID: PMC4556397 DOI: 10.1111/cas.12716] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 12/20/2022] Open
Abstract
The results of previous studies investigating whether there is an association between active smoking and risk of death among breast cancer patients have been inconsistent. We investigated the association between active and passive smoking and risk of all-cause and breast cancer-specific death among female breast cancer patients in relation to menopausal and tumor estrogen/progesterone receptor (ER/PR) status. The present study included 848 patients admitted to a single hospital in Japan from 1997 to 2007. Active or passive smoking status was assessed using a self-administered questionnaire. The patients were followed until 31 December 2010. We used a Cox proportional-hazard model to estimate hazard ratios (HR). During a median follow-up period of 6.7 years, 170 all-cause and 132 breast cancer-specific deaths were observed. Among premenopausal patients, current smokers showed a non-significant higher risk of all-cause and breast cancer-specific death. A duration of smoking >21.5 years was positively associated with all-cause (HR = 3.09, 95% confidence interval [CI], 1.17–8.20) and breast cancer-specific death (HR = 3.35, 95% CI: 1.22–9.23, Ptrend = 0.035) among premenopausal patients. In premenopausal patients with ER+ or PR+ tumors, there was some suggestion that a longer duration of smoking was associated with higher risk of all-cause and breast cancer-specific death. Passive smoking demonstrated no significant risk. Our results suggest that a longer duration of active smoking is associated with an increased risk of all-cause and breast cancer-specific death among premenopausal patients, possibly with hormonal receptor-positive tumors. Breast cancer patients should be informed about the importance of smoking cessation.
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Affiliation(s)
- Yoichiro Kakugawa
- Department of Breast Oncology, Miyagi Cancer Center Hospital, Miyagi, Japan
| | - Masaaki Kawai
- Department of Breast Oncology, Miyagi Cancer Center Hospital, Miyagi, Japan.,Division of Community Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yoshikazu Nishino
- Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, Miyagi, Japan
| | | | - Takanori Ishida
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriaki Ohuchi
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuko Minami
- Division of Community Health, Tohoku University Graduate School of Medicine, Miyagi, Japan.,Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, Miyagi, Japan
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Newton-Bishop JA, Davies JR, Latheef F, Randerson-Moor J, Chan M, Gascoyne J, Waseem S, Haynes S, O'Donovan C, Bishop DT. 25-Hydroxyvitamin D2 /D3 levels and factors associated with systemic inflammation and melanoma survival in the Leeds Melanoma Cohort. Int J Cancer 2015; 136:2890-9. [PMID: 25403087 PMCID: PMC4397121 DOI: 10.1002/ijc.29334] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/30/2014] [Indexed: 01/12/2023]
Abstract
Lower 25-hydroxyvitamin D2 /D3 levels at melanoma diagnosis are associated with thicker primaries and poorer survival. We postulated that this might relate to the deleterious effect of systemic inflammation as 25-hydroxyvitamin D2 /D3 levels are inversely associated with levels of C-reactive protein. 2,182 participants in the Leeds Melanoma Cohort (median follow-up 7.98 years) provided data on drug exposure, comorbidities and a serum 25-hydroxyvitamin D2 /D3 level at recruitment. Factors reported to modify systemic inflammation (low vitamin D levels, high body mass index, use of aspirin or nonsteroidal anti-inflammatory drugs or smoking were tested as predictors of microscopic ulceration (in which primary tumors are inflamed) and melanoma-specific survival (MSS). Ulceration was independently associated with lower 25-hydroxyvitamin D2 /D3 levels (odds ratio (OR) = 0.94 per 10 nmol/L, 95% CI 0.88-1.00, p = 0.05) and smoking at diagnosis (OR = 1.47, 95% CI 1.00-2.15, p = 0.04). In analyses adjusted for age and sex, a protective effect was seen of 25-hydroxyvitamin D2 /D3 levels at diagnosis on melanoma death (OR = 0.89 per 10 nmol/L, 95% CI 0.83-0.95, p < 0.001) and smoking increased the risk of death (OR = 1.13 per 10 years, 95% CI 1.05-1.22, p = 0.001). In multivariable analyses (adjusted for tumor thickness) the associations with death from melanoma were low 25-hydroxyvitamin D2 /D3 level at recruitment (<20 nmol/L vs. 20-60 nmol/L, hazard ratio (HR) = 1.52, 95% CI 0.97-2.40, p = 0.07) and smoking duration at diagnosis (HR = 1.11, 95% CI 1.03-1.20, p = 0.009). The study shows evidence that lower vitamin D levels and smoking are associated with ulceration of primary melanomas and poorer MSS. Further analyses are necessary to understand any biological mechanisms that underlie these findings.
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Affiliation(s)
- Julia A Newton-Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
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Smoking and survival in female breast cancer patients. Breast Cancer Res Treat 2015; 150:395-403. [PMID: 25724306 DOI: 10.1007/s10549-015-3317-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to determine if smoking affects survival in female breast cancer patients, both overall and stratified by race, ethnicity, and socioeconomic status. We linked data from the 1996-2007 Florida cancer data system, the Florida Agency for Health Care Administration, and the U.S. census. Inclusion criteria were females ≥18 years, diagnosed with breast cancer, and residing in Florida (n = 127,754). To analyze the association between smoking and survival, we performed sequential multivariate Cox proportional hazard regression models with progressive adjustment for main confounders. Compared to never smokers, worse survival was found in current (hazard ratio 1.33; 95 % CI 1.28-1.38) and former smokers (1.09; 1.06-1.13). Those who smoked <1, 1-2, and >2 packs/day had worse survival (HR 1.28; 1.20-1.36; HR 1.40; 1.33-1.47 and 1.70; 1.45-1.99, respectively) (p for linear trend <0.001), than never smokers. Among Whites, current and former smokers had worse survival (HR 1.38; 1.33-1.44 and HR 1.11; 1.07-1.15, respectively) than never smokers. Worse survival was also found for current and former smokers (HR 1.34; 1.29-1.40 and HR 1.10; 1.06-1.15, respectively) compared with never smokers among non-Hispanics; similarly, worse survival was found among current Hispanic smokers (HR 1.13; 1.01-1.26). The association was not significant for Blacks. Current smoking is associated with worse survival in White breast cancer patients and through all socioeconomic status categories and ethnicities compared to never smoking. Former smoking is associated with worse survival in White and non-Hispanic females. Blacks had similar survival regardless of smoking status. Nonetheless, all female breast cancer patients should be advised to quit smoking.
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Izano M, Satariano WA, Hiatt RA, Braithwaite D. Smoking and mortality after breast cancer diagnosis: the health and functioning in women study. Cancer Med 2014; 4:315-24. [PMID: 25511535 PMCID: PMC4329014 DOI: 10.1002/cam4.359] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 11/06/2022] Open
Abstract
We examined the effect of smoking on long-term mortality from breast cancer and other causes among a cohort of women with breast cancer. A total of 975 women diagnosed with breast cancer and aged 40-84 years were followed for a median follow-up of 11 years in the U.S. Health and Functioning in Women (HFW) study. The impact of the individual smoking status and smoking intensity reported in the first few months following breast cancer diagnosis on the risk of mortality from breast cancer and other causes was examined using Cox proportional hazards models. In this study, former smoking was associated with increased risk of other-cause mortality (hazard ratio [HR] = 1.47, 95% confidence interval [CI]: 1.13-1.90), and the risk doubled with increased intensity (HR for <50 pack-years [py]: 1.36, 95% CI: 1.03-1.79; HR for ≥50 py: 2.45, 95% CI: 1.41-4.23). Current smoking (HR = 2.45, 95% CI: 1.81-3.32) and each additional 10 py smoked (HR = 1.16, 95% CI: 1.11-1.22) were associated with statistically significant increases in the risk of other-cause mortality. The effect of current smoking on other-cause mortality decreased with advancing stage and increasing body mass index (BMI). Breast cancer-specific mortality was associated with current smoking of ≥50 py (HR = 2.36, 95% CI: 1.26-4.44), and each additional 10 py smoked (HR = 1.07, 95% CI: 1.01-1. 14). Current smoking, but not former smoking, was associated with increased risk of breast cancer-specific mortality in women with local disease (HR = 2.32, 95% CI: 1.32-4.09), but not in those with regional and distant disease (HR = 1.10, 95% CI: 0.73-1.68). Our findings suggest that current smoking at the time of breast cancer diagnosis may be associated with increased risk of breast-cancer specific and other-cause mortality, whereas former smoking is associated with increased risk of other-cause mortality. Smoking cessation at the time of diagnosis may lead to better prognosis among women with breast cancer.
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Affiliation(s)
- Monika Izano
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California; School of Public Health, University of California, Berkeley, California
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Sitas F, Weber MF, Egger S, Yap S, Chiew M, O'Connell D. Smoking Cessation After Cancer. J Clin Oncol 2014; 32:3593-5. [DOI: 10.1200/jco.2014.55.9666] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Freddy Sitas
- Cancer Council New South Wales, Wooloomooloo; University of Sydney, Camperdown; and University of New South Wales, Kensington, New South Wales, Australia
| | - Marianne F. Weber
- Cancer Council New South Wales, Wooloomooloo; and University of Sydney, Camperdown, New South Wales, Australia
| | - Sam Egger
- Cancer Council New South Wales, Wooloomooloo, New South Wales, Australia
| | - Sarsha Yap
- Cancer Council New South Wales, Wooloomooloo, New South Wales, Australia
| | - May Chiew
- Cancer Council New South Wales, Wooloomooloo, New South Wales, Australia
| | - Dianne O'Connell
- Cancer Council New South Wales, Wooloomooloo; University of Sydney, Camperdown; University of New South Wales, Kensington; and University of Newcastle, Callaghan, New South Wales, Australia
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Gritz ER, Toll BA, Warren GW. Tobacco use in the oncology setting: advancing clinical practice and research. Cancer Epidemiol Biomarkers Prev 2014; 23:3-9. [PMID: 24420982 DOI: 10.1158/1055-9965.epi-13-0896] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although tobacco is a well-established causal agent for many human cancers, less emphasis has been placed on translating this evidence by evaluating the effects of continued tobacco use after a cancer diagnosis. A broad assessment of the effects of continued tobacco use demonstrates that tobacco increases cancer treatment toxicity, recurrence, second primary tumors, and mortality in patients with cancer. Few studies report the potential benefits of cessation after a cancer diagnosis, but data suggest improved treatment outcomes in patients with cancer who quit smoking. Improving tobacco cessation treatment efficacy and access to cessation support has been sparsely researched in the oncology setting compared with the general population; however, patients with cancer are receptive to standard evidence-based tobacco cessation guidelines. Several studies demonstrate moderate tobacco cessation success in patients with cancer using the general principles of evidence-based tobacco cessation support. Several systems-level issues and research efforts are needed to standardize tobacco use definitions, increase access to tobacco cessation support, improve tobacco cessation efficacy, understand the time-dependent effects of tobacco and cessation on cancer biology, and realize the potential benefits of tobacco cessation for patients with cancer.
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Affiliation(s)
- Ellen R Gritz
- Authors' Affiliations: The University of Texas MD Anderson Cancer Center, Houston, Texas; Yale University School of Medicine; Yale Cancer Center; Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut; and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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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; 3:1448-57. [PMID: 25073713 PMCID: PMC4302695 DOI: 10.1002/cam4.304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/23/2014] [Accepted: 06/11/2014] [Indexed: 12/30/2022] Open
Abstract
Several recent cohort studies have found an association between smoking and breast cancer, but the association between lifetime smoking exposure and breast cancer mortality is less well described. We examined whether smoking before breast cancer diagnosis is a predictor of breast cancer mortality in a large cohort with more than 4.1 million years of follow-up, with a special focus on women who initiated smoking before first childbirth. Information on smoking status was collected before breast cancer diagnosis and used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of breast cancer mortality in a cohort of 302,865 Norwegian women with 1106 breast cancer deaths. Women were enrolled between 1974 and 2003 and followed up through linkages to national registries until 31 December 2007. We found that breast cancer mortality was slightly but significantly increased for current (HR = 1.15, 95% CI 1.01-1.32) and ever (HR = 1.15, 95% CI 1.02-1.30) smokers as compared to never smokers. No statistically significantly increased mortality was found for women who initiated smoking before first childbirth, and no dose-response association was revealed for any of the different measures of smoking exposure. A large proportion of heavy smokers may have died from other causes than breast cancer during follow-up, possibly diluting our results. This study found that lifetime smoking exposure had a significantly increased risk of breast cancer mortality compared with never smokers.
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Affiliation(s)
- Eivind Bjerkaas
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of NorwayN-9037, Tromsø, Norway
| | - Ranjan Parajuli
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of NorwayN-9037, Tromsø, Norway
| | - Anders Engeland
- Division of Epidemiology, Department of Pharmacoepidemiology, Norwegian Institute of Public HealthOslo, Norway
- Department of Global Public Health and Primary Care, University of BergenBergen, Norway
| | | | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of NorwayN-9037, Tromsø, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholm, Sweden
- Department of Genetic Epidemiology, Folkhälsan Research Center, Samfundet FolkhälsanHelsinki, Finland
- Department of Research, Cancer Registry of NorwayOslo, Norway
| | - Inger Torhild Gram
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of NorwayN-9037, Tromsø, Norway
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North NorwayTromsø, Norway
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Taira N, Arai M, Ikeda M, Iwasaki M, Okamura H, Takamatsu K, Yamamoto S, Ohsumi S, Mukai H. The Japanese Breast Cancer Society clinical practice guideline for epidemiology and prevention of breast cancer. Breast Cancer 2014; 22:16-27. [DOI: 10.1007/s12282-014-0555-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/14/2014] [Indexed: 12/29/2022]
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Pre-diagnostic smoking behaviour and poorer prognosis in a German breast cancer patient cohort – Differential effects by tumour subtype, NAT2 status, BMI and alcohol intake. Cancer Epidemiol 2014; 38:419-26. [DOI: 10.1016/j.canep.2014.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/14/2014] [Accepted: 05/18/2014] [Indexed: 11/21/2022]
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Karam-Hage M, Cinciripini PM, Gritz ER. Tobacco use and cessation for cancer survivors: an overview for clinicians. CA Cancer J Clin 2014; 64:272-90. [PMID: 24817674 PMCID: PMC4377321 DOI: 10.3322/caac.21231] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 01/01/2023] Open
Abstract
Approximately 30% of all cancer deaths in the United States are caused by tobacco use and smoking. Cancers of eighteen sites have been causally linked to smoking, the most common of which are the lung, head and neck, bladder, and esophagus. While quit rates and quit attempt rates are relatively high shortly after a cancer diagnosis, the recidivism rates are also high. Therefore, screening, treating, and preventing relapse to tobacco use is imperative among patients with and survivors of cancer. To date, research has consistently shown that a combination of pharmacologic and behavioral interventions is needed to achieve the highest smoking cessation rates, with a recent emphasis on individualized treatment as a most promising approach. Challenges in health care systems, including the lack of appropriate resources and provider training, have slowed the progress in addition to important clinical considerations relevant to the treatment of tobacco dependence (eg, a high degree of comorbidity with psychiatric disorders and other substance use disorders). However, continued tobacco use has been shown to limit the effectiveness of major cancer treatments and to increase the risk of complications and of developing secondary cancers. The authors recommend that oncology providers screen all patients for tobacco use and refer users to specialized treatment when available. Alternatively, oncology clinicians can provide basic advice on tobacco use cessation and pharmacotherapy and/or referral to outside resources (eg, quitlines). Herein, the authors summarize the current knowledge on tobacco use and its treatment, with a focus on the related available evidence for patients with and survivors of cancer.
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Affiliation(s)
- Maher Karam-Hage
- Associate Professor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul M. Cinciripini
- Professor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ellen R. Gritz
- Professor and Chair, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bérubé 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:R42. [PMID: 24745601 PMCID: PMC4053238 DOI: 10.1186/bcr3646] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/02/2014] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In women with breast cancer who smoke, it is unclear whether smoking could impair their survival from the disease. METHODS We examined the relation of smoking at diagnosis to breast cancer-specific and overall survival among 5,892 women with invasive breast cancer treated in one Canadian center (1987 to 2008). Women were classified as never, former or current smokers. Current smokers were further classified according to total, intensity and duration of smoking. Deaths were identified through linkage to population mortality data. Cox proportional-hazards multivariate models were used. A systematic review with meta-analysis combines new findings with published results. RESULTS Compared with never smokers, current smokers at diagnosis had a slightly, but not statistically significant, higher breast cancer-specific mortality (hazard ratio = 1.15, 95% confidence interval (CI): 0.97 to 1.37). Among current smokers, breast cancer-specific mortality increased with total exposure to, intensity and duration of smoking (all Ptrend <0.05). Compared to never smokers, breast cancer-specific mortality was 32 to 56% higher among heavy smokers (more than 30 pack years of smoking, more than 20 cigarettes per day or more than 30 years of smoking). Smoking at diagnosis was associated with an increased all-cause mortality rate. A meta-analysis of all studies showed a statistically significant, 33% increased mortality from breast cancer in women with breast cancer who are smokers at diagnosis compared to never smokers (hazard ratio = 1.33, 95% CI: 1.12 to 1.58). CONCLUSIONS Available evidence to date indicates that smoking at diagnosis is associated with a reduction of both overall and breast cancer-specific survival. Studies of the effect of smoking cessation after diagnosis on breast cancer-specific outcomes are needed.
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Affiliation(s)
- Sylvie Bérubé
- Centre des maladies du sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, Qc G1S 4 L8, Canada
- Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Québec, Canada
| | - Julie Lemieux
- Centre des maladies du sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, Qc G1S 4 L8, Canada
- Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Québec, Canada
- Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
- Département de médecine et Service d’hémato-oncologie, CHU de Québec, Québec, Canada
| | - Lynne Moore
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada
- Unité de traumatologie-urgence-soins intensifs, CHU de Québec, Québec, Canada
| | - Elizabeth Maunsell
- Centre des maladies du sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, Qc G1S 4 L8, Canada
- Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Québec, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada
| | - Jacques Brisson
- Centre des maladies du sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, Qc G1S 4 L8, Canada
- Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Québec, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada
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Izano MA, Fung TT, Chiuve SS, Hu FB, Holmes MD. Are diet quality scores after breast cancer diagnosis associated with improved breast cancer survival? Nutr Cancer 2014; 65:820-6. [PMID: 23909725 DOI: 10.1080/01635581.2013.804939] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Previous studies have found that diets rich in fruits and vegetables are associated with reduced breast cancer mortality. However, these eating patterns do not necessarily reflect overall diet quality. The association of breast cancer mortality with a priori defined dietary scores, which are based on recommended dietary guidelines and reflect diet quality, has not been evaluated. We hypothesized that diet quality indices based on recommended guidelines are associated with decreased risk of breast cancer and nonbreast cancer mortality in breast cancer survivors. We examined the association between the Dietary Approaches to Stop Hypertension (DASH) score, and the Alternative Healthy Eating Index (AHEI)-2010, and the risk of breast cancer mortality and total mortality among women from the Nurses' Health Study diagnosed with breast cancer. Adherence to DASH-style and AHEI-2010 diets were associated with reduced risk of nonbreast cancer mortality (comparing the fifth quintile with the first quintile, relative risk (RR) = 0.72, 95% confidence interval (CI): 0.53-0.99, P trend = 0.03 for DASH, and RR = 0.57, 95% CI: 0.42-0.77, P trend <0.0001 for AHEI-2010). Diet scores were not significantly associated with breast cancer mortality. Our findings suggest that adherence to a higher quality diet after breast cancer diagnosis does not considerably change the risk of breast cancer death and recurrence. However, healthy dietary choices after breast cancer were associated with reduced risk of nonbreast cancer mortality in women with breast cancer.
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Affiliation(s)
- Monika A Izano
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Smoking and breast cancer recurrence after breast conservation therapy. Int J Breast Cancer 2014; 2014:327081. [PMID: 24693439 PMCID: PMC3947862 DOI: 10.1155/2014/327081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/19/2013] [Indexed: 11/21/2022] Open
Abstract
Background. Prior studies have shown earlier recurrence and decreased survival in patients with head and neck cancer who smoked while undergoing radiation therapy. The purpose of the current study was to determine whether smoking status at the time of partial mastectomy and radiation therapy for breast cancer affected recurrence or survival. Method. A single institution retrospective chart review was performed to correlate smoking status with patient demographics, tumor characteristics, and outcomes for patients undergoing partial mastectomy and radiation therapy. Results. There were 624 patients who underwent breast conservation surgery between 2002 and 2010 for whom smoking history and follow-up data were available. Smoking status was associated with race, patient age, and tumor stage, but not with grade, histology, or receptor status. African American women were more likely to be current smokers (22% versus 7%, P < 0.001). With a mean follow-up of 45 months, recurrence was significantly higher in current smokers compared to former or never smokers (P = 0.039). In a multivariate model adjusted for race and tumor stage, recurrence among current smokers was 6.7 times that of never smokers (CI 2.0–22.4). Conclusions. Although the numbers are small, this study suggests that smoking may negatively influence recurrence rates after partial mastectomy and radiation therapy. A larger study is needed to confirm these observations.
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Pierce JP, Patterson RE, Senger CM, Flatt SW, Caan BJ, Natarajan L, Nechuta SJ, Poole EM, Shu XO, Chen WY. Lifetime cigarette smoking and breast cancer prognosis in the After Breast Cancer Pooling Project. J Natl Cancer Inst 2013; 106:djt359. [PMID: 24317179 DOI: 10.1093/jnci/djt359] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is controversy on whether former smokers have increased risk for breast cancer recurrence or all-cause mortality, regardless of how much they smoked. METHODS Data were from three US cohorts in the After Breast Cancer Pooling Project, with detailed information on smoking among 9975 breast cancer survivors. Smoking was assessed an average of 2 years after diagnosis. Delayed entry Cox proportional hazards models were used to examine the relationships of smoking status, cigarettes per day, years of smoking, and pack years with breast cancer prognosis. Endpoints included breast cancer recurrence (n = 1727), breast cancer mortality (n = 1059), and overall mortality (n = 1803). RESULTS Compared with never smokers, former smokers with less than 20 pack-years of exposure had no increased risk of any outcome. However, former smokers with 20 to less than 34.9 pack-years of exposure had a 22% increased risk of breast cancer recurrence (hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 1.01 to 1.48) and a 26% increased risk of all-cause mortality (HR = 1.26; 95% CI = 1.07 to 1.48). For former smokers with 35 or more pack-years of exposure, the probability of recurrence increased by 37% (HR = 1.37; 95% CI = 1.13 to 1.66), breast cancer mortality increased by 54% (HR = 1.54; 95% CI = 1.24 to 1.91), and all-cause mortality increased by 68% (HR = 1.68; 95% CI = 1.44 to 1.96). Current smoking increased the probability of recurrence by 41% (HR = 1.41; 95% CI = 1.16 to 1.71), increased breast cancer mortality by 60% (HR = 1.61; 95% CI = 1.28 to 2.03), and doubled the risk of all-cause mortality (HR = 2.17; 95% CI = 1.85 to 2.54). CONCLUSIONS Lifetime cigarette smoking was statistically significantly associated with a poor prognosis among women diagnosed with breast cancer, dose-dependent increased risks of recurrence, and breast cancer and all-cause mortality.
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Affiliation(s)
- John P Pierce
- Affiliations of authors: Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California-San Diego, La Jolla, CA (JPP, REP, CMS, SWF, LN); Division of Research, Kaiser Permanente, Oakland, CA (BJC); Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (SJN, X-OS); Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (EMP, WYC); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (WYC)
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Saquib N, Stefanick ML, Natarajan L, Pierce JP. Mortality risk in former smokers with breast cancer: pack-years vs. smoking status. Int J Cancer 2013; 133:2493-7. [PMID: 23649774 DOI: 10.1002/ijc.28241] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/15/2013] [Indexed: 01/17/2023]
Abstract
It is unclear why successful quitting at time of breast cancer diagnosis should remove risk from a significant lifetime of smoking. Studies concluding this may be biased by how smoking is measured in many epidemiological cohorts. In the late 1990s, a randomized trial of diet and breast cancer outcomes enrolled early-stage female breast cancer survivors diagnosed within the previous 4 years. Smoking history and key covariate measures were available at study entry for 2,953 participants. Participants were followed for an average of 7.3 years (96% response rate). There were 10.1% deaths (83% from breast cancer). At enrollment, 55.2% were never smokers, 41.2% former smokers and 4.6% current smokers. Using current smoking status in a Cox regression, there was no increased risk for former smokers for either all-cause mortality [hazard ratio (HR) = 1.11; 95% confidence interval (CI) = 0.87-1.41; p-value = 0.42) or breast cancer mortality. However, when we categorized on extensive lifetime exposure, former smokers with 20+ pack-years of smoking (25.8%) had a significantly higher risk of both all-cause (HR = 1.77; 95% CI = 1.17-2.48; p-value = 0.0007) and breast cancer-specific mortality (HR = 1.62; 95% CI = 1.11-2.37; p-value = 0.01). Lifetime smoking exposure, not current status, should be used to assess mortality risk among former smokers.
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Affiliation(s)
- Nazmus Saquib
- Stanford Prevention Research Center, Stanford University, Stanford, CA
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Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women. Am J Clin Oncol 2013; 36:181-7. [PMID: 22314001 DOI: 10.1097/coc.0b013e3182436ec1] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Although clinical trials have demonstrated the benefit of adjuvant hormonal therapy for hormone receptor-positive breast cancer, it is not known whether poor medication adherence might impact outcomes, particularly in the context of a low-income population traditionally underrepresented in clinical trials. We explored the relationship between adherence to tamoxifen or selective aromatase inhibitors with cancer recurrence and death in a low-income, Medicaid-insured population. METHODS Using a Medicaid claims-tumor registry and National Death Index data, we evaluated adherence to adjuvant hormonal therapy [defined by the medication possession ratio (MPR)], cancer recurrence, and cancer-specific survival for female breast cancer diagnosed from 1998 to 2002, in North Carolina. Multivariate Cox proportional hazards models and logistic regression models were used to examine the role of adherence on cancer recurrence and survival. RESULTS The sample consisted of 857 cases, mean age 67.7 years, 56.9% white, 60.9% local stage, with a mean follow-up of 4.4 years. Mean first-year MPR was 77%. MPR adherence was not significantly associated with cancer-related death [adjusted hazards ratio=1.18 (95% confidence interval, 0.54-2.59)], or recurrence [adjusted odds ratio=1.49 (95% confidence interval, 0.78-2.84)]. There was also no significant interaction between adherence and use of concurrent CYP2D6 enzyme inhibitors. DISCUSSION Hormonal therapy adherence was not associated with breast cancer outcomes in this low-income population with relatively poor adherence. Although suboptimal adherence is considered to be an important clinical problem, its effects on breast cancer outcomes may be masked by patient genetic profiles, tumor characteristics, and behavioral factors.
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Social networks, social support mechanisms, and quality of life after breast cancer diagnosis. Breast Cancer Res Treat 2013; 139:515-27. [PMID: 23657404 DOI: 10.1007/s10549-013-2477-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 03/06/2013] [Indexed: 10/26/2022]
Abstract
We examined mechanisms through which social relationships influence quality of life (QOL) in breast cancer survivors. This study included 3,139 women from the Pathways Study who were diagnosed with breast cancer from 2006 to 2011 and provided data on social networks (the presence of a spouse or intimate partner, religious/social ties, volunteering, and numbers of close friends and relatives), social support (tangible support, emotional/informational support, affection, positive social interaction), and QOL, measured by the FACT-B, approximately 2 months post diagnosis. We used logistic models to evaluate associations between social network size, social support, and lower versus higher than median QOL scores. We further stratified by stage at diagnosis and treatment. In multivariate-adjusted analyses, women who were characterized as socially isolated had significantly lower FACT-B (OR = 2.18, 95 % CI: 1.72-2.77), physical well-being (WB) (OR = 1.61, 95 % CI: 1.27-2.03), functional WB (OR = 2.08, 95 % CI: 1.65-2.63), social WB (OR = 3.46, 95 % CI: 2.73-4.39), and emotional WB (OR = 1.67, 95 % CI: 1.33-2.11) scores and higher breast cancer symptoms (OR = 1.48, 95 % CI: 1.18-1.87) compared with socially integrated women. Each social network member independently predicted higher QOL. Simultaneous adjustment for social networks and social support partially attenuated associations between social networks and QOL. The strongest mediator and type of social support that was most predictive of QOL outcomes was "positive social interaction." However, each type of support was important depending on outcome, stage, and treatment status. Larger social networks and greater social support were related to higher QOL after a diagnosis of breast cancer. Effective social support interventions need to evolve beyond social-emotional interventions and need to account for disease severity and treatment status.
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Braithwaite D, Izano M, Moore DH, Kwan ML, Tammemagi MC, Hiatt RA, Kerlikowske K, Kroenke CH, Sweeney C, Habel L, Castillo A, Weltzien E, Caan B. Smoking and survival after breast cancer diagnosis: a prospective observational study and systematic review. Breast Cancer Res Treat 2012; 136:521-33. [PMID: 23053660 DOI: 10.1007/s10549-012-2276-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 09/21/2012] [Indexed: 11/28/2022]
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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Affiliation(s)
- Dejana Braithwaite
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
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Weaver KE, Danhauer SC, Tooze JA, Blackstock AW, Spangler J, Thomas L, Sutfin EL. Smoking cessation counseling beliefs and behaviors of outpatient oncology providers. Oncologist 2012; 17:455-62. [PMID: 22334454 DOI: 10.1634/theoncologist.2011-0350] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Many cancer patients continue to smoke after diagnosis, increasing their risk for treatment complications, reduced treatment efficacy, secondary cancers, and reduced survival. Outpatient oncology providers may not be using the "teachable moment" of cancer diagnosis to provide smoking cessation assistance. PROVIDERS AND METHODS: Physicians and midlevel providers (n = 74) who provide outpatient oncology services completed an online survey regarding smoking cessation counseling behaviors, beliefs, and perceived barriers. Outpatient medical records for 120 breast, lung, head and neck, colon, prostate, and acute leukemia cancer patients were reviewed to assess current smoking cessation assessment and intervention documentation practices. RESULTS Providers reported commonly assessing smoking in new patients (82.4% frequently or always), but rates declined at subsequent visits for both current smokers and recent quitters. Rates of advising patients to quit smoking were also high (86.5% frequently or always), but <30% of providers reported frequently or always providing intervention to smoking patients (e.g., nicotine replacement therapy or other medications, self-help materials, and/or referrals). Only 30% of providers reported that they frequently or always followed up with patients to assess progress with quitting. Few providers (18.1%) reported high levels of confidence in their ability to counsel smoking patients. Patients' lack of motivation was identified as the most important barrier to smoking cessation. CONCLUSIONS Although beliefs about providing cessation services to smoking patients were generally positive, few providers reported commonly providing interventions beyond advice to quit. Additional training and clinic-based interventions may improve adherence to tobacco cessation practice guidelines in the outpatient oncology setting.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Wells Fargo Building, 14th Floor, Winston-Salem, North Carolina 27157, USA.
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Variation in breast cancer risk with mutation position, smoking, alcohol, and chest X-ray history, in the French National BRCA1/2 carrier cohort (GENEPSO). Breast Cancer Res Treat 2011; 130:927-38. [PMID: 21761160 DOI: 10.1007/s10549-011-1655-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/22/2011] [Indexed: 01/14/2023]
Abstract
Germline mutations in BRCA1/2 confer a high risk of breast cancer (BC), but the magnitude of this risk varies according to various factors. Although controversial, there are data to support the hypothesis of allelic-risk heterogeneity. We assessed variation in BC risk according to the location of mutations recorded in the French study GENEPSO. Since the women in this study were selected from high-risk families, oversampling of affected women was eliminated by using a weighted Cox-regression model. Women were censored at the date of diagnosis when affected by any cancer, or the date of interview when unaffected. A total of 990 women were selected for the analysis: 379 were classified as affected, 611 as unaffected. For BRCA1, there was some evidence of a central region where the risk of BC is lower (codons 374-1161) (HR = 0.59, P = 0.04). For BRCA2, there was a strong evidence for a region at decreased risk (codons 957-1827) (HR = 0.35, P = 0.005) and for one at increased risk (codons 2546-2968) (HR = 3.56, P = 0.01). Moreover, we found an important association between radiation exposure from chest X-rays and BC risk (HR = 4.29, P < 10(-3)) and a positive association between smoking more than 21 pack-years and BC risk (HR = 2.09, P = 0.04). No significant variation in BC risk associated with chest X-ray exposure, smoking, and alcohol consumption was found according to the location of the mutation in BRCA1 and BRCA2. Our findings are consistent with those suggesting that the risk of BC is lower in the central regions of BRCA1/2. A new high-risk region in BRCA2 is described. Taking into account environmental and lifestyle modifiers, the location of mutations might be important in the clinical management of BRCA mutation carriers.
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The prognostic factors of chest wall metastasis resection. Eur J Cardiothorac Surg 2011; 40:328-33. [PMID: 21466960 DOI: 10.1016/j.ejcts.2010.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 12/10/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Limited data exist regarding the outcomes after resection of pure hematogenous chest wall (CW) metastases. Therefore, we reviewed our 17 years' experience to determine clinically relevant factors. METHODS A retrospective review of all patients who underwent CW metastasectomy (other than breast cancer) from October 1991 to August 2008 at a single institution was performed. Post-CW metastasectomy survival curves were estimated by the Kaplan-Meier method and compared using log-rank test. Factors predictive of improved survival were determined by univariable and multivariable Cox proportional hazard regression analysis. RESULTS A total of 90 CW metastasectomies were performed on 79 patients (33 females and 46 males). The median follow-up period was 25.6 months. Operative mortality was 1.1%. The 5-year survival was 40%. Significant factors after multivariable analysis were margin status, histology, and a history of heavy smoking (≥ 20 pack years). Microscopically positive margin (P=0.01; hazard ratio (HR) 2.85; 95% confidence interval (CI) 1.28-6.35) and grossly positive margin (P<0.01; HR 9.55; 95% CI 2.60-35.1) fared worse. Compared with carcinoma, sarcoma (P<0.01; HR 3.9; 95% CI 1.7-9.2) and melanoma (P<0.01; HR 6.4; 95% CI 1.7-24) had worse survival. A history of heavy smoking diminished survival (P<0.01; HR 3.7; 95% CI 1.6-8.4). CONCLUSIONS The resection of CW metastases in highly selected patients as a part of multimodality treatment has low risk and is associated with prolonged survival. The margin status and histology are significant factors in the survival after CW metastasectomy. In addition, heavy smoking history also has a significant negative impact on survival.
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Hu R, Dawood S, Holmes MD, Collins LC, Schnitt SJ, Cole K, Marotti JD, Hankinson SE, Colditz GA, Tamimi RM. Androgen receptor expression and breast cancer survival in postmenopausal women. Clin Cancer Res 2011; 17:1867-74. [PMID: 21325075 DOI: 10.1158/1078-0432.ccr-10-2021] [Citation(s) in RCA: 270] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Androgen receptor (AR) is commonly expressed in breast cancers. However, the association between tumor AR status and breast cancer survival is uncertain. Hence, we examined the association between AR status and breast cancer survival in the Nurses' Health Study (NHS). EXPERIMENTAL DESIGN It was a prospective study of postmenopausal women enrolled in the Nurses' Health Study with stage I to III breast cancer diagnosed between 1976 and 1997 and followed from the date of diagnosis until January 1, 2008 or death. Analyses were conducted using Kaplan-Meier methods and Cox proportional hazard models, to determine the association of AR status with survival outcomes adjusting for covariates. RESULTS Among 1467 breast cancers, 78.7% were AR-positive (AR+). Among 1,164 estrogen receptor (ER)-positive cases, 88.0% were AR+. AR positivity was associated with a significant reduction in breast cancer mortality (HR, 0.68; 95% CI, 0.47-0.99) and overall mortality (HR, 0.70; 95% CI, 0.53-0.91) after adjustment for covariates. In contrast, among women with ER-negative tumors (303 cases), 42.9% were AR+. There was a nonsignificant association between AR status and breast cancer death (HR, 1.59; 95% CI, 0.94-2.68). CONCLUSIONS The association of AR status and breast cancer survival is dependent on ER status. In particular, AR expression was associated with a more favorable prognosis among women with ER-positive tumors. Thus, determination of AR status may provide additional information on prognosis for postmenopausal women with breast cancer, and provide novel opportunities for targeted therapy.
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Affiliation(s)
- Rong Hu
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Modifiable risk factors and survival in women diagnosed with primary breast cancer: results from a prospective cohort study. Eur J Cancer Prev 2010; 19:366-73. [PMID: 20502344 DOI: 10.1097/cej.0b013e32833b4828] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examines the impact of smoking, body mass index, alcohol consumption, hormone replacement therapy, and physical activity on all-cause mortality among 528 Danish women diagnosed with primary breast cancer. Participants were women enrolled in the Copenhagen City Heart Study. Prospective self-reported exposure information was collected from four points of follow-up in 1976-1978, 1981-1983, 1991-1994, and 2001-2003. Kaplan-Meier survival curves and multivariate Cox regression analyses were performed adjusting for age, disease stage, adjuvant treatment, menopausal status, parity, alcohol intake, smoking, physical activity, body mass index, and hormone replacement therapy. The study shows that smoking for total mortality [hazard ratio, 1.16; 95% confidence interval, 1.05-1.29] and obesity for both total mortality (1.61; 1.12-2.33) and breast cancer-specific mortality (1.82; 1.11-2.99) were significantly associated with decreased survival after breast cancer diagnosis. A moderate alcohol intake of 1-6 units/week (0.85; 0.64-1.12), 7-14 units/week (0.77; 0.56-1.08), and treatment with hormone replacement therapy (0.79; 0.59-1.05) were less than 1, but not statistically significantly associated with prolonged survival. A moderate physical activity of 2-4 h/week (1.07; 0.77-1.49) and a high physical activity of more than 4 h/week (1.00; 0.69-1.45) showed no association with survival after breast cancer diagnosis.
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Song M, Lee KM, Kang D. Breast cancer prevention based on gene-environment interaction. Mol Carcinog 2010; 50:280-90. [DOI: 10.1002/mc.20639] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 03/17/2010] [Accepted: 03/22/2010] [Indexed: 01/18/2023]
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