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Teng YT, Wang YA, Dong YH, Liu JJ. Five-year survival prognosis of young, middle-aged, and elderly adult female invasive breast cancer patients by clinical and lifestyle characteristics. Breast Cancer Res Treat 2024; 205:619-631. [PMID: 38526687 PMCID: PMC11101574 DOI: 10.1007/s10549-024-07280-3] [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: 12/12/2023] [Accepted: 02/07/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Early-onset breast cancer incidence has been increasing globally and in Taiwan. However, previous studies have not comprehensively examined how clinical and lifestyle characteristics influence the 5-year survival of breast cancer diagnosed at different stages of adulthood. METHODS We analyzed the Taiwan National Cancer Registry and Cause of Death datasets to understand how clinical factors (including tumor and treatment characteristics) and lifestyle factors (including body mass index, cigarette smoking, and alcohol consumption) were associated with the 5-year survival of 8471 young, 57,695 middle-aged, and 14,074 elderly female adult invasive breast cancer patients respectively diagnosed at age 20-39, 40-64, and ≥ 65 years between 2002 and 2015, with mortality follow-up to 2020. Poisson regression was used for obtaining the crude and adjusted 5-year survival risk ratios. RESULTS Clinical and lifestyle characteristics were distributed differently but had mostly similar direction of association with 5-year survival for the three age groups. Receiving any treatment was associated with better survival, especially for elderly patients. Being underweight at initial cancer treatment was associated with worse survival than having normal weight, especially for elderly patients. Current smokers had worse survival than never smokers for middle-aged and elderly patients. The 5-year breast cancer-specific survival was not significantly higher for those of age 45-49 years than 40-44 years, despite the recommended starting screening age is 45 years in Taiwan. CONCLUSION Our findings contribute to the understanding of early-onset and later-onset female breast cancer characteristics and prognosis, which may inform surveillance and treatment strategies to achieve better breast cancer prognosis.
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Affiliation(s)
- Yu-Tung Teng
- Institute of Public Health, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei, 112, Taiwan
| | - Yong Alison Wang
- Koo Foundation Sun-Yat Sen Cancer Center, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yaa-Hui Dong
- Institute of Public Health, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei, 112, Taiwan
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jason J Liu
- Institute of Public Health, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei, 112, Taiwan.
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2
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Uong SP, Torres JM, Alexeeff SE, Morey BN, Caan BJ, Kushi LH, Kroenke CH. Differences in Smoking Behavior by Nativity, Race/Ethnicity, and Education among Women Diagnosed with Breast Cancer. Cancer Epidemiol Biomarkers Prev 2024; 33:694-702. [PMID: 38345508 PMCID: PMC11062809 DOI: 10.1158/1055-9965.epi-23-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/22/2023] [Accepted: 02/08/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND We evaluated smoking differences across nativity and race/ethnicity among women diagnosed with breast cancer. METHODS In our Northern Californian pooled population of 5,653 [670 Asian, 690 Hispanic, and 4,300 non-Hispanic White (White)] women diagnosed with breast cancer, we evaluated smoking differences across nativity, race/ethnicity, and acculturation and effect modification of nativity by race/ethnicity and education. RESULTS Foreign-born women currently smoked less than US-born women [odds ratio (OR) = 0.46, 95% confidence limit (CL): 0.29-0.72]. Hispanic (OR = 0.50; 95% CL: 0.32-0.78) women currently smoked less than White women. Among those who ever smoked (n = 2,557), foreign-born women smoked 5.23 fewer pack-years (PY) than US-born women (95% CL: -2.75 to -7.70). Furthermore, Asian (-4.60, 95% CL: -0.81 to -8.39) and Hispanic (-6.79, 95% CL: -4.14 to -9.43) women smoked fewer PY than White women. Associations were generally suggestive of greater smoking with greater acculturation (immigration age, US years, survey language). Finally, associations for nativity differed by education but not race/ethnicity, with a higher likelihood of smoking in US-born women only among those with less than a bachelor's degree (OR = 2.84, 95% CL: 2.15-3.77; current smoking: P = 0.01, PY: P = 0.05). CONCLUSIONS Asian and Hispanic (vs. White) and foreign-born (vs. US-born) breast cancer survivors reported fewer smoking behaviors. Smoking differences across nativity and education were driven by higher rates of smoking in US-born women with lower educational attainment. IMPACT Smoking behavioral patterns were similar among breast cancer survivors and the general population, informing potential smoking interventions.
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Affiliation(s)
- Stephen P. Uong
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | | | - Stacey E. Alexeeff
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | | | - Bette J. Caan
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Lawrence H. Kushi
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Candyce H. Kroenke
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
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3
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Lai YC, Chen YH, Wu YC, Liang FW, Wang JJ, Lim SW, Ho CH. The Association between Smoking and Mortality in Women with Breast Cancer: A Real-World Database Analysis. Cancers (Basel) 2022; 14:cancers14194565. [PMID: 36230488 PMCID: PMC9558950 DOI: 10.3390/cancers14194565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Smoking increases the cancer-specific and overall mortality risk in women with breast cancer (BC). However, the effect of smoking cessation remains controversial, and detailed research is lacking in Asia. We aimed to investigate the association between smoking status and mortality in women with BC using the population-based cancer registry. The Taiwan Cancer Registry was used to identify women with BC from 2011 to 2017. A total of 54,614 women with BC were enrolled, including 1687 smokers and 52,927 non-smokers. The outcome, mortality, was identified using Taiwan’s cause-of-death database. The association between smoking status and mortality was estimated using Cox proportional regression. Women with BC who smoked had a 1.25-fold higher (95% C.I.: 1.08–1.45; p = 0.0022) risk of overall mortality and a 1.22-fold higher (95% C.I.: 1.04–1.44; p = 0.0168) risk of cancer-specific mortality compared with non-smokers. The stratified analysis also indicated that women with BC who smoked showed a significantly higher overall mortality risk (HR: 1.20; 95% CI: 1.01–1.43; p = 0.0408) than women with BC who did not smoke among women without comorbidities. Additionally, current smokers had a 1.57-fold higher risk (95% CI: 1.02–2.42; p = 0.0407) of overall mortality compared with ever smokers among women with BC who smoked. It was shown that a current smoking status is significantly associated with an increase in overall and cancer-specific mortality risk in women with BC. Quitting smoking could reduce one’s mortality risk. Our results underscore the importance of smoking cessation for women with BC.
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Affiliation(s)
- Yi-Chen Lai
- Department of Emergency Medicine, Tainan Municipal AN-NAN Hospital-China Medical University, Tainan City 70965, Taiwan
| | - Yu-Han Chen
- Department of Family Medicine, Tainan Municipal AN-NAN Hospital-China Medical University, Tainan City 70965, Taiwan
| | - Yu-Cih Wu
- Department of Medical Research, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi Mei Medical Center, Chiali, Tainan 722, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan 73658, Taiwan
- Correspondence: (S.-W.L.); (C.-H.H.)
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan 71004, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan
- Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Correspondence: (S.-W.L.); (C.-H.H.)
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4
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Di Sotto A, Gullì M, Minacori M, Mancinelli R, Garzoli S, Percaccio E, Incocciati A, Romaniello D, Mazzanti G, Eufemi M, Di Giacomo S. β-Caryophyllene Counteracts Chemoresistance Induced by Cigarette Smoke in Triple-Negative Breast Cancer MDA-MB-468 Cells. Biomedicines 2022; 10:biomedicines10092257. [PMID: 36140359 PMCID: PMC9496176 DOI: 10.3390/biomedicines10092257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Exposure to cigarette smoke (CS) has been associated with an increased risk of fatal breast cancers and recurrence, along with chemoresistance and chemotherapy impairment. This strengthens the interest in chemopreventive agents to be exploited both in healthy and oncological subjects to prevent or repair CS damage. In the present study, we evaluated the chemopreventive properties of the natural sesquiterpene β-caryophyllene towards the damage induced by cigarette smoke condensate (CSC) in triple negative breast cancer MDA-MB-468 cells. Particularly, we assessed the ability of the sesquiterpene to interfere with the mechanisms exploited by CSC to promote cell survival and chemoresistance, including genomic instability, cell cycle progress, autophagy/apoptosis, cell migration and related pathways. β-Caryophyllene was found to be able to increase the CSC-induced death of MDA-MB-468 cells, likely triggering oxidative stress, cell cycle arrest and apoptosis; moreover, it hindered cell recovery, autophagy activation and cell migration; at last, a marked inhibition of the signal transducer and activator of transcription 3 (STAT3) activation was highlighted: this could represent a key mechanism of the chemoprevention by β-caryophyllene. Although further studies are required to confirm the in vivo efficacy of β-caryophyllene, the present results suggest a novel strategy to reduce the harmful effect of smoke in cancer patients and to improve the survival expectations in breast cancer women.
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Affiliation(s)
- Antonella Di Sotto
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Correspondence: (A.D.S.); (G.M.)
| | - Marco Gullì
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Marco Minacori
- Department of Biochemical Science “A. Rossi Fanelli”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Romina Mancinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Stefania Garzoli
- Department of Chemistry and Technology of Drugs, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Ester Percaccio
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Alessio Incocciati
- Department of Biochemical Science “A. Rossi Fanelli”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Donatella Romaniello
- Department of Biochemical Science “A. Rossi Fanelli”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
| | - Gabriela Mazzanti
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Correspondence: (A.D.S.); (G.M.)
| | - Margherita Eufemi
- Department of Biochemical Science “A. Rossi Fanelli”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Silvia Di Giacomo
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
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5
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Lu Y, Gehr AW, Anikpo I, Meadows RJ, Craten KJ, Narra K, Lingam A, Kamath S, Tanna B, Ghabach B, Ojha RP. Cardiotoxicity among socioeconomically marginalized breast cancer patients. Breast Cancer Res Treat 2022; 195:401-411. [PMID: 35971056 PMCID: PMC9464741 DOI: 10.1007/s10549-022-06695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022]
Abstract
Purpose Evidence of cardiotoxicity risk related to anthracycline or trastuzumab exposure is largely derived from breast cancer cohorts that under-represent socioeconomically marginalized women, who may be at increased risk of cardiotoxicity because of high prevalence of cardiovascular disease risk factors. Therefore, we aimed to estimate cardiotoxicity risk among socioeconomically marginalized breast cancer patients treated with anthracyclines or trastuzumab and describe clinical consequences of cardiotoxicity. Methods We linked electronic health records with institutional registry data from a Comprehensive Community Cancer Program within a safety-net health system. Eligible patients were adult females, diagnosed with first primary invasive breast cancer between 2013 and 2017, and initiated anthracyclines or trastuzumab as part of first-line therapy. We estimated cumulative incidence (risk) of cardiotoxicity with corresponding 95% confidence limits (CL) using the Aalen-Johansen estimator with death as competing risk. Results Our study population comprised 169 women with breast cancer (103 initiated anthracyclines and 66 initiated trastuzumab). Cumulative incidence of cardiotoxicity was 21% (95% CL: 12%, 32%) at one year and 25% (95% CL: 15%, 35%) at three years among women who initiated trastuzumab, whereas cumulative incidence was 3.9% (95% CL: 1.3%, 8.9%) at one year and 5.9% (95% CL: 2.4%, 12%) at three years among women who initiated anthracyclines. More than half of patients with cardiotoxicity experienced interruption of cancer treatment. Conclusion Our findings suggest high risk of cardiotoxicity among socioeconomically marginalized breast cancer patients after initiation of anthracyclines or trastuzumab. Strategies are needed for optimizing cancer treatment effectiveness while minimizing cardiotoxicity in this population. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06695-0.
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Affiliation(s)
- Yan Lu
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Aaron W Gehr
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Ifedioranma Anikpo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rachel J Meadows
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Kevin J Craten
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Kalyani Narra
- Oncology and Infusion Center, JPS Health Network, Fort Worth, TX, USA.,Department of Internal Medicine, TCU School of Medicine, Fort Worth, TX, USA
| | - Anuradha Lingam
- Oncology and Infusion Center, JPS Health Network, Fort Worth, TX, USA
| | - Sandeep Kamath
- Department of Cardiology, JPS Health Network, Fort Worth, TX, USA
| | - Bhavna Tanna
- Department of Family Medicine, JPS Health Network, Fort Worth, TX, USA
| | - Bassam Ghabach
- Oncology and Infusion Center, JPS Health Network, Fort Worth, TX, USA
| | - Rohit P Ojha
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA.
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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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Alkhaifi M, Clayton A, Kishibe T, Simpson JS. The Association Between Smoking Status and Breast Cancer Recurrence: A Systematic Review. J Breast Cancer 2022; 25:278-287. [PMID: 35657004 PMCID: PMC9411030 DOI: 10.4048/jbc.2022.25.e23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/21/2022] [Accepted: 05/08/2022] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To determine whether smoking status (active/passive) affects recurrence events after breast cancer (BC) diagnosis among women. METHODS A comprehensive literature search of MEDLINE, Cochrane Central, EMBASE, and Web of Science databases on smoking status and BC outcomes retrieved 5,940 articles. After reviewing the inclusion and exclusion criteria, we selected 14 articles for a full review and synthesis. RESULTS Five studies were cohort retrospective, 6 were case-control, 2 were prospective cohort studies, and 1 was a secondary analysis of a randomized control trial. Among the 8 articles that focused on active smoking, 6 showed an increased risk of BC recurrence, and 2 showed no evidence of such an association. Studies that examined former smokers found little evidence of an increased risk of BC recurrence. This association may be dose-dependent. CONCLUSION Given the current evidence, although limited, active smokers should quit smoking after BC diagnosis as trends indicate a positive association between active and BC recurrence. More robust evidence is needed to assess such associations and examine the outcomes of quitting smoking in such patients.
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Affiliation(s)
- Muna Alkhaifi
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Adam Clayton
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Teruko Kishibe
- Library Services, St. Michael Hospital, Unity Health Toronto, Toronto, Canada
| | - Jory S Simpson
- Division of General Surgery, Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Faculty of Medicine, University of Toronto, Toronto, Canada
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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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9
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The Impact of Treatment for Smoking on Breast Cancer Patients’ Survival. Cancers (Basel) 2022; 14:cancers14061464. [PMID: 35326615 PMCID: PMC8946483 DOI: 10.3390/cancers14061464] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary This was a retrospective analysis of breast cancer patients who were self-identified as smokers at diagnosis and who were invited to participate in a comprehensive tobacco treatment program (TP) that provided pharmacotherapy and motivational counseling to quit smoking. Our study shows that quitting smoking is associated with improved survival among breast cancer patients who smoke across all tumor stages. In our survival analysis, tobacco abstainers were more likely than smokers to be alive with no evidence of disease (hazard ratio = 0.616 95%CI (0.402–0.945), p = 0.026). Comprehensive approach to address smoking cessation may prolong survival outcomes when started as early as the time of diagnosis. Abstract Background: Smoking negatively affects overall survival after successful breast cancer (BC) treatment. We hypothesized that smoking cessation would improve survival outcomes of BC patients who were smokers at the time of diagnosis. Methods: This was a retrospective analysis of self-identified smokers with BC treated at The University of Texas MD Anderson Cancer Center. Patient demographics, date of diagnosis, tumor stage, tobacco treatment program (TP) participation, and time to death were extracted from our departmental databases and institutional electronic health records. We examined associations between tobacco abstinence status and survival using survival models, with and without interactions, adjusted for personal characteristics and biomarkers of disease. Results: Among all 31,069 BC patients treated at MD Anderson between 2006 and 2017, we identified 2126 smokers (6.8%). From those 2126 self-identified smokers, 665 participated in the TP, reporting a conservative estimate of 31% abstinence (intent-to-treat) 9 months into the program. Patients without reported follow-up abstinence status (including TP and non-TP participants) were handled in the analyses as smokers. Survival analysis controlled for multiple factors, including disease characteristics and participation in the TP, indicated that abstainers were more likely to be alive with no evidence of disease compared to non-abstainers (HR, 0.593; 95% CI, 0.386–0.911; p = 0.017). Conclusion: Our results suggest that quitting smoking is associated with improved survival among BC patients who were smokers at time of diagnosis across all tumor stages. Comprehensive approaches for smoking cessation in patients diagnosed with BC may prolong survival when started as early as the time of diagnosis.
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10
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Future care for long-term cancer survivors: towards a new model. Clin Transl Oncol 2021; 24:350-362. [PMID: 34716541 PMCID: PMC8555713 DOI: 10.1007/s12094-021-02696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Abstract
Purpose The increase in the prevalence "long-term cancer survivor” (LCS) patients is expected to increase the cost of LCS care. The aim of this study was to obtain information that would allow to optimise the current model of health management in Spain to adapt it to one of efficient LCS patient care. Methods This qualitative study was carried out using Delphi methodology. An advisory committee defined the criteria for participation, select the panel of experts, prepare the questionnaire, interpret the results and draft the final report. Results 232 people took part in the study (48 oncologists). Absolute consensus was reached in three of the proposed sections: oncological epidemiology, training of health professionals and ICT functions. Conclusion The role of primary care in the clinical management of LCS patients needs to be upgraded, coordination with the oncologist and hospital care is essential. The funding model needs to be adapted to determine the funding conditions for new drugs and technologies.
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11
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Golčić M, Tomaš I, Stevanović A, Golčić G, Dobrila-Dintinjana R, Erić S, Šambić-Penc M, Baretić Marinac M, Gović-Golčić L, Majnarić T. Smoking Cessation after a Cancer Diagnosis: A Cross-Sectional Analysis in the Setting of a Developing Country. Clin Pract 2021; 11:509-519. [PMID: 34449569 PMCID: PMC8395437 DOI: 10.3390/clinpract11030067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
Since smoking accounts for around 30% of all cancer deaths, public health campaigns often focus on smoking cessation as a means of primary prevention. However, smoking after cancer diagnosis is also associated with a higher symptom burden and lower survival rate. As data regarding smoking cessation vary dramatically between different populations, we aimed to analyze smoking prevalence in cancer patients, smoking cessation after cancer diagnosis, and the factors associated with smoking cessation in the setting of a developing country. We performed a cross-sectional survey on 695 patients in two clinical hospital centers. After cancer diagnosis, 15.6% of cancer patients stopped smoking. Male gender, younger age, and smoking-related cancer were the main factors associated with greater smoking cessation (p < 0.05). A total of 96% of breast cancer patients continued to smoke after cancer diagnosis and, compared to lung and colorectal cancer patients, exhibited a lower reduction in the number of cigarettes smoked (p = 0.023). An alarming rate of smoking prevalence was recorded in younger patients (45.6% at the time of cancer diagnosis) suggesting a future rise in smoking-related cancers and complications. These results should guide anti-smoking public health campaigns in transitional countries with a critical focus on younger and breast cancer patients.
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Affiliation(s)
- Marin Golčić
- Clinical Hospital Center Rijeka, Department of Radiotherapy and Oncology, 51000 Rijeka, Croatia; (G.G.); (R.D.-D.)
- Correspondence: ; Tel.: +385-51-658-391
| | - Ilijan Tomaš
- Clinical Hospital Center Osijek, Department of Radiotherapy and Oncology, 31000 Osijek, Croatia; (I.T.); (S.E.); (M.Š.-P.)
- School of Medicine, University of Osijek Josip Juraj Strossmayer, 31000 Osijek, Croatia
| | - Aleksandra Stevanović
- Department of Basic Medical Sciences, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia;
- Department of Psychiatry and Psychological Medicine, School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Goran Golčić
- Clinical Hospital Center Rijeka, Department of Radiotherapy and Oncology, 51000 Rijeka, Croatia; (G.G.); (R.D.-D.)
| | - Renata Dobrila-Dintinjana
- Clinical Hospital Center Rijeka, Department of Radiotherapy and Oncology, 51000 Rijeka, Croatia; (G.G.); (R.D.-D.)
| | - Suzana Erić
- Clinical Hospital Center Osijek, Department of Radiotherapy and Oncology, 31000 Osijek, Croatia; (I.T.); (S.E.); (M.Š.-P.)
- School of Medicine, University of Osijek Josip Juraj Strossmayer, 31000 Osijek, Croatia
| | - Mirela Šambić-Penc
- Clinical Hospital Center Osijek, Department of Radiotherapy and Oncology, 31000 Osijek, Croatia; (I.T.); (S.E.); (M.Š.-P.)
- School of Medicine, University of Osijek Josip Juraj Strossmayer, 31000 Osijek, Croatia
| | - Martina Baretić Marinac
- Family Medicine Practice, Community Health Center of Primorsko-Goranska County, 51000 Rijeka, Croatia; (M.B.M.); (L.G.-G.)
| | - Lidija Gović-Golčić
- Family Medicine Practice, Community Health Center of Primorsko-Goranska County, 51000 Rijeka, Croatia; (M.B.M.); (L.G.-G.)
| | - Tea Majnarić
- Institute of Emergency Medicine of Primorsko-Goranska County, 51000 Rijeka, Croatia;
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Electronic cigarette aerosols alter the expression of cisplatin transporters and increase drug resistance in oral cancer cells. Sci Rep 2021; 11:1821. [PMID: 33469038 PMCID: PMC7815770 DOI: 10.1038/s41598-021-81148-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/29/2020] [Indexed: 11/26/2022] Open
Abstract
Tobacco smoking is the leading preventable cause of cancer. Moreover, continued smoking during cancer therapy reduces overall survival. Aware of the negative consequences of tobacco smoking and the challenges of smoking cessation, cancer patients are inquiring whether they should switch to electronic cigarettes (e-cigarettes). To obtain evidence-based data to inform this decision, we examined the effects of e-cigarette aerosol exposure on cisplatin resistance in head and neck cancer cells. Our results show that cancer cells exposed to e-cigarette aerosol extracts and treated with cisplatin have a significant decrease in cell death, increase in viability, and increase in clonogenic survival when compared to non-exposed cells. Moreover, exposure to e-cigarette aerosol extracts increased the concentration of cisplatin needed to induce a 50% reduction in cell growth (IC50) in a nicotine-independent manner. Tobacco smoke extracts induced similar increases in cisplatin resistance. Changes in the expression of drug influx and efflux transporters, rather than activation of cell growth-promoting pathways or DNA damage repair, contribute to e-cigarette induced cisplatin resistance. These results suggest that like combustible tobacco, e-cigarette use might increase chemotherapy resistance, and emphasize the urgent need for rigorous evaluation of e-cigarettes health effects to ensure evidence-based public health policies.
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Freyer-Adam J, Noetzel F, Baumann S, Aghdassi AA, Siewert-Markus U, Gaertner B, John U. Behavioral health risk factor profiles in general hospital patients: identifying the need for screening and brief intervention. BMC Public Health 2019; 19:1594. [PMID: 31783832 PMCID: PMC6884835 DOI: 10.1186/s12889-019-7931-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Little is known about the clustering of behavioral health risk factors (HRFs), namely the occurrence of 16 specific combinations of tobacco smoking, at-risk alcohol use, overweight and physical inactivity in general hospital patients. Furthermore, social inequalities in HRFs, health and life expectancy are a major concern in public health. In order to establish the need for screening and intervention in general hospital care, the study aimed to determine the co-occurrence of HRFs in patients in four medical departments, and to investigate differences by gender, age and socio-economic characteristics. METHODS Over 17 months, a systematic multiple HRF screening was conducted at one general hospital in northeastern Germany. In total, 6251 18-64 year old patients (92% of eligibles) participated. Proportions and confidence intervals were calculated for all 16 HRF profiles stratified by department, gender, age group, school education, and employment status. RESULTS In total, 92.2% of the participants (58.6% male) reported ≥1 HRF, and 65.7% ≥2 HRFs. Men (71.2%), patients aged 35-49 (67.9%) and 50-64 years (69.5%), lower educated (79.0%), and unemployed (77.8%) patients had larger proportions of ≥2 HRFs than their counterparts. In all departments, the most common HRF profiles included overweight. HRF profiles that included alcohol and/ or smoking were more common in ear-nose-throat and trauma surgery than in internal medicine and general surgery patients. Men had higher rates concerning almost all HRF profiles including ≥2 HRFs and alcohol; women concerning profiles that included ≤2 HRFs and inactivity. In older patients, profiles with ≥2 HRFs including overweight; and in younger patients, profiles with smoking and/or alcohol were more common. In lower educated patients, profiles with ≥2 HRFs including inactivity; and in higher educated patients profiles with ≤2 HRFs including alcohol were more common. Compared to others, unemployed patients had higher rates of profiles with ≥3 HRFs including smoking. CONCLUSIONS Two in three patients require interventions targeting two or more HRFs. The findings help to develop screening and brief intervention for patients with specific health risk profiles, that can reach most patients, including those most in need and those most hard to reach, with socio-economically disadvantaged people in particular. REGISTRY: clinicaltrials.gov: NCT01291693.
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Grants
- 108376, 109737, 110676, 110543, 111346 Deutsche Krebshilfe
- 108376, 109737, 110676, 110543, 111346 Deutsche Krebshilfe
- 108376, 109737, 110676, 110543, 111346 Deutsche Krebshilfe
- 70110543 Deutsche Krebshilfe
- 70110543 Deutsche Krebshilfe
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475 Greifswald, Germany
| | - Florian Noetzel
- Clinic and Policlinic of Urology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Sophie Baumann
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475 Greifswald, Germany
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ali Alexander Aghdassi
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475 Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, General-Pape-Str. 62-66, 12101 Berlin, Germany
| | - Ulrich John
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475 Greifswald, Germany
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
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Hwang ES, Hyslop T, Lynch T, Frank E, Pinto D, Basila D, Collyar D, Bennett A, Kaplan C, Rosenberg S, Thompson A, Weiss A, Partridge A. The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS). BMJ Open 2019; 9:e026797. [PMID: 30862637 PMCID: PMC6429899 DOI: 10.1136/bmjopen-2018-026797] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) is a non-invasive non-obligate precursor of invasive breast cancer. With guideline concordant care (GCC), DCIS outcomes are at least as favourable as some other early stage cancer types such as prostate cancer, for which active surveillance (AS) is a standard of care option. However, AS has not yet been tested in relation to DCIS. The goal of the COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial for low-risk DCIS is to gather evidence to help future patients consider the range of treatment choices for low-risk DCIS, from standard therapies to AS. The trial will determine whether there may be some women who do not substantially benefit from current GCC and who could thus be safely managed with AS. This protocol is version 5 (11 July 2018). Any future protocol amendments will be submitted to Quorum Centralised Institutional Review Board/local institutional review boards for approval via the sponsor of the study (Alliance Foundation Trials). METHODS AND ANALYSIS COMET is a phase III, randomised controlled clinical trial for patients with low-risk DCIS. The primary outcome is ipsilateral invasive breast cancer rate in women undergoing GCC compared with AS. Secondary objectives will be to compare surgical, oncological and patient-reported outcomes. Patients randomised to the GCC group will undergo surgery as well as radiotherapy when appropriate; those in the AS group will be monitored closely with surgery only on identification of invasive breast cancer. Patients in both the GCC and AS groups will have the option of endocrine therapy. The total planned accrual goal is 1200 patients. ETHICS AND DISSEMINATION The COMET trial will be subject to biannual formal review at the Alliance Foundation Data Safety Monitoring Board meetings. Interim analyses for futility/safety will be completed annually, with reporting following Consolidated Standards of Reporting Trials (CONSORT) guidelines for non-inferiority trials. TRIAL REGISTRATION NUMBER NCT02926911; Pre-results.
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Affiliation(s)
- E Shelley Hwang
- Department of Surgery, Division of Surgical Oncology, Duke University, Durham, North Carolina, USA
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Thomas Lynch
- Department of Surgery, Division of Surgical Oncology, Duke University, Durham, North Carolina, USA
| | | | | | | | | | - Antonia Bennett
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Celia Kaplan
- Department of Medicine, University of California, San Francisco, California, USA
| | - Shoshana Rosenberg
- Department of Medicine, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alastair Thompson
- Department of Breast Surgery, Division of Surgical Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Anna Weiss
- Alliance Foundation Trials, Boston, Massachusetts, USA
| | - Ann Partridge
- Department of Medicine, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, Massachusetts, USA
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15
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Derksen JW, Beijer S, Koopman M, Verkooijen HM, van de Poll-Franse LV, May AM. Monitoring potentially modifiable lifestyle factors in cancer survivors: A narrative review on currently available methodologies and innovations for large-scale surveillance. Eur J Cancer 2018; 103:327-340. [DOI: 10.1016/j.ejca.2018.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/28/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
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16
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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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Huang J, Weinstein SJ, Moore SC, Derkach A, Hua X, Liao LM, Gu F, Mondul AM, Sampson JN, Albanes D. Serum Metabolomic Profiling of All-Cause Mortality: A Prospective Analysis in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study Cohort. Am J Epidemiol 2018; 187:1721-1732. [PMID: 29390044 DOI: 10.1093/aje/kwy017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/23/2018] [Indexed: 12/12/2022] Open
Abstract
Tobacco use, hypertension, hyperglycemia, overweight, and inactivity are leading causes of overall and cardiovascular disease (CVD) mortality worldwide, yet the relevant metabolic alterations responsible are largely unknown. We conducted a serum metabolomic analysis of 620 men in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (1985-2013). During 28 years of follow-up, there were 435 deaths (197 CVD and 107 cancer). The analysis included 406 known metabolites measured with ultra-high-performance liquid chromatography/mass spectrometry-gas chromatography/mass spectrometry. We used Cox regression to estimate mortality hazard ratios for a 1-standard-deviation difference in metabolite signals. The strongest associations with overall mortality were N-acetylvaline (hazard ratio (HR) = 1.28; P < 4.1 × 10-5, below Bonferroni statistical threshold) and dimethylglycine, 7-methylguanine, C-glycosyltryptophan, taurocholate, and N-acetyltryptophan (1.23 ≤ HR ≤ 1.32; 5 × 10-5 ≤ P ≤ 1 × 10-4). C-Glycosyltryptophan, 7-methylguanine, and 4-androsten-3β,17β-diol disulfate were statistically significantly associated with CVD mortality (1.49 ≤ HR ≤ 1.62, P < 4.1 × 10-5). No metabolite was associated with cancer mortality, at a false discovery rate of <0.1. Individuals with a 1-standard-deviation higher metabolite risk score had increased all-cause and CVD mortality in the test set (HR = 1.4, P = 0.05; HR = 1.8, P = 0.003, respectively). The several serum metabolites and their composite risk score independently associated with all-cause and CVD mortality may provide potential leads regarding the molecular basis of mortality.
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Affiliation(s)
- Jiaqi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stephanie J Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven C Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andriy Derkach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Xing Hua
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Fangyi Gu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Alison M Mondul
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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18
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Wang K, Li F, Zhang X, Li Z, Li H. Smoking increases risks of all-cause and breast cancer specific mortality in breast cancer individuals: a dose-response meta-analysis of prospective cohort studies involving 39725 breast cancer cases. Oncotarget 2018; 7:83134-83147. [PMID: 27863414 PMCID: PMC5347758 DOI: 10.18632/oncotarget.13366] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/17/2016] [Indexed: 12/18/2022] Open
Abstract
Smoking is associated with the risks of mortality from breast cancer (BC) or all causes in BC survivors. Two-stage dose-response meta-analysis was conducted. A search of PubMed and Embase was performed, and a random-effect model was used to yield summary hazard ratios (HRs). Eleven prospective cohort studies were included. The summary HR per 10 cigarettes/day, 10 pack-years, 10 years increase were 1.10 (95% confidence interval (CI) = 1.04–1.16), 1.09 (95% CI = 1.06–1.12), 1.10 (95% CI = 1.06–1.14) for BC specific mortality, and 1.15 (95% CI = 1.10–1.19), 1.15 (95% CI = 1.10–1.20), 1.17 (95% CI = 1.11–1.23) for all-cause mortality, respectively. The linear or non-linear associations between smoking and risks of mortality from BC or all causes were revealed. Subgroup analyses suggested a positive association between ever or former smoking and the risk of all-cause mortality in BC patients, especially in high doses consumption. In conclusion, higher smoking intensity, more cumulative amount of cigarettes consumption and longer time for smoking is associated with elevated risk of mortality from BC and all causes in BC individuals. The results regarding smoking cessation and “ever or former” smokers should be treated with caution due to limited studies.
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Affiliation(s)
- Kang Wang
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Feng Li
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Xiang Zhang
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhuyue Li
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hongyuan Li
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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Gupta V, Haque I, Chakraborty J, Graff S, Banerjee S, Banerjee SK. Racial disparity in breast cancer: can it be mattered for prognosis and therapy. J Cell Commun Signal 2017; 12:119-132. [PMID: 29188479 DOI: 10.1007/s12079-017-0416-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 01/01/2023] Open
Abstract
Breast cancer (BC) has emerged as a deadly disease that affects the lives of millions of women worldwide. It is the second leading cause of cancer-related deaths in the United States. Advancements in BC screening, preventive measures and treatment have resulted in significant decline in BC related deaths. However, unacceptable levels of racial disparity have been consistently reported, especially in African-American (AA) women compared to European American (EA). AA women go through worse prognosis, shorter survival time and higher mortality rates, despite higher cancer incidence reported in EA. These disparities are independent of socioeconomic status, access to healthcare or age, or even the stage of BC. Recent race-specific genetic and epigenetic studies have reported biological causes, which form the crux of this review. However, the developments are just the tip of the iceberg. Prioritizing primary research towards studying race-specific tumor microenvironment and biological composition of the host system in delineating the cause of these disparities is utmost necessary to ameliorate the disparity and design appropriate diagnosis/treatment regimen for AA women suffering from BC. In this review article, we discuss emerging trends and exciting discoveries that reveal how genetic/epigenetic circuitry contributed to racial disparity and discussed the strategies that may help in future therapeutic development.
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Affiliation(s)
- Vijayalaxmi Gupta
- Cancer Research Unit, Research Division 151, VA Medical Center, 4801 Linwood Boulevard, Kansas City, MO, 64128, USA.,Department of Pathology and Integrative Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Inamul Haque
- Cancer Research Unit, Research Division 151, VA Medical Center, 4801 Linwood Boulevard, Kansas City, MO, 64128, USA.,Department of Pathology and Integrative Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jinia Chakraborty
- Cancer Research Unit, Research Division 151, VA Medical Center, 4801 Linwood Boulevard, Kansas City, MO, 64128, USA.,Blue Valley West High School, Overland Park, KS, USA
| | - Stephanie Graff
- Sarah Cannon Cancer Center at HCA Midwest Health, Kansas City, MO, USA
| | - Snigdha Banerjee
- Cancer Research Unit, Research Division 151, VA Medical Center, 4801 Linwood Boulevard, Kansas City, MO, 64128, USA. .,Department of Pathology and Integrative Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Sushanta K Banerjee
- Cancer Research Unit, Research Division 151, VA Medical Center, 4801 Linwood Boulevard, Kansas City, MO, 64128, USA. .,Department of Pathology and Integrative Science, University of Kansas Medical Center, Kansas City, KS, USA. .,Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA.
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20
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Hamer J, Warner E. Lifestyle modifications for patients with breast cancer to improve prognosis and optimize overall health. CMAJ 2017; 189:E268-E274. [PMID: 28246240 DOI: 10.1503/cmaj.160464] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Julia Hamer
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Ellen Warner
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
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21
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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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22
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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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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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24
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Præstegaard C, Jensen A, Jensen SM, Nielsen TSS, Webb PM, Nagle CM, DeFazio A, Høgdall E, Rossing MA, Doherty JA, Wicklund KG, Goodman MT, Modugno F, Moysich K, Ness RB, Edwards R, Matsuo K, Hosono S, Goode EL, Winham SJ, Fridley BL, Cramer DW, Terry KL, Schildkraut JM, Berchuck A, Bandera EV, Paddock LE, Massuger LF, Wentzensen N, Pharoah P, Song H, Whittemore A, McGuire V, Sieh W, Rothstein J, Anton-Culver H, Ziogas A, Menon U, Gayther SA, Ramus SJ, Gentry-Maharaj A, Wu AH, Pearce CL, Pike M, Lee AW, Sutphen R, Chang-Claude J, Risch HA, Kjaer SK. Cigarette smoking is associated with adverse survival among women with ovarian cancer: Results from a pooled analysis of 19 studies. Int J Cancer 2017; 140:2422-2435. [PMID: 28063166 PMCID: PMC5489656 DOI: 10.1002/ijc.30600] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/26/2016] [Accepted: 12/09/2016] [Indexed: 01/24/2023]
Abstract
Cigarette smoking is associated with an increased risk of developing mucinous ovarian tumors but whether it is associated with ovarian cancer survival overall or for the different histotypes is unestablished. Furthermore, it is unknown whether the association between cigarette smoking and survival differs according to strata of ovarian cancer stage at diagnosis. In a large pooled analysis, we evaluated the association between various measures of cigarette smoking and survival among women with epithelial ovarian cancer. We obtained data from 19 case-control studies in the Ovarian Cancer Association Consortium (OCAC), including 9,114 women diagnosed with ovarian cancer. Cox regression models were used to estimate adjusted study-specific hazard ratios (HRs), which were combined into pooled hazard ratios (pHR) with corresponding 95% confidence intervals (CIs) under random effects models. Overall, 5,149 (57%) women died during a median follow-up period of 7.0 years. Among women diagnosed with ovarian cancer, both current (pHR = 1.17, 95% CI: 1.08-1.28) and former smokers (pHR = 1.10, 95% CI: 1.02-1.18) had worse survival compared with never smoking women. In histotype-stratified analyses, associations were observed for mucinous (current smoking: pHR = 1.91, 95% CI: 1.01-3.65) and serous histotypes (current smoking: pHR = 1.11, 95% CI: 1.00-1.23; former smoking: pHR = 1.12, 95% CI: 1.04-1.20). Further, our results suggested that current smoking has a greater impact on survival among women with localized than disseminated disease. The identification of cigarette smoking as a modifiable factor associated with survival has potential clinical importance as a focus area to improve ovarian cancer prognosis.
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Affiliation(s)
- Camilla Præstegaard
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Signe M. Jensen
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Thor S. S. Nielsen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Penelope M. Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Christina M. Nagle
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Anna DeFazio
- Centre for Cancer Research, The Westmead Millenium Institute for Medical Research, The University of Sydney Westmead, NSW, Australia
- Department of Gynecological Oncology, Westmead Hospital, Westmead, NSW, Australia
| | | | - Estrid Høgdall
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Molecular Unit, Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mary Anne Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Jennifer A. Doherty
- Department of Epidemiology, The Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Kristine G. Wicklund
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marc T. Goodman
- Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
- Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Francesmary Modugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
- Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Kirsten Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY
| | - Roberta B. Ness
- School of Public Health, The University of Texas, Houston, TX
| | - Robert Edwards
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Satoyo Hosono
- Division of Epidemiology and Prevention, Aichi Cancer Center Research institute, Nagoya, Aichi, Japan
| | - Ellen L. Goode
- Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, MN
| | - Stacey J Winham
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Daniel W. Cramer
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Kathryn L. Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Joellen M. Schildkraut
- Department of Public Health Science, School of Medicine, University of Virginia, Charlottesville, VA
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Elisa V. Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers School of Public Health, Piscataway, NJ
| | - Lisa E. Paddock
- New Jersey Department of Health and Senior Services, Trenton, NJ
- School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ
| | - Leon F. Massuger
- Department of Gynaecology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Paul Pharoah
- Department of Oncology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research laboratory, Cambridge, United Kingdom
| | - Honglin Song
- Department of Oncology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research laboratory, Cambridge, United Kingdom
| | - Alice Whittemore
- Department of Health Research and Policy - Epidemiology, Stanford University School of Medicine, Stanford, CA
- Departments of Health Research & Policy and of Biomedical Data Science, Stanford School of Medicine, Stanford, CA
| | - Valerie McGuire
- Department of Health Research and Policy - Epidemiology, Stanford University School of Medicine, Stanford, CA
| | - Weiva Sieh
- Departments of Population Health Science & Policy and of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph Rothstein
- Departments of Population Health Science & Policy and of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hoda Anton-Culver
- Department of Epidemiology, Center for Cancer Genetics Research & Prevention, School of Medicine, University of California Irvine, Irvine, CA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California Irvine, Irvine, CA
| | - Usha Menon
- Women’s Cancer, Institute for Women’s Health, University College London, London, United Kingdom
| | - Simon A. Gayther
- Center for Cancer Prevention and Translational Genomics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Susan J. Ramus
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | | | - Anna H. Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Celeste L. Pearce
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Malcolm Pike
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alice W. Lee
- Department of Health Science, California State University, Fullerton, CA
| | - Rebecca Sutphen
- Epidemiology Center, College of Medicine, University of South Florida, Tampa, FL
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harvey A. Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Susanne K. Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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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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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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Breast tumor DNA methylation patterns associated with smoking in the Carolina Breast Cancer Study. Breast Cancer Res Treat 2017; 163:349-361. [PMID: 28275920 DOI: 10.1007/s10549-017-4178-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/26/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Tobacco smoking is a risk factor in several cancers, yet its roles as a putative etiologic exposure or poor prognostic factor in breast cancer are less clear. Altered DNA methylation contributes to breast cancer development and may provide a mechanistic link between smoking and gene expression changes leading to cancer development or progression. METHODS Using a cancer-focused array, we examined methylation at 933 CpGs in 517 invasive breast tumors in the Carolina Breast Cancer Study to determine whether methylation patterns differ by exposure to tobacco smoke. Multivariable generalized linear regression models were used to compare tumor methylation profiles between smokers and never smokers, overall, or stratified on hormone receptor (HR) status. RESULTS Modest differences in CpG methylation were detected at p < 0.05 in breast tumors from current or ever smokers compared with never smokers. In stratified analyses, HR- tumors from smokers exhibited primarily hypomethylation compared with tumors from never smokers; hypomethylation was similarly detected within the more homogeneous basal-like subtype. Most current smoking-associated CpG loci exhibited methylation levels in former smokers that were intermediate between those in current and never smokers and exhibited progressive changes in methylation with increasing duration of smoking. Among former smokers, restoration of methylation toward baseline (never smoking) levels was observed with increasing time since quitting. Moreover, smoking-related hypermethylation was stronger in HR+ breast tumors from blacks than in whites. CONCLUSIONS Our results suggest that breast tumor methylation patterns differ with tobacco smoke exposure; however, additional studies are needed to confirm these findings.
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Ennour-Idrissi K, Têtu B, Maunsell E, Poirier B, Montoni A, Rochette PJ, Diorio C. Association of Telomere Length with Breast Cancer Prognostic Factors. PLoS One 2016; 11:e0161903. [PMID: 27571273 PMCID: PMC5003390 DOI: 10.1371/journal.pone.0161903] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/12/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Telomere length, a marker of cell aging, seems to be affected by the same factors thought to be associated with breast cancer prognosis. Objective To examine associations of peripheral blood cell-measured telomere length with traditional and potential prognostic factors in breast cancer patients. Methods We conducted a cross-sectional analysis of data collected before surgery from 162 breast cancer patients recruited consecutively between 01/2011 and 05/2012, at a breast cancer reference center. Data on the main lifestyle factors (smoking, alcohol consumption, physical activity) were collected using standardized questionnaires. Anthropometric factors were measured. Tumor biological characteristics were extracted from pathology reports. Telomere length was measured using a highly reproducible quantitative PCR method in peripheral white blood cells. Spearman partial rank-order correlations and multivariate general linear models were used to evaluate relationships between telomere length and prognostic factors. Results Telomere length was positively associated with total physical activity (rs = 0.17, P = 0.033; Ptrend= 0.069), occupational physical activity (rs = 0.15, P = 0.054; Ptrend= 0.054) and transportation-related physical activity (rs = 0.19, P = 0.019; P = 0.005). Among post-menopausal women, telomere length remained positively associated with total physical activity (rs = 0.27, P = 0.016; Ptrend= 0.054) and occupational physical activity (rs = 0.26, P = 0.021; Ptrend= 0.056) and was only associated with transportation-related physical activity among pre-menopausal women (rs = 0.27, P = 0.015; P = 0.004). No association was observed between telomere length and recreational or household activities, other lifestyle factors or traditional prognostic factors. Conclusions Telomeres are longer in more active breast cancer patients. Since white blood cells are involved in anticancer immune responses, these findings suggest that even regular low-intensity physical activity, such as that related to transportation or occupation, could be recommended to breast cancer patients.
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Affiliation(s)
- Kaoutar Ennour-Idrissi
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec city (QC), Canada
| | - Bernard Têtu
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Département de biologie moléculaire, biochimie médicale et pathologie, Faculté de médecine, Université Laval, Quebec city (QC), Canada.,Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec city (QC), Canada
| | - Elizabeth Maunsell
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec city (QC), Canada.,Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec city (QC), Canada
| | - Brigitte Poirier
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec city (QC), Canada.,Department de chirurgie, Faculté de médecine, Université Laval, Quebec city (QC), Canada
| | - Alicia Montoni
- Axe Médecine Régénératrice, Centre de recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada
| | - Patrick J Rochette
- Axe Médecine Régénératrice, Centre de recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada
| | - Caroline Diorio
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec city (QC), Canada.,Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec city (QC), Canada
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Lööf-Johanson M, Brudin L, Sundquist M, Rudebeck CE. Breastfeeding Associated with Reduced Mortality in Women with Breast Cancer. Breastfeed Med 2016; 11:321-327. [PMID: 27269432 DOI: 10.1089/bfm.2015.0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To study whether breastfeeding affects survival from breast cancer. BACKGROUND There are few studies on the relationship between breastfeeding, reproductive health, and breast cancer survival. This study is a follow-up of an earlier study showing no convincing associations between breastfeeding and breast cancer prognostic parameters. METHODS From a cohort of 629 women with primary breast cancer having undergone surgery between 1988 and 1992, 341 were traced and consequently studied 20 years later regarding breastfeeding and reproductive variables, as well as for prognostic parameters such as the Nottingham histological grade, tumor size, lymph node status, and vascular invasion (VI). Multivariate Cox regression analyses were used. RESULTS Increased breast cancer mortality was associated with the Nottingham prognostic index (hazard rate ratio (HR) 4.47; 95% confidence interval (CI) 2.04-9.79), VI (HR 3.44; CI 2.03-5.82), fewer pregnancies (three categories; >2, 1-2, 0) (HR per category 2.04; CI 1.34-3.11), and breastfeeding ≤6 months (HR 2.74; CI 1.41-5.35). The HRs for overall mortality were, as expected, lower for the Nottingham prognostic index (HR 1.28; CI 0.89-1.85) and VI (HR 2.09; CI 1.38-3.17), and they were slightly lower for the number of pregnancies (HR 1.61; CI 1.48-4.59), but notably similar for breastfeeding (HR 3.01;CI 1.92-4.73). CONCLUSION A total breastfeeding history >6 months and pregnancy are associated with both greater overall and breast cancer-specific survival for women diagnosed with breast cancer, having lived long enough for other causes of death to contribute substantially to mortality.
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Affiliation(s)
| | - Lars Brudin
- 1 Department of Medical and Health Sciences, University of Linköping , Linköping, Sweden .,2 Department of Clinical Physiology, County Hospital , Kalmar, Sweden
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30
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Modifiable Lifestyle Factors and Triple-negative Breast Cancer Survival: A Population-based Prospective Study. Epidemiology 2016; 26:909-16. [PMID: 26360370 DOI: 10.1097/ede.0000000000000373] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Very little is known about the effect of modifiable lifestyle factors on outcomes of triple-negative breast cancer. We examined this association in a population-based prospective cohort study of patients with triple-negative breast cancer. METHODS A total of 518 women with confirmed triple-negative breast cancer, recruited by the Shanghai Breast Cancer Survival Study, completed 6-, 18-, 36-, and 60-month postdiagnosis surveys. We applied Cox proportional hazard models to evaluate the associations. RESULTS The mean age at diagnosis was 53.4 (standard deviation = 10.6) years old. After a median follow-up of 9.1 years (range: 0.6-11.8), 128 deaths and 112 recurrences were documented. Exercise during the first 60 months postdiagnosis was inversely associated with total mortality and recurrence/disease-specific mortality with adjusted hazard ratios (HRs) of 0.67 (95% confidence interval [CI] = 0.46, 0.96) and 0.58 (95% CI = 0.39, 0.86), respectively. Women with higher exercise-metabolic equivalent scores (≥7.6 metabolic equivalent-hours/week) and longer duration of exercise (≥2.5 hours/week) had lower risk of total and recurrence/disease-specific mortality than did nonexercisers. Compared with nontea drinkers, survival was better among women who were regular tea drinkers during the first 60 months for all cause (HR = 0.57, 95% CI = 0.34, 0.93) and recurrence/disease-specific mortality (HR = 0.54, 95% CI = 0.31, 0.96). There was no dose-response pattern for tea consumption. No interactions were observed for body mass index, menopausal status, and comorbidity. CONCLUSIONS These findings show that postdiagnosis exercise and tea intake were associated with improved survival among women with triple-negative breast cancer.
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Sposto R, Keegan THM, Vigen C, Kwan ML, Bernstein L, John EM, Cheng I, Yang J, Koo J, Kurian AW, Caan BJ, Lu Y, Monroe KR, Shariff-Marco S, Gomez SL, Wu AH. The Effect of Patient and Contextual Characteristics on Racial/Ethnic Disparity in Breast Cancer Mortality. Cancer Epidemiol Biomarkers Prev 2016; 25:1064-72. [PMID: 27197297 PMCID: PMC4930680 DOI: 10.1158/1055-9965.epi-15-1326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/29/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Racial/ethnic disparity in breast cancer-specific mortality in the United States is well documented. We examined whether accounting for racial/ethnic differences in the prevalence of clinical, patient, and lifestyle and contextual factors that are associated with breast cancer-specific mortality can explain this disparity. METHODS The California Breast Cancer Survivorship Consortium combined interview data from six California-based breast cancer studies with cancer registry data to create a large, racially diverse cohort of women with primary invasive breast cancer. We examined the contribution of variables in a previously reported Cox regression baseline model plus additional contextual, physical activity, body size, and comorbidity variables to the racial/ethnic disparity in breast cancer-specific mortality. RESULTS The cohort comprised 12,098 women. Fifty-four percent were non-Latina Whites, 17% African Americans, 17% Latinas, and 12% Asian Americans. In a model adjusting only for age and study, breast cancer-specific HRs relative to Whites were 1.69 (95% CI, 1.46-1.96), 1.00 (0.84-1.19), and 0.52 (0.33-0.85) for African Americans, Latinas, and Asian Americans, respectively. Adjusting for baseline-model variables decreased disparity primarily by reducing the HR for African Americans to 1.13 (0.96-1.33). The most influential variables were related to disease characteristics, neighborhood socioeconomic status, and smoking status at diagnosis. Other variables had negligible impact on disparity. CONCLUSIONS Although contextual, physical activity, body size, and comorbidity variables may influence breast cancer-specific mortality, they do not explain racial/ethnic mortality disparity. IMPACT Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality. Cancer Epidemiol Biomarkers Prev; 25(7); 1064-72. ©2016 AACR.
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Affiliation(s)
- Richard Sposto
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California. Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.
| | - Theresa H M Keegan
- Division of Hematology and Oncology, Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Cheryl Vigen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Esther M John
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California
| | - Juan Yang
- Cancer Prevention Institute of California, Fremont, California
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, California
| | - Allison W Kurian
- Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Yani Lu
- City of Hope, Duarte, California
| | - Kristine R Monroe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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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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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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Taghizadeh N, Vonk JM, Boezen HM. Lifetime Smoking History and Cause-Specific Mortality in a Cohort Study with 43 Years of Follow-Up. PLoS One 2016; 11:e0153310. [PMID: 27055053 PMCID: PMC4824471 DOI: 10.1371/journal.pone.0153310] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 03/28/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In general, smoking increases the risk of mortality. However, it is less clear how the relative risk varies by cause of death. The exact impact of changes in smoking habits throughout life on different mortality risks is less studied. METHODS We studied the impact of baseline and lifetime smoking habits, and duration of smoking on the risk of all-cause mortality, mortality of cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), any cancer and of the four most common types of cancer (lung, colorectal, prostate, and breast cancer) in a cohort study (Vlagtwedde-Vlaardingen 1965-1990, with a follow-up on mortality status until 2009, n = 8,645). We used Cox regression models adjusted for age, BMI, sex, and place of residence. Since previous studies suggested a potential effect modification of sex, we additionally stratified by sex and tested for interactions. In addition, to determine which cause of death carried the highest risk we performed competing-risk analyses on mortality due to CVD, cancer, COPD and other causes. RESULTS Current smoking (light, moderate, and heavy cigarette smoking) and lifetime persistent smoking were associated with an increased risk of all-cause, CVD, COPD, any cancer, and lung cancer mortality. Higher numbers of pack years at baseline were associated with an increased risk of all-cause, CVD, COPD, any cancer, lung, colorectal, and prostate cancer mortality. Males who were lifetime persistent pipe/cigar smokers had a higher risk of lung cancer [HR (95% CI) = 7.72 (1.72-34.75)] as well as all-cause and any cancer mortality. A longer duration of smoking was associated with a higher risk of COPD, any and lung cancer [HR (95% CI) = 1.06 (1.00-1.12), 1.03 (1.00-1.06) and 1.10 (1.03-1.17) respectively], but not with other mortality causes. The competing risk analyses showed that ex- and current smokers had a higher risk of cancer, CVD, and COPD mortality compared to all other mortality causes. In addition, heavy smokers had a higher risk for COPD mortality compared to cancer, and CVD mortality. CONCLUSION Our study indicates that lifetime numbers of cigarettes smoked and the duration of smoking have different impacts for different causes of mortality. Moreover, our findings emphasize the importance of smoking-related competing risks when studying the smoking-related cancer mortality in a general population and that smoking cessation immediately effectively reduces the risk of all-cause and any cancer mortality.
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Affiliation(s)
- Niloofar Taghizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Cumming School of Medicine, Division of Respiratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judith M. Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - H. Marike Boezen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Gangler A, Lesur A, Dalenc F. PPAC (programme personnalisé de l’après-cancer) : rationnel et mise en place. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2595-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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Kalantari-Dehaghi M, Parnell EA, Armand T, Bernard HU, Grando SA. The nicotinic acetylcholine receptor-mediated reciprocal effects of the tobacco nitrosamine NNK and SLURP-1 on human mammary epithelial cells. Int Immunopharmacol 2015; 29:99-104. [DOI: 10.1016/j.intimp.2015.04.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/29/2015] [Accepted: 04/17/2015] [Indexed: 12/17/2022]
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Sanner T, Grimsrud TK. Nicotine: Carcinogenicity and Effects on Response to Cancer Treatment - A Review. Front Oncol 2015; 5:196. [PMID: 26380225 PMCID: PMC4553893 DOI: 10.3389/fonc.2015.00196] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/13/2015] [Indexed: 12/12/2022] Open
Abstract
Tobacco use is considered the single most important man-made cause of cancer that can be avoided. The evidence that nicotine is involved in cancer development is reviewed and discussed in this paper. Both tobacco smoke and tobacco products for oral use contain a number of carcinogenic substances, such as polycyclic hydrocarbons and tobacco-specific N-nitrosamines (TSNA), which undoubtedly contribute to tobacco related cancer. Recent studies have shown that nicotine can affect several important steps in the development of cancer, and suggest that it may cause aggravation and recurrence of the disease. TSNA may be formed from nicotine in the body. The role of nicotine as the major addictive component of tobacco products may have distracted our attention from toxicological effects on cell growth, angiogenesis, and tumor malignancy. Effects on cancer disease are important aspects in the evaluation of possible long-term effects from sources of nicotine, such as e-cigarettes and products for nicotine replacement therapy, which both have a potential for life-long use.
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Affiliation(s)
- Tore Sanner
- Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Tom K. Grimsrud
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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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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Regan T, Carey M, Bryant J, Waller A, Mansfield E, Sitas F, Tracey E. Prevalence and correlates of current smoking among medical oncology outpatients. Psychooncology 2015; 24:1258-1264. [DOI: 10.1002/pon.3893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/25/2015] [Accepted: 06/02/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Tim Regan
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; University of Newcastle; Callaghan New South Wales Australia
- Hunter Medical Research Institute; New Lambton New South Wales Australia
| | - Mariko Carey
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; University of Newcastle; Callaghan New South Wales Australia
- Hunter Medical Research Institute; New Lambton New South Wales Australia
| | - Jamie Bryant
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; University of Newcastle; Callaghan New South Wales Australia
- Hunter Medical Research Institute; New Lambton New South Wales Australia
| | - Amy Waller
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; University of Newcastle; Callaghan New South Wales Australia
- Hunter Medical Research Institute; New Lambton New South Wales Australia
| | - Elise Mansfield
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; University of Newcastle; Callaghan New South Wales Australia
- Hunter Medical Research Institute; New Lambton New South Wales Australia
| | - Freddy Sitas
- Cancer Research Division; Cancer Council NSW; Kings Cross New South Wales Australia
| | - Elizabeth Tracey
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; University of Newcastle; Callaghan New South Wales Australia
- Hunter Medical Research Institute; New Lambton New South Wales Australia
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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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Larsen SB, Kroman N, Ibfelt EH, Christensen J, Tjønneland A, Dalton SO. Influence of metabolic indicators, smoking, alcohol and socioeconomic position on mortality after breast cancer. Acta Oncol 2015; 54:780-8. [PMID: 25761087 DOI: 10.3109/0284186x.2014.998774] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Factors differently distributed among social groups like obesity, metabolic syndrome, diabetes, smoking, and alcohol intake predict survival after breast cancer diagnosis and therefore might mediate part of the observed social inequality in survival. MATERIAL AND METHODS We conducted a cohort study among 1250 postmenopausal breast cancer patients identified among 29 875 women in the Danish Diet, Cancer and Health Study. Participants completed questionnaires and anthropometric measurements were made at enrollment. Information on survival, socioeconomic position, and comorbidity was obtained by linkage to national Danish registries. Clinical information was obtained from the nationwide Danish Breast Cancer Database. Selected information was obtained from hospital records at time of diagnosis. All analyses were based on Cox proportional hazard models, using death from all causes as outcome. RESULTS Median follow-up was 9.6 years [interquartile range (IQR), 2.2-17.0 years]. The hazard ratio (HR) for death from all causes increased with lower education (p for trend, 0.01). Adjustment for disease-related prognostic factors, comorbidity and metabolic indicators measured as BMI, waist circumference and diabetes, and smoking and alcohol affected but did not explain the social gradient. CONCLUSION The findings indicate that these factors explain some but not all the social inequality in survival after breast cancer and that improvement of lifestyle to some extent would improve survival among women with low socioeconomic position.
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Carter BD, Abnet CC, Feskanich D, Freedman ND, Hartge P, Lewis CE, Ockene JK, Prentice RL, Speizer FE, Thun MJ, Jacobs EJ. Smoking and mortality--beyond established causes. N Engl J Med 2015; 372:631-40. [PMID: 25671255 DOI: 10.1056/nejmsa1407211] [Citation(s) in RCA: 483] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking. METHODS We pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort. RESULTS During the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure (relative risk, 2.0; 95% confidence interval [CI], 1.7 to 2.3), intestinal ischemia (relative risk, 6.0; 95% CI, 4.5 to 8.1), hypertensive heart disease (relative risk, 2.4; 95% CI, 1.9 to 3.0), infections (relative risk, 2.3; 95% CI, 2.0 to 2.7), various respiratory diseases (relative risk, 2.0; 95% CI, 1.6 to 2.4), breast cancer (relative risk, 1.3; 95% CI, 1.2 to 1.5), and prostate cancer (relative risk, 1.4; 95% CI, 1.2 to 1.7). Among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased. CONCLUSIONS A substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated. (Funded by the American Cancer Society.).
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Affiliation(s)
- Brian D Carter
- From the Epidemiology Research Program, American Cancer Society, Atlanta (B.D.C., M.J.T., E.J.J.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (C.C.A., N.D.F., P.H.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (D.F., F.E.S.); the Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham (C.E.L.); the Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (J.K.O.); and the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle (R.L.P.)
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Ilic M, Vlajinac H, Marinkovic J. Cigarette smoking and breast cancer: a case-control study in Serbia. Asian Pac J Cancer Prev 2015; 14:6643-7. [PMID: 24377581 DOI: 10.7314/apjcp.2013.14.11.6643] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the fact that breast cancer is the most common female cancer worldwide, more than half of the breast cancer risk factors remained unexplained. The aim of this study was to investigate the association of cigarette smoking with risk of breast cancer. MATERIALS AND METHODS A case-control study was conducted in the Clinical Centre of Kragujevac, Serbia, covering 382 participants (191 cases and 191 controls). In the analysis of data logistic regression was used. RESULTS Breast cancer risk was significantly increased in those who quit smoking at ≤ 50 years of age (OR=2.72; 95% confidence interval - 95%CI=1.02-7.27) and in those who quit smoking less than 5 years before diagnosis of the disease (OR=4.36; 95%CI=1.12-16.88). When smokers were compared with nonsmokers without passive exposure to smoking, former smoking significantly increased breast cancer risk (OR=2.37; 95%CI=1.07-5.24). Risk for breast cancer was significantly increased in those who quit smoking at ≤ 50 years of age (OR=3.29; 95%CI=1.17-9.27) and in those who quit smoking less than 5 years before diagnosis of the disease (OR=5.46; 95%CI=1.34-22.28). CONCLUSIONS These data suggest that cigarette smoking is associated with an elevated risk of breast cancer among former smokers in Serbia.
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Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia E-mail :
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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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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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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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Abstract
The main objective of following patients after the primary treatment of breast cancer is the detection of potentially curable events, particularly the detection of local recurrences and contralateral breast cancer. Additionally, medical counseling on therapies, psychosocial aspects, side effects of therapies, and lifestyle interventions is important to improve the quality of life. There is an ongoing discussion about whether early detection of asymptomatic metastasis could improve the course of disease. Today, the follow-up is still symptom-orientated. Intensified imaging and laboratory check-ups have not been beneficial for the patients' survival. A follow-up in the first 2-3 years is recommended every 3 months. Because of the decreasing incidence of recurrence from year 4, 6-monthly screening intervals are recommended. The screening should include a history, physical examination, and a consultation. Routine diagnostic imaging - except for mammography/ultrasound - is not indicated in asymptomatic patients. Innovative therapies for patients with metastatic breast cancer have been introduced. Therefore, measures of an intensified follow-up could change in the future as novel endocrine combination or targeted therapies in molecular subtypes could significantly improve the survival in early detected metastasis. In the future, more individualized follow-up programs are conceivable. However, this idea is so far not supported by the available data.
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Affiliation(s)
- Christoph Mundhenke
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Volker Moebus
- Frauenklinik, Klinikum Frankfurt-Hoechst, Frankfurt/M., Germany
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Abstract
A microfluidic immunoassay is successfully developed for rapid analysis of cotinine saliva samples, which is a metabolite of nicotine and is widely used as a biomarker to evaluate the smoking status and exposure to tobacco smoke. The core microfluidic chip is fabricated by polydimethylsiloxane (PDMS) with standard soft lithography. Each chip is capable of eight parallel analyses of cotinine samples. The analyses can be completed within 40 min with 12 μl sample consumption. The linear detection range is 1 ~ 250 ng/ml and the minimum detectable concentration is 1 ng/ml respectively. The correlation coefficient of the calibration curve established from standard samples is 0.9989. The immunoassay was also validated by real saliva samples, and the results showed good reproducibility and accuracy. All the results were confirmed with traditional ELISA measurements. The result from microfluidic chip device and ELISA kits showed good correspondence, and the correlation coefficients are higher than 0.99. Compared with traditional technique, this microfluidic immunoassay is more economic, rapid, simple and sensitive, perfect for on-site cotinine measurements as well as for the evaluation of the exposure to tobacco smoking. Moreover, this immunoassay has potential to be applied in the analysis of other biomarkers in human saliva samples.
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A role for cAMP-driven transactivation of EGFR in cancer aggressiveness - therapeutic implications. Med Hypotheses 2014; 83:142-7. [PMID: 24932579 DOI: 10.1016/j.mehy.2014.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/18/2014] [Accepted: 05/01/2014] [Indexed: 12/29/2022]
Abstract
In many common cancers, production of cAMP boosts cancer proliferation, survival, and aggressiveness, reflecting the fact that, through mechanisms that require further clarification, cAMP can promote tyrosine phosphorylation, notably transactivation of the epidermal growth factor receptor (EGFR). Hormones which activate adenylate cyclase in many cancers include PGE2 - often produced by cox-2 activity within tumors - and adrenergic hormones, acting on beta2 receptors. NSAID cyclooxygenase inhibitors, including low-dose aspirin, clearly reduce risk for many adenocarcinomas, but the impact of cox-2 inhibitors in clinical cancer therapy remains somewhat equivocal. There is increasing evidence that increased sympathetic drive, often reflecting psychic stress or tobacco usage, increases risk for, and promotes the aggressiveness of, many cancers. The non-specific beta antagonist propranolol shows cancer-retardant activity in pre-clinical rodent studies, especially in stressed animals, and a limited amount of epidemiology concludes that concurrent propranolol usage is associated with superior prognosis in breast cancer, ovarian cancer, and melanoma. Epidemiology correlating increased resting heart rate with increased total cancer mortality can be interpreted as compelling evidence that increased sympathetic drive encourages the onset and progression of common cancers. Conversely, hormones which inhibit adenylate cyclase activity in cancers may have potential for cancer control; GABA, which can be administered as a well-tolerated nutraceutical, has potential in this regard. Combination regimens intended to down-regulate cancer cAMP levels, perhaps used in conjunction with EGFR inhibitors, may have considerable potential for suppressing the contribution of cAMP/EGFR to cancer aggressiveness. This model also predicts that certain other hormones which activate adenylate cylase in various tissue may play a yet-unsuspected role in cancer induction and spread.
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