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Hughes RT, Ip EH, Urbanic JJ, Hu JJ, Weaver KE, Lively MO, Winkfield KM, Shaw EG, Diaz LB, Brown DR, Strasser J, Sears JD, Lesser GJ. Smoking and Radiation-induced Skin Injury: Analysis of a Multiracial, Multiethnic Prospective Clinical Trial. Clin Breast Cancer 2022; 22:762-770. [PMID: 36216768 PMCID: PMC10003823 DOI: 10.1016/j.clbc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Smoking during breast radiotherapy (RT) may be associated with radiation-induced skin injury (RISI). We aimed to determine if a urinary biomarker of tobacco smoke exposure is associated with increased rates of RISI during and after breast RT. PATIENTS AND METHODS Women with Stage 0-IIIA breast cancer treated with breast-conserving surgery or mastectomy followed by RT to the breast or chest wall with or without regional nodal irradiation were prospectively enrolled on a multicenter study assessing acute/late RISI. 980 patients with urinary cotinine (UCot) measurements (baseline and end-RT) were categorized into three groups. Acute and late RISI was assessed using the ONS Acute Skin Reaction scale and the LENT-SOMA Criteria. RESULTS Late Grade 2+ and Grade 3+ RISI occurred in 18.2% and 1.9% of patients, respectively-primarily fibrosis, pain, edema, and hyperpigmentation. Grade 2+ late RISI was associated with UCot group (P= 006). Multivariable analysis identified UCot-based light smoker/secondhand smoke exposure (HR 1.79, P= .10) and smoking (HR 1.60, p = .06) as non-significantly associated with an increased risk of late RISI. Hypofractionated breast RT was associated with decreased risk of late RISI (HR 0.51, P=.03). UCot was not associated with acute RISI, multivariable analysis identified race, obesity, RT site/fractionation, and bra size to be associated with acute RISI. CONCLUSIONS Tobacco exposure during breast RT may be associated with an increased risk of late RISI without an effect on acute toxicity. Smoking cessation should be encouraged prior to radiotherapy to minimize these and other ill effects of smoking.
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Affiliation(s)
- Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Edward H Ip
- Department of Biostatistics & Data Science, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States; Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - James J Urbanic
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, United States.
| | - Jennifer J Hu
- Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136.
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | | | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, 1005 Dr DB Todd Jr Blvd, Nashville, TN 37208, United States.
| | | | - Luis Baez Diaz
- Puerto Rico Minority Underserved NCI Community Oncology Research Program, 89 De Diego Avenue, PMB #711, Suite 105, San Juan, Puerto Rico 00927.
| | - Doris R Brown
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Jon Strasser
- Helen F Graham Cancer Center, 4701 Ogletown Stanton Rd, Newark, DE 19713, United States.
| | - Judith D Sears
- Piedmont Radiation Oncology, 1010 Bethesda Court, Winston-Salem, NC 27103, United States.
| | - Glenn J Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine.
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Aggarwal P, Hutcheson KA, Goepfert RP, Garden AS, Garg N, Mott FE, Fuller CD, Lai SY, Gunn GB, Chambers MS, Hanna EY, Sturgis EM, Shete S. Risk factors associated with patient-reported fatigue among long-term oropharyngeal carcinoma survivors. Head Neck 2022; 44:952-963. [PMID: 35084077 PMCID: PMC8981739 DOI: 10.1002/hed.26991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 12/28/2021] [Accepted: 01/14/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The study objective is to identify risk factors associated with fatigue among long-term OPC survivors. METHODS This cross-sectional study included disease-free OPC survivors treated curatively between 2000 and 2013 who were surveyed from September 2015 to July 2016. The outcome variable was patient-reported fatigue. Multivariable logistic regression was used to identify factors associated with moderate to severe fatigue. RESULTS Among 863 OPC survivors, 17.4% reported moderate to severe fatigue. Self-reported thyroid problems (OR: 2.01; p = 0.003), current cigarette smoking at time of survey (OR: 3.85; p = 0.001), late lower cranial neuropathy (OR: 3.44; p = 0.002), and female sex (OR: 1.91; p = 0.010) were concurrent risk factors of reporting moderate to severe fatigue. Ipsilateral intensity-modulated radiotherapy (OR: 0.18; p = 0.014) was associated with lower risk of reporting moderate to severe fatigue. CONCLUSIONS Our study identified thyroid problems, smoking, and late lower cranial neuropathy as associated with moderate to severe fatigue. These findings should be further validated in prospective studies to address fatigue among OPC survivors.
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Affiliation(s)
- Puja Aggarwal
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naveen Garg
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frank E Mott
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gary Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark S Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erich M Sturgis
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Stang A, Knowlton R, Rekowski J, Gershman ST, Galea S. Smoking cessation potential among newly diagnosed cancer patients: a population-based study of the ten most common cancers in Massachusetts, USA, 2008-2013. Ann Epidemiol 2020; 56:55-60.e11. [PMID: 33189878 DOI: 10.1016/j.annepidem.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE In cancer patients, cigarette smoking is causally linked with increased mortality. We examined the relationship between smoking status at the time of diagnosis and cancer mortality to help estimate the scope of smoking cessation services required to meet the needs of cancer patients. METHODS We studied the ten most common cancers in Massachusetts, 2008-2013 including 175,489 incident cases and used smoking status at the time of diagnosis to provide smoking prevalence. We calculated adjusted hazard ratios of all-cause mortality comparing smoker subgroups. RESULTS Smoking prevalence was more than threefold higher for lung cancer and more than twofold higher for head and neck cancer and bladder cancer than in the general population. Cancer cases who smoked at the time of diagnosis had a higher adjusted mortality rate than cancer cases who were former smokers. The three sites with the highest increased hazard ratios comparing current smokers with former smokers were cancers of the thyroid (HR = 1.67, 95% CI 1.14-2.45), head and neck (HR = 1.65, 95% CI 1.39-1.95), and prostate (HR = 1.60, 95% CI 1.36-1.90). CONCLUSIONS Smoking remains high among cancer patients. More widespread adoption of smoking cessation programs among cancer patients may play a substantial role in improving cancer morbidity and mortality.
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Affiliation(s)
- Andreas Stang
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Germany; School of Public Health, Boston University, Boston, MA.
| | - Richard Knowlton
- Massachusetts Cancer Registry, Office of Data Management and Outcomes Assessment, Office of Population Health Massachusetts Department of Public Health, Boston, MA
| | - Jan Rekowski
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Germany
| | - Susan T Gershman
- Massachusetts Cancer Registry, Office of Data Management and Outcomes Assessment, Office of Population Health Massachusetts Department of Public Health, Boston, MA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA
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Asare M, McIntosh S, Culakova E, Alio A, Umstattd Meyer MR, Kleckner AS, Adunlin G, Kleckner IR, Ylitalo KR, Kamen CS. Assessing Physical Activity Behavior of Cancer Survivors by Race and Social Determinants of Health. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 40:7-16. [PMID: 31242086 DOI: 10.1177/0272684x19857427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction Black cancer survivors remain at a higher risk for secondary cancers, cancer recurrence, and comorbid conditions than non-Hispanic White survivors. Physical activity may help improve health outcomes and overall quality of life. We assessed cancer survivors’ physical activity by race/ethnicity and the effect of social determinants of health (SDH) constructs (i.e., economic stability, education, and access to health care) on physical activity. Methods This was a cross-sectional analysis of data from the 2016 Behavioral Risk Factor Surveillance System. The outcome variable was physical activity after cancer diagnosis and the predictor variables were SDH and race. Multivariable logistic regressions were used to examine associations between race and physical activity and the effect of SDH on physical activity. Results Among 3,787 cancer survivors, 91.6% self-identified as White and 8.4% as Black. Blacks were more likely than Whites to report low economic stability, low access to health care, and low health literacy (all ps < .01). Blacks were less likely than Whites to engage in physical activity after controlling for demographic and clinical factors (adjusted odds ratio [ORAdj] = 0.71; 95% confidence interval [CI] = 0.56–0.91; p = .01) and after additional adjustment of SDH (ORAdj = 0.77; 95% CI = 0.60–0.99; p = .04). Conclusions The findings suggest that though Black cancer survivors are less than White to engage in physical activity, and SDH partially explained the racial difference in physical activity behaviors. These findings highlight the need to address barriers to health-care access, economic stability, and educational attainment.
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Affiliation(s)
- Matthew Asare
- 1 Public Health, Health, Human Performance, & Recreation, Baylor University, Waco, TX, USA
| | - Scott McIntosh
- 2 University of Rochester Medical Center, Public Health Sciences, Rochester, NY, USA
| | - Eva Culakova
- 3 University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Amina Alio
- 2 University of Rochester Medical Center, Public Health Sciences, Rochester, NY, USA
| | - M Renee Umstattd Meyer
- 1 Public Health, Health, Human Performance, & Recreation, Baylor University, Waco, TX, USA
| | - Amber S Kleckner
- 3 University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Georges Adunlin
- 4 Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
| | - Ian R Kleckner
- 3 University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Kelly R Ylitalo
- 1 Public Health, Health, Human Performance, & Recreation, Baylor University, Waco, TX, USA
| | - Charles S Kamen
- 3 University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
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Smoking cessation among men following cancer diagnosis: a matched cohort study. J Cancer Surviv 2018; 12:786-793. [PMID: 30302603 DOI: 10.1007/s11764-018-0715-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/03/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE Cigarette smoking among cancer survivors increases the risk of recurrence and secondary cancers. We sought to investigate smoking cessation following diagnosis of cancer compared to those not diagnosed with cancer. We also investigated cessation following diagnosis of a smoking-related and non-smoking-related cancer separately. METHODS We conducted a matched cohort study within the Health Professionals Follow-Up Study (HPFS). We identified 566 men diagnosed with cancer who were current cigarette smokers at the time of diagnosis between 1986 and 2010 (exposed). Men diagnosed with cancer were age-matched 1:4 to men without a diagnosis of cancer who were also current cigarette smokers (unexposed). Multivariable conditional logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) to evaluate the association between a cancer diagnosis and smoking cessation within 2 and 4 years post diagnosis adjusted for potential confounders, overall and for smoking-related and non-smoking-related cancers. RESULTS Of the men with cancer, 38% quit within 2 years and 42% within 4 years of diagnosis. Men diagnosed with cancer were more likely to quit smoking within 2 (OR = 2.5, 95% CI: 2.0-3.0) and 4 years (OR = 1.6, 95% CI: 1.3-2.0) post diagnosis, compared to matched men without cancer. The association was similar for smoking-related (OR = 3.4, 95%: 1.6-7.2) and non-smoking-related cancers (OR = 3.8, 95%: 2.8-5.2). CONCLUSIONS Men diagnosed with cancer were more likely to quit smoking compared to men not diagnosed with cancer. A cancer diagnosis may be a "teachable moment" in which strategies to promote smoking cessation for individuals diagnosed with smoking-related and non-smoking-related cancers should be investigated. IMPLICATIONS FOR CANCER SURVIVORS There is a continued need for the widespread implementation of cessation interventions for cancer survivors.
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Alton D, Eng L, Lu L, Song Y, Su J, Farzanfar D, Mohan R, Krys O, Mattina K, Harper C, Liu S, Yoannidis T, Milne R, Brown MC, Vennettilli A, Hope AJ, Howell D, Jones JM, Selby P, Xu W, Goldstein DP, Liu G, Giuliani ME. Perceptions of Continued Smoking and Smoking Cessation Among Patients With Cancer. J Oncol Pract 2018; 14:e269-e279. [PMID: 29676948 DOI: 10.1200/jop.17.00029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Continued smoking after a cancer diagnosis leads to poorer treatment outcomes, survival, and quality of life. We evaluated the perceptions of the effects of continued smoking on quality of life, survival, and fatigue among patients with cancer after a cancer diagnosis and the effects of these perceptions on smoking cessation. PATIENTS AND METHODS Patients with cancer from all disease subsites from Princess Margaret Cancer Centre (Toronto, Ontario) were surveyed between April 2014 and May 2016 for sociodemographic variables, smoking history, and perceptions of continued smoking on quality of life, survival, and fatigue. Multivariable regression models evaluated the association between patients' perceptions and smoking cessation and the factors influencing patients' perceptions of smoking. RESULTS Among 1,121 patients, 277 (23%) were smoking cigarettes up to 1 year before diagnosis, and 54% subsequently quit; 23% had lung cancer, and 27% had head and neck cancers. The majority felt that continued smoking after a cancer diagnosis negatively affected quality of life (83%), survival (86%), and fatigue (82%). Current smokers during the peridiagnosis period were less likely to perceive that continued smoking was harmful when compared with ex-smokers and never-smokers ( P < .01). Among current smokers, perceiving that smoking negatively affected quality of life (adjusted odds ratio [aOR], 2.68 [95% CI, 1.26 to 5.72]; P = .011), survival (aOR, 5.00 [95% CI, 2.19 to 11.43]; P < .001), and fatigue (aOR, 3.57 [95% CI, 1.69 to 7.54]; P < .001) were each strongly associated with smoking cessation. Among all patients, those with a greater smoking history were less likely to believe that smoking was harmful in terms of quality of life (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), survival (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), and fatigue (aOR, 0.99 [95% CI, 0.98 to 0.99]; P < .001). CONCLUSION The perceptions of continued smoking after a cancer diagnosis among patients with cancer are strongly associated with smoking cessation. Counseling about the harms of continued smoking in patients with cancer, and in particular among those who have lower risk perceptions, should be considered when developing a smoking cessation program.
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Affiliation(s)
- Devon Alton
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Lawson Eng
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Lin Lu
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Yuyao Song
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Jie Su
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Delaram Farzanfar
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Rahul Mohan
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Olivia Krys
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Katie Mattina
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Christopher Harper
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Sophia Liu
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Tom Yoannidis
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Robin Milne
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - M Catherine Brown
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Ashlee Vennettilli
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Andrew J Hope
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Doris Howell
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Jennifer M Jones
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Peter Selby
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - David P Goldstein
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Geoffrey Liu
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Meredith E Giuliani
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
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Allemani C, Berrino F, Krogh V, Sieri S, Pupa SM, Tagliabue E, Tagliabue G, Sant M. Do Pre-Diagnostic Drinking Habits Influence Breast Cancer Survival? TUMORI JOURNAL 2018; 97:142-8. [DOI: 10.1177/030089161109700202] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Alcohol consumption increases the risk of developing breast cancer and may also be associated with late diagnosis, recurrence, distant metastases and death. Many studies have examined the role of alcohol as a risk factor for the development of breast cancer, but very few studies have addressed the role of alcohol as a prognostic factor for survival among women diagnosed with breast cancer. The aim of this study was to investigate the survival of women with breast cancer in relation to pre-diagnostic alcohol intake and other factors known to influence prognosis. Methods We analyzed data for 264 women in the EUROCARE and ORDET studies who were diagnosed with breast cancer from 1987 up to 31 December 2001 and for whom information was available on follow-up, stage at diagnosis, HER-2 and hormone receptor status, and pre-diagnostic dietary alcohol intake, categorized as zero (0 g/day, non-drinkers), moderate (up to 13 g/day, about 1 serving) and high (>13 g/day). Ten-year relative survival was estimated using the maximum-likelihood approach. The excess risk of death within 10 years of diagnosis was modeled by level of alcohol intake, adjusting separately for age, stage, body mass index and tumor subtype. Results Ten-year relative survival was lowerin women who drank more than 13g/day (65%; 95% CI, 47–78) than in non-drinkers (88%; 95% CI, 75–95). The excess risk of death within 10 years was significantly higher in women who drank more than 13 g/day than non-drinkers (relative excess risk, 4.13; 95% CI, 1.69–10.10) and was not altered by adjustment for other prognostic factors. The excess risk within 10 years was higher for women with a body mass index of 25 kg/m2 or higher (relative excess risk, 2.20; 95% CI, 1.01–4.70) and higher for those with more advanced disease. Conclusions Women who drank more than 13 g alcohol per day had lower survival than non-drinkers. The excess risk of death within 10 years of diagnosis was unaffected by other known risk factors. High alcohol consumption may be an adverse prognostic factor for breast cancer.
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Affiliation(s)
- Claudia Allemani
- Department of Preventive and Predictive Medicine, Analytical Epidemiology Unit, Milan
| | - Franco Berrino
- Department of Preventive and Predictive Medicine, Unit of Etiological Epidemiology and Prevention, Milan
| | - Vittorio Krogh
- Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, Milan
| | - Sabina Sieri
- Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, Milan
| | - Serenella M Pupa
- Laboratories and Department of Experimental Oncology, Molecular Biology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Elda Tagliabue
- Laboratories and Department of Experimental Oncology, Molecular Biology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Giovanna Tagliabue
- Department of Preventive and Predictive Medicine, Lombardy Cancer Registry, Varese Province, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Milena Sant
- Department of Preventive and Predictive Medicine, Analytical Epidemiology Unit, Milan
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8
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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. [PMID: 29608187 PMCID: PMC5875926 DOI: 10.1093/jncics/pkx001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [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-/postdiagnosis 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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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9
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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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10
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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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11
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Xiong W, Zhao J, Wang L, Jiang X. UPLC-MS/MS method for the determination of tobacco-specific biomarker NNAL, tamoxifen and its main metabolites in rat plasma. Biomed Chromatogr 2017; 31. [PMID: 27862094 DOI: 10.1002/bmc.3890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/20/2016] [Accepted: 11/03/2016] [Indexed: 12/27/2022]
Abstract
Cigarette smoke is known to interact with tamoxifen-metabolizing enzymes and transporters and potentially affect its treatment outcome. 4-(N-nitrosomethylamino)-1-(3-pyridyl)-1-butanol (NNAL) is an important metabolite of 4-(methylnitro-samino)-1-(3-pyridyl)-1-butanone (NNK) because it is frequently used as a biomarker to assess human smoke exposure. In order to study the potential pharmacokinetic interaction between cigarette smoke and tamoxifen in rats a UPLC-MS/MS method for the simultaneous determination of NNAL and tamoxifen along with its metabolites in rat plasma has been developed and validated. Analytes were extracted with methanol and separated on a HSS T3 column by a gradient elution with the mobile phase consisting of acetonitrile and water. The lower limits of quantitation ranged from 0.05 to 0.62 ng/mL. Precisions showed RSD <15.8% and accuracy in the range 80.6-116.0%. Mean analyte recoveries ranged from 76.9 to 108.4%. The method was successfully applied to study the effects of cigarette smoke condensate (CSC), NNK and benzo(a)pyrene pre-treatment on the pharmacokinetics of tamoxifen and its metabolites in rats. Significant effects of CSC, NNK, benzo(a)pyrene were observed on pharmacokinetics of tamoxifen and its metabolites. We also found that plasma NNAL levels are statistically significant correlated with plasma 4-hydroxy-tamoxifen and endoxifen.
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Affiliation(s)
- Wei Xiong
- Department of Clinical Pharmacy, Pharmacy School of Sichuan University, Chengdu, Sichuan, China
- Sichuan Tobacco Quality Supervision and Testing Station, Chengdu, People's Republic of China
| | - Jiajia Zhao
- Department of Clinical Pharmacy, Pharmacy School of Sichuan University, Chengdu, Sichuan, China
| | - Ling Wang
- Department of Clinical Pharmacy, Pharmacy School of Sichuan University, Chengdu, Sichuan, China
| | - Xuehua Jiang
- Department of Clinical Pharmacy, Pharmacy School of Sichuan University, Chengdu, Sichuan, China
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12
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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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13
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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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14
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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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15
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Sitas F, Weber MF, Egger S, Yap S, Chiew M, O'Connell D. Smoking Cessation After Cancer. J Clin Oncol 2014; 32:3593-5. [DOI: 10.1200/jco.2014.55.9666] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Freddy Sitas
- Cancer Council New South Wales, Wooloomooloo; University of Sydney, Camperdown; and University of New South Wales, Kensington, New South Wales, Australia
| | - Marianne F. Weber
- Cancer Council New South Wales, Wooloomooloo; and University of Sydney, Camperdown, New South Wales, Australia
| | - Sam Egger
- Cancer Council New South Wales, Wooloomooloo, New South Wales, Australia
| | - Sarsha Yap
- Cancer Council New South Wales, Wooloomooloo, New South Wales, Australia
| | - May Chiew
- Cancer Council New South Wales, Wooloomooloo, New South Wales, Australia
| | - Dianne O'Connell
- Cancer Council New South Wales, Wooloomooloo; University of Sydney, Camperdown; University of New South Wales, Kensington; and University of Newcastle, Callaghan, New South Wales, Australia
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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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17
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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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Bérubé S, Lemieux J, Moore L, Maunsell E, Brisson J. Smoking at time of diagnosis and breast cancer-specific survival: new findings and systematic review with meta-analysis. Breast Cancer Res 2014; 16:R42. [PMID: 24745601 PMCID: PMC4053238 DOI: 10.1186/bcr3646] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/02/2014] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In women with breast cancer who smoke, it is unclear whether smoking could impair their survival from the disease. METHODS We examined the relation of smoking at diagnosis to breast cancer-specific and overall survival among 5,892 women with invasive breast cancer treated in one Canadian center (1987 to 2008). Women were classified as never, former or current smokers. Current smokers were further classified according to total, intensity and duration of smoking. Deaths were identified through linkage to population mortality data. Cox proportional-hazards multivariate models were used. A systematic review with meta-analysis combines new findings with published results. RESULTS Compared with never smokers, current smokers at diagnosis had a slightly, but not statistically significant, higher breast cancer-specific mortality (hazard ratio = 1.15, 95% confidence interval (CI): 0.97 to 1.37). Among current smokers, breast cancer-specific mortality increased with total exposure to, intensity and duration of smoking (all Ptrend <0.05). Compared to never smokers, breast cancer-specific mortality was 32 to 56% higher among heavy smokers (more than 30 pack years of smoking, more than 20 cigarettes per day or more than 30 years of smoking). Smoking at diagnosis was associated with an increased all-cause mortality rate. A meta-analysis of all studies showed a statistically significant, 33% increased mortality from breast cancer in women with breast cancer who are smokers at diagnosis compared to never smokers (hazard ratio = 1.33, 95% CI: 1.12 to 1.58). CONCLUSIONS Available evidence to date indicates that smoking at diagnosis is associated with a reduction of both overall and breast cancer-specific survival. Studies of the effect of smoking cessation after diagnosis on breast cancer-specific outcomes are needed.
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Affiliation(s)
- Sylvie Bérubé
- Centre des maladies du sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, Qc G1S 4 L8, Canada
- Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Québec, Canada
| | - Julie Lemieux
- Centre des maladies du sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, Qc G1S 4 L8, Canada
- Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Québec, Canada
- Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
- Département de médecine et Service d’hémato-oncologie, CHU de Québec, Québec, Canada
| | - Lynne Moore
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada
- Unité de traumatologie-urgence-soins intensifs, CHU de Québec, Québec, Canada
| | - Elizabeth Maunsell
- Centre des maladies du sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, Qc G1S 4 L8, Canada
- Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Québec, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada
| | - Jacques Brisson
- Centre des maladies du sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, Qc G1S 4 L8, Canada
- Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Québec, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada
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Eng L, Su J, Qiu X, Palepu PR, Hon H, Fadhel E, Harland L, La Delfa A, Habbous S, Kashigar A, Cuffe S, Shepherd FA, Leighl NB, Pierre AF, Selby P, Goldstein DP, Xu W, Liu G. Second-Hand Smoke As a Predictor of Smoking Cessation Among Lung Cancer Survivors. J Clin Oncol 2014; 32:564-70. [DOI: 10.1200/jco.2013.50.9695] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Second-hand smoke (SHS; ie, exposure to smoking of friends and spouses in the household) reduces the likelihood of smoking cessation in noncancer populations. We assessed whether SHS is associated with cessation rates in lung cancer survivors. Patients and Methods Patients with lung cancer were recruited from Princess Margaret Cancer Centre, Toronto, ON, Canada. Multivariable logistic regression and Cox proportional hazard models evaluated the association of sociodemographics, clinicopathologic variables, and SHS with either smoking cessation or time to quitting. Results In all, 721 patients completed baseline and follow-up questionnaires with a mean follow-up time of 54 months. Of the 242 current smokers at diagnosis, 136 (56%) had quit 1 year after diagnosis. Exposure to smoking at home (adjusted odds ratio [aOR], 6.18; 95% CI, 2.83 to 13.5; P < .001), spousal smoking (aOR, 6.01; 95% CI, 2.63 to 13.8; P < .001), and peer smoking (aOR, 2.49; 95% CI, 1.33 to 4.66; P = .0043) were each associated with decreased rates of cessation. Individuals exposed to smoking in all three settings had the lowest chances of quitting (aOR, 9.57; 95% CI, 2.50 to 36.64; P < .001). Results were similar in time-to-quitting analysis, in which 68% of patients who eventually quit did so within 6 months after cancer diagnosis. Subgroup analysis revealed similar associations across early- and late-stage patients and between sexes. Conclusion SHS is an important factor associated with smoking cessation in lung cancer survivors of all stages and should be a key consideration when developing smoking cessation programs for patients with lung cancer.
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Affiliation(s)
- Lawson Eng
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Jie Su
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Xin Qiu
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Prakruthi R. Palepu
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Henrique Hon
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Ehab Fadhel
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Luke Harland
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Anthony La Delfa
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Steven Habbous
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Aidin Kashigar
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Sinead Cuffe
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Frances A. Shepherd
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Natasha B. Leighl
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Andrew F. Pierre
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - David P. Goldstein
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Wei Xu
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Lawson Eng, Jie Su, Xin Qiu, Prakruthi R. Palepu, Henrique Hon, Ehab Fadhel, Luke Harland, Anthony La Delfa, Steven Habbous, Aidin Kashigar, Sinead Cuffe, Frances A. Shepherd, Natasha B. Leighl, Andrew F. Pierre, David P. Goldstein, Wei Xu, and Geoffrey Liu, Princess Margaret Hospital/Ontario Cancer Institute/University Health Network, University of Toronto; Peter Selby, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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Pierce JP, Patterson RE, Senger CM, Flatt SW, Caan BJ, Natarajan L, Nechuta SJ, Poole EM, Shu XO, Chen WY. Lifetime cigarette smoking and breast cancer prognosis in the After Breast Cancer Pooling Project. J Natl Cancer Inst 2013; 106:djt359. [PMID: 24317179 DOI: 10.1093/jnci/djt359] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is controversy on whether former smokers have increased risk for breast cancer recurrence or all-cause mortality, regardless of how much they smoked. METHODS Data were from three US cohorts in the After Breast Cancer Pooling Project, with detailed information on smoking among 9975 breast cancer survivors. Smoking was assessed an average of 2 years after diagnosis. Delayed entry Cox proportional hazards models were used to examine the relationships of smoking status, cigarettes per day, years of smoking, and pack years with breast cancer prognosis. Endpoints included breast cancer recurrence (n = 1727), breast cancer mortality (n = 1059), and overall mortality (n = 1803). RESULTS Compared with never smokers, former smokers with less than 20 pack-years of exposure had no increased risk of any outcome. However, former smokers with 20 to less than 34.9 pack-years of exposure had a 22% increased risk of breast cancer recurrence (hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 1.01 to 1.48) and a 26% increased risk of all-cause mortality (HR = 1.26; 95% CI = 1.07 to 1.48). For former smokers with 35 or more pack-years of exposure, the probability of recurrence increased by 37% (HR = 1.37; 95% CI = 1.13 to 1.66), breast cancer mortality increased by 54% (HR = 1.54; 95% CI = 1.24 to 1.91), and all-cause mortality increased by 68% (HR = 1.68; 95% CI = 1.44 to 1.96). Current smoking increased the probability of recurrence by 41% (HR = 1.41; 95% CI = 1.16 to 1.71), increased breast cancer mortality by 60% (HR = 1.61; 95% CI = 1.28 to 2.03), and doubled the risk of all-cause mortality (HR = 2.17; 95% CI = 1.85 to 2.54). CONCLUSIONS Lifetime cigarette smoking was statistically significantly associated with a poor prognosis among women diagnosed with breast cancer, dose-dependent increased risks of recurrence, and breast cancer and all-cause mortality.
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Affiliation(s)
- John P Pierce
- Affiliations of authors: Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California-San Diego, La Jolla, CA (JPP, REP, CMS, SWF, LN); Division of Research, Kaiser Permanente, Oakland, CA (BJC); Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (SJN, X-OS); Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (EMP, WYC); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (WYC)
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Randén M, Helde-Frankling M, Runesdotter S, Gunvén P. Unfavorable cancers of unknown primaries: presentation and prognostic factors. A population-based 8-year experience. Med Oncol 2013; 30:706. [DOI: 10.1007/s12032-013-0706-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/20/2013] [Indexed: 01/02/2023]
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Saquib N, Stefanick ML, Natarajan L, Pierce JP. Mortality risk in former smokers with breast cancer: pack-years vs. smoking status. Int J Cancer 2013; 133:2493-7. [PMID: 23649774 DOI: 10.1002/ijc.28241] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/15/2013] [Indexed: 01/17/2023]
Abstract
It is unclear why successful quitting at time of breast cancer diagnosis should remove risk from a significant lifetime of smoking. Studies concluding this may be biased by how smoking is measured in many epidemiological cohorts. In the late 1990s, a randomized trial of diet and breast cancer outcomes enrolled early-stage female breast cancer survivors diagnosed within the previous 4 years. Smoking history and key covariate measures were available at study entry for 2,953 participants. Participants were followed for an average of 7.3 years (96% response rate). There were 10.1% deaths (83% from breast cancer). At enrollment, 55.2% were never smokers, 41.2% former smokers and 4.6% current smokers. Using current smoking status in a Cox regression, there was no increased risk for former smokers for either all-cause mortality [hazard ratio (HR) = 1.11; 95% confidence interval (CI) = 0.87-1.41; p-value = 0.42) or breast cancer mortality. However, when we categorized on extensive lifetime exposure, former smokers with 20+ pack-years of smoking (25.8%) had a significantly higher risk of both all-cause (HR = 1.77; 95% CI = 1.17-2.48; p-value = 0.0007) and breast cancer-specific mortality (HR = 1.62; 95% CI = 1.11-2.37; p-value = 0.01). Lifetime smoking exposure, not current status, should be used to assess mortality risk among former smokers.
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Affiliation(s)
- Nazmus Saquib
- Stanford Prevention Research Center, Stanford University, Stanford, CA
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Johnson L, Agbaje O, Doig M, Fentiman IS. Serum cotinine and prognosis in breast cancer. Breast Cancer Res Treat 2012; 134:811-4. [PMID: 22678157 DOI: 10.1007/s10549-012-2098-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/14/2012] [Indexed: 11/24/2022]
Abstract
Various studies have suggested that women who smoke have a worse prognosis if they develop breast cancer. Cotinine levels have been measured in sera from 511 patients with stage I and II breast cancer diagnosed between 1975 and 1980, all of whom had complete follow-up. Although the known prognostic factors, axillary nodal status, tumour size and grade were found to be significant, there was no relationship between serum cotinine and metastasis-free survival. A point estimate of serum cotinine was not found to be a determinant of survival in women with early breast cancer.
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Affiliation(s)
- L Johnson
- Research Oncology, Kings College London, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
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Modifiable risk factors and survival in women diagnosed with primary breast cancer: results from a prospective cohort study. Eur J Cancer Prev 2010; 19:366-73. [PMID: 20502344 DOI: 10.1097/cej.0b013e32833b4828] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examines the impact of smoking, body mass index, alcohol consumption, hormone replacement therapy, and physical activity on all-cause mortality among 528 Danish women diagnosed with primary breast cancer. Participants were women enrolled in the Copenhagen City Heart Study. Prospective self-reported exposure information was collected from four points of follow-up in 1976-1978, 1981-1983, 1991-1994, and 2001-2003. Kaplan-Meier survival curves and multivariate Cox regression analyses were performed adjusting for age, disease stage, adjuvant treatment, menopausal status, parity, alcohol intake, smoking, physical activity, body mass index, and hormone replacement therapy. The study shows that smoking for total mortality [hazard ratio, 1.16; 95% confidence interval, 1.05-1.29] and obesity for both total mortality (1.61; 1.12-2.33) and breast cancer-specific mortality (1.82; 1.11-2.99) were significantly associated with decreased survival after breast cancer diagnosis. A moderate alcohol intake of 1-6 units/week (0.85; 0.64-1.12), 7-14 units/week (0.77; 0.56-1.08), and treatment with hormone replacement therapy (0.79; 0.59-1.05) were less than 1, but not statistically significantly associated with prolonged survival. A moderate physical activity of 2-4 h/week (1.07; 0.77-1.49) and a high physical activity of more than 4 h/week (1.00; 0.69-1.45) showed no association with survival after breast cancer diagnosis.
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Cummings KM, Mahoney MC. Strategies for smoking cessation: what is new and what works? Expert Rev Respir Med 2010; 2:201-13. [PMID: 20477249 DOI: 10.1586/17476348.2.2.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While the prevalence of smoking in the USA has declined over the past half century, there still remain over 40 million current smokers, ensuring that smoking will continue to be a major factor influencing premature morbidity and mortality rates for years to come. Most people begin smoking during their teenage years and struggle to quit as adults. Nicotine dependence should be considered a chronic health condition with exacerbations and remissions. Clinicians have an important role to play in helping their patients to stop smoking. The systematic identification of all smokers is the initial step in addressing smoking cessation. Providing both pharmacotherapy and counseling support for all quit attempts helps to optimize rates of cessation. First-line pharmacotherapy to support a quit attempt include nicotine replacement (gum, patch, lozenge, nasal spray or inhaler), bupropion or varenicline. Use of these agents can increase quit rates by 1.5- to threefold. Several studies have shown that combining the nicotine patch with either gum or nasal spray can increase quit rates over single modality therapy. Recent studies have also suggested that giving smokers stop-smoking medications for several weeks in advance of their quit date may help to boost long-term quit rates. New medications are under development, including a nicotine vaccine and faster delivery nicotine medications. However, from a public health perspective, a ban on the sale of nicotine-containing combustion tobacco products may represent the most straightforward means to minimize the harm caused by tobacco use.
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Affiliation(s)
- K Michael Cummings
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Disparities in smoking and cessation status among cancer survivors and non-cancer individuals: a population-based study from National Health and Nutrition Examination Survey. J Cancer Surviv 2010; 4:313-21. [PMID: 20464638 DOI: 10.1007/s11764-010-0127-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 04/17/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Continued smoking after a cancer diagnosis is a critical problem. This study examined smoking prevalence among all and specific cancer survivors, and compared demographic profiles of the current smokers between cancer and non-cancer individuals. METHODS We used data from 2,188 cancer survivors and 22,441 non-cancer individuals who participated in the 10-year National Health and Nutrition Examination Survey (NHANES 1999-2008). All analyses were weighted to represent the United States population. RESULTS The current smoking rates decreased as age increased in both cancer and non-cancer populations. The smoking rate was higher in young cancer survivors (age <=40) than in young non-cancer individuals. The cervical, colon cancer and melanoma survivors had higher age-adjusted smoking rates than survivors of other cancers. For non-cancer individuals, the results showed that poorer white males with lower educational levels, with widowed, divorced, or separated marital status, who were underweight and had at least 12 alcoholic beverages a year, were more likely to be current smokers. DISCUSSIONS/CONCLUSIONS We can observe that age, race, education, marital status, and year since cancer diagnosis were important predictors of smoking status in cancer survivors based on the results of multivariable modeling and comparisons of age-adjusted smoking rates in specific cancer sub-groups. This implies that developing smoking cessation programs for cervical cancer and melanoma is of particularly high priority because survivors of these cancers had relatively high smoking rates and low quit smoking rates after diagnosis. These efforts should improve their quality of life and health status as well as reduce smoking-related health disparities.
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McKenzie F, Jeffreys M. Do lifestyle or social factors explain ethnic/racial inequalities in breast cancer survival? Epidemiol Rev 2009; 31:52-66. [PMID: 19675112 DOI: 10.1093/epirev/mxp007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite numerous studies documenting ethnic inequalities in breast cancer survival between minority and majority ethnic groups worldwide, reasons for these inequalities remain unclear. The authors performed a systematic review of published literature to identify studies that investigated the explanatory power of smoking, alcohol consumption, body mass index (BMI), and socioeconomic position (SEP) on ethnic inequalities in breast cancer survival. Sixteen studies were included in the review. From 5 studies, the authors found that differences in breast cancer survival between ethnic groups may be in part explained by BMI, but there was little evidence to implicate smoking or alcohol consumption as explanatory factors of this inequality. From 12 studies, the authors found that SEP explains part of the ethnic inequality in all-cause survival but that it was not evident for breast-cancer-specific survival. SEP explains more of the disparities among African-American versus white women in the United States compared with other ethnic comparisons. Furthermore, given social patterning of BMI and other lifestyle habits, it is possible that results for SEP and BMI are measuring the same effect. In this review, the authors make suggestions regarding the role of epidemiology in facilitating further research to better inform the development of effective policies to address ethnic differences in survival.
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Affiliation(s)
- Fiona McKenzie
- Centre for Public Health Research, Massey University, Wellington, New Zealand.
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Yao T, Lee AH, Mao Z. Potential unintended consequences of smoke-free policies in public places on pregnant women in China. Am J Prev Med 2009; 37:S159-64. [PMID: 19591756 PMCID: PMC3685472 DOI: 10.1016/j.amepre.2009.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/31/2009] [Accepted: 05/10/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Smoke-free policies in public places have become more common in China. Little is known, however, about the potential unintended consequences of such policies on pregnant women. METHODS The study was conducted in 2006 in Chengdu, China. Nonsmoking pregnant women (N=55) whose husband were smokers participated in a study of their knowledge about secondhand smoke and smoke-free policies, their exposure to secondhand smoke, and their husbands' smoking status at home. This study presents descriptive statistics, analyses based on family income and pregnant women's education level, and the findings of focus group discussions that examined the potential unintended consequences of the smoke-free policies on pregnant women. RESULTS Exposure to secondhand smoke at home was reported by 69.1% of the pregnant women. Both family income and the education level of the pregnant women had a significant (p<0.05) association with exposure to secondhand smoke. The four main potential unintended consequences of the smoke-free policies were: (1) increased exposure of pregnant women to secondhand smoke at home; (2) reduced work efficiency; (3) adverse effect on family harmony; and (4) poor air quality at home. CONCLUSIONS Education is needed to increase knowledge of secondhand smoke among smokers and nonsmokers alike. When the smoking location is shifted from public places and workplaces to home, women, and in particular pregnant women, become the victims. Policymakers should recognize such potential unintended consequences and take necessary measures to increase awareness about the harms of secondhand smoke.
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Affiliation(s)
- Tingting Yao
- Huaxi School of Public Health, Sichuan University, Chengdu, China
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Rezaianzadeh A, Peacock J, Reidpath D, Talei A, Hosseini SV, Mehrabani D. Survival analysis of 1148 women diagnosed with breast cancer in Southern Iran. BMC Cancer 2009; 9:168. [PMID: 19497131 PMCID: PMC2699348 DOI: 10.1186/1471-2407-9-168] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 06/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there has been much research regarding risk factors and prognostic factors for breast cancer in general, research specific to Iran is sparse. Further, the association between breast cancer survival and socio-demographic and pathologic factors has been widely studied but the majority of these studies are from developed countries. Southern Iran has a population of approximately 4 million. To date, no research has been performed to determine breast cancer survival and to explore the association between the survival and socio-demographic and pathologic factors in Southern Iran, where this study was conducted. METHODS The data were obtained from the cancer registry in Fars province, Southern Iran and included 1148 women diagnosed with breast cancer between 2000 and 2005. The association between survival, and sociodemographic and pathological factors, distant metastasis at diagnosis, and treatment options was investigated using Cox regression. RESULTS The majority of patients were diagnosed with an advanced tumour size. Five-year overall survival was 58% (95%CI; 53%-62%). Cox regression showed that family income (good vs poor: hazard ratio 0.46, 95%CI; 0.23-0.90) smoking (HR = 1.40, 95%CI; 1.07-1.86), metastases to bone (HR = 2.25, 95%CI; 1.43-3.52) and lung (HR = 3.21, 95%CI;1.70-6.05), tumour size (< or = 2 cm vs > or = 5 cm: HR = 2.07, 95%CI;1.39-3.09) and grade (poorly vs well differentiated HR = 2.33, 95%CI; 1.52-3.37), lymph node ratio (0 vs 1: HR = 15.31, 95%CI; 8.89-26.33) and number of involved node (1 vs >15: HR = 14.98, 95%CI; 8.83-25.33) were significantly related to survival. CONCLUSION This is the first study to evaluate breast cancer survival in Southern Iran and has used a wide range of explanatory factors, 44. The results demonstrate that survival is relatively poor and is associated with diagnosis with late stage disease. We hypothesise that this is due to low level of awareness, lack of screening programs and subsequent late access to treatment.
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Affiliation(s)
- Abbas Rezaianzadeh
- Nemazee Hospital Cancer Registry Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Daniell HW. Patient Characteristics and Prognosis in Metastatic Breast Cancer. J Clin Oncol 2009; 27:1147; author reply 1147-8. [DOI: 10.1200/jco.2008.20.0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Harry W. Daniell
- Department of Family Practice, University of California Davis Medical School, Davis, CA
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Jeffreys M, Sarfati D, Stevanovic V, Tobias M, Lewis C, Pearce N, Blakely T. Socioeconomic inequalities in cancer survival in New Zealand: the role of extent of disease at diagnosis. Cancer Epidemiol Biomarkers Prev 2009; 18:915-21. [PMID: 19223561 DOI: 10.1158/1055-9965.epi-08-0685] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined socioeconomic inequalities in cancer survival in New Zealand among 132,006 people ages 15 to 99 years who had a cancer registered (1994-2003) and were followed up to 2004. Relative survival rates (RSR) were calculated using deprivation-specific life tables. A census-based measure of socioeconomic position (New Zealand deprivation based on the 1996 census) based on residence at the time of cancer registration was used. All RSRs were age-standardized, and further standardization was used to investigate the effect of extent of disease at diagnosis on survival. Weighted linear regression was used to estimate the deprivation gap (slope index of inequality) between the most and least deprived cases. Socioeconomic inequalities in cancer survival were evident for all of the major cancer sites, with the deprivation gap being particularly high for prostate (-0.15), kidney and uterus (both -0.14), bladder (-0.12), colorectum (-0.10), and brain (+0.10). Accounting for extent of disease explained some of the inequalities in survival from breast and colorectal cancer and melanoma and all of the deprivation gaps in survival of cervical cancer; however, it did not affect RSRs for cancers of the kidney, uterus, and brain. No substantial differences between the total compared with the non-Māori population were found, indicating that the findings were not due to confounding by ethnicity. In summary, socioeconomic disparities in survival were consistent for nearly all cancer sites, persisted in ethnic-specific analyses, and were only partially explained by differential extent of disease at diagnosis. Further investigation of reasons for persisting inequalities is required.
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Affiliation(s)
- Mona Jeffreys
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whately Road, Bristol BS8 2PS, United Kingdom.
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Eaker S, Halmin M, Bellocco R, Bergkvist L, Ahlgren J, Holmberg L, Lambe M. Social differences in breast cancer survival in relation to patient management within a National Health Care System (Sweden). Int J Cancer 2009; 124:180-7. [PMID: 18844231 DOI: 10.1002/ijc.23875] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Epidemiologic studies have shown that cancer survival is poorer in low compared with high socioeconomic groups. We investigated whether these differences were associated with disparities in tumour characteristics and management. This cohort study was based on 9,908 women aged 20-79 years at diagnosis with primary breast cancer identified in a Swedish population-based clinical register. Information on socioeconomic standing was obtained from a social database. The 5-year cause-specific survival (CSS) and mortality hazard ratios (HR) were estimated by Cox proportional hazard models to assess differences in survival between socioeconomic groups while adjusting for diagnostic intensity, tumour characteristics and treatment. Following adjustment for age, year and stage at diagnosis, the risk of dying of breast cancer was 35% lower among women with high education compared with that of low education (HR = 0.65, 95% CI 0.53-0.80). When compared with women with high education, a lower percentage of women with low education had been investigated for proliferation (84 vs. 76%) or hormone receptor status (89 vs. 81%), had tumours <or=20 mm (68 vs. 64%), were treated at a main hospital (75 vs. 68%) and had received radiation treatment (80 vs. 67%) or chemotherapy (31 vs. 18%). However, these proportional differences could not explain the observed social gradient in survival. To minimize social differences in breast cancer survival, further research should address not only factors leading to inequities in management but also focus on patient factors such as health awareness, comorbidity burden and compliance to adjuvant treatment.
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Affiliation(s)
- Sonja Eaker
- Department of Surgery, Uppsala University, Uppsala, Sweden.
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Sundelöf M, Lagergren J, Ye W. Patient demographics and lifestyle factors influencing long-term survival of oesophageal cancer and gastric cardia cancer in a nationwide study in Sweden. Eur J Cancer 2008; 44:1566-71. [PMID: 18434132 DOI: 10.1016/j.ejca.2008.04.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 03/26/2008] [Accepted: 04/01/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Little is known about the possible influence of demographic and aetiologic risk factors on the survival amongst patients with oesophageal and cardia cancer. METHODS In a Swedish nationwide case-control study conducted in 1995-1997, 618 patients diagnosed with oesophageal or cardia cancer were interviewed regarding demographic and lifestyle factors, and followed up for survival through a 2004. Information about the treatment was collected through review of medical records, and 38 patients with missing records were excluded. Survival curves were estimated by Kaplan-Meier method. Cox proportional hazards regression models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustment for known or suspected prognostic factors. RESULTS Amongst the 580 included patients, 177 had oesophageal adenocarcinoma, 159 oesophageal squamous-cell carcinoma and 244 had cardia adenocarcinoma. Surgical resection was conducted in 224 patients (39%). The overall 5-year survival rate was 12%. Amongst patients with oesophageal adenocarcinoma, obese patients had a favourable prognosis compared to those of normal weight (HR=0.6, 95%CI 0.3-1.0). Amongst patients with oesophageal squamous-cell carcinoma, lean patients had a better prognosis (HR=0.6, 95%CI 0.4-1.0), whilst previous smokers (HR=2.1, 95%CI 1.0-4.4) and low educated (HR=1.9, 95%CI 1.1-3.4) had a worse prognosis. There were no statistically significant associations between sex, age, reflux symptoms, alcohol consumption or physical activity and prognosis in any of the three studied cancer subtypes. CONCLUSIONS Body mass, tobacco smoking and education might influence the long-term survival of patients with oesophageal cancer.
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Affiliation(s)
- Martin Sundelöf
- Department of Clinical Sciences, Division of Surgery, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
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Kellen E, Vansant G, Christiaens MR, Neven P, Van Limbergen E. Lifestyle changes and breast cancer prognosis: a review. Breast Cancer Res Treat 2008; 114:13-22. [DOI: 10.1007/s10549-008-9990-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 03/21/2008] [Indexed: 01/24/2023]
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Berstein LM. Role of Endocrine-Genotoxic Switchings in Cancer and Other Human Diseases:. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2008; 630:35-51. [DOI: 10.1007/978-0-387-78818-0_3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Zhan M, Flaws JA, Gallicchio L, Tkaczuk K, Lewis LM, Royak-Schaler R. Profiles of tamoxifen-related side effects by race and smoking status in women with breast cancer. ACTA ACUST UNITED AC 2007; 31:384-90. [PMID: 18023540 DOI: 10.1016/j.cdp.2007.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Tamoxifen (TAM) is a selective estrogen receptor modulator (SERM) that is widely used as adjuvant therapy in breast cancer patients; however, it is also associated with undesirable side effects. The goal of this study was to investigate TAM-related side effects, and determine profiles of side effects by race and by smoking status. METHODS A secondary data analysis was conducted using cross-sectional study data from 138 African American and Caucasian women with breast cancer taking TAM 20mg daily for at least 30 days prior to enrollment. Participants completed questionnaires that obtained information about demographic characteristics, reproductive history, health and lifestyle characteristics, TAM use and its related side effects. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals. RESULTS Compared to never smokers, a significantly greater percentage of current smokers reported ever experiencing TAM-related nausea (28.0% versus 5.0%, P=0.007), depression (40.0% versus 7.1%, P=0.001) and migraines (19.2% versus 1.7%, P=0.02). These differences remained statistically significant after controlling for race, age, obesity, tumor stage, and duration of TAM treatment. No significant differences by race were noted in women reporting TAM side effects. CONCLUSION The findings from this study suggest that current smokers with breast cancer should be informed of the increased probability of reporting TAM-related side effects such as nausea, depression and migraines, and counseled about smoking cessation which may reduce the incidence of these side effects.
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Affiliation(s)
- Min Zhan
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Smoking and risk of breast cancer in carriers of mutations in BRCA1 or BRCA2 aged less than 50 years. Breast Cancer Res Treat 2007; 109:67-75. [PMID: 17972172 DOI: 10.1007/s10549-007-9621-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 05/10/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cigarette smoke contains compounds that may damage DNA, and the repair of damage may be impaired in women with germline mutations in BRCA1 or BRCA2. However, the effect of cigarette smoking on breast cancer risk in mutation carriers is the subject of conflicting reports. We have examined the relation between smoking and breast cancer risk in non-Hispanic white women under the age of 50 years who carry a deleterious mutation in BRCA1 or BRCA2. METHODS We conducted a case-control study using data from carriers of mutations in BRCA1 (195 cases and 302 controls) and BRCA2 (128 cases and 179 controls). Personal information, including smoking history, was collected using a common structured questionnaire by eight recruitment sites in four countries. Odds-ratios (OR) for breast cancer risk according to smoking were adjusted for age, family history, parity, alcohol use, and recruitment site. RESULTS Compared to non-smokers, the OR for risk of breast cancer for women with five or more pack-years of smoking was 2.3 (95% confidence interval 1.6-3.5) for BRCA1 carriers and 2.6 (1.8-3.9) for BRCA2 carriers. Risk increased 7% per pack-year (p<0.001) in both groups. CONCLUSIONS These results indicate that smoking is associated with increased risk of breast cancer before age 50 years in BRCA1 and BRCA2 mutation carriers. If confirmed, they provide a practical way for carriers to reduce their risks. Previous studies in prevalent mutation carriers have not shown smoking to increase risk of breast cancer, but are subject to bias, because smoking decreases survival after breast cancer.
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Murthy BL, Thomson CS, Dodwell D, Shenoy H, Mikeljevic JS, Forman D, Horgan K. Postoperative wound complications and systemic recurrence in breast cancer. Br J Cancer 2007; 97:1211-7. [PMID: 17968426 PMCID: PMC2360477 DOI: 10.1038/sj.bjc.6604004] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Many factors involved in wound healing can stimulate tumour growth in the experimental setting. This study examined the relationship between wound complications and the development of systemic recurrence after treatment of primary breast cancer. One thousand and sixty-five patients diagnosed with operable primary invasive breast cancer between 1994 and 2001 were assessed for development of systemic recurrence according to whether or not a wound complication occurred after surgery, with a median follow-up of 54 months (range 15–119). There were 93 wound complications (9%). There was a statistically significant greater risk of developing systemic recurrence in patients with wound problems than those without (hazard ratio (HR) 2.87; 95% CI: 1.97, 4.18; P<0.0001). This remained in a multivariate analysis after adjustment for case mix variables, including Nottingham Prognostic Index (NPI) and oestrogen–progesterone receptor status (HR: 2.52; 95% CI: 1.69, 3.77; P<0.0001). In the good prognostic NPI group, 4 out of 27 patients (15%) with wound problems vs 11 out of 334 (3%) without wound problems developed systemic recurrence. The corresponding figures were 10 out of 35 (29%) vs 48 out of 412 (12 %) in the moderate prognostic group and 18 out of 29 (62%) vs 75 out of 199 (38%) in the poor prognostic group. In 29 patients NPI could not be calculated. Smokers at the time of diagnosis were more likely to develop metastatic disease than the non-smokers (HR: 1.50; 95% CI: 1.04, 2.15; P=0.03) after adjustment for other factors. The results suggest that patients with wound complications at primary surgery have increased rates of systemic recurrence of breast cancer.
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Affiliation(s)
- B L Murthy
- Department of Surgery, The General Infirmary at Leeds, Leeds LS1 3EX, UK
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Greaves L, Jategaonkar N. Tobacco policies and vulnerable girls and women: toward a framework for gender sensitive policy development. J Epidemiol Community Health 2007; 60 Suppl 2:57-65. [PMID: 17708012 PMCID: PMC2491895 DOI: 10.1136/jech.2005.045393] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This article assesses the effects of comprehensive tobacco control policies on diverse subpopulations of girls and women who are at increased vulnerability to tobacco use because of disadvantage. The authors report on a recent assessment of experimental literature examining tobacco taxation; smoking location restrictions in public and private spaces; and sales restrictions. A comprehensive search was undertaken to identify relevant studies and evaluation reports. Gender based and diversity analyses were performed to identify pertinent sex differences and gender influences that would affect the application and impact of the policy. Finally, the results were contextualised within the wider literature on women's tobacco use and women's health. The authors consider not only the intended policy effects, but also explicitly examine the gendered and/or unintended consequences of these policies on other aspects of girls and women's health and wellbeing. A framework for developing gender sensitive tobacco programmes and policies for low income girls and women is provided.
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Affiliation(s)
- Lorraine Greaves
- British Columbia Centre of Excellence for Women's Health, Vancouver, BC, Canada.
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Aksoy S, Harputluoglu H, Guler N, Altundag K, Hayran M, Tekuzman G, Ozisik Y. Influence of smoking history on breast cancer prognosis: retrospective study of 240 operable breast cancer patients who received adjuvant cyclophosphamide, doxorubicin, and 5-fluorouracil chemotherapy regimen. Breast J 2007; 13:431-2. [PMID: 17593056 DOI: 10.1111/j.1524-4741.2007.00459.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nagle CM, Bain CJ, Webb PM. Cigarette smoking and survival after ovarian cancer diagnosis. Cancer Epidemiol Biomarkers Prev 2007; 15:2557-60. [PMID: 17164386 DOI: 10.1158/1055-9965.epi-06-0592] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We have examined the association between cigarette smoking and ovarian cancer survival in 676 women with invasive epithelial ovarian cancer, recruited into a case-control study in the early 1990s. Information about cigarette smoking and other personal and reproductive factors was obtained from a personal interview at the time of diagnosis. Cox proportional hazards models were used to evaluate the association between cigarette smoking and time to ovarian cancer death. Current smokers at diagnosis were more likely to die early than women who had never smoked [adjusted hazard ratio (HR), 1.36; 95% confidence interval (95% CI), 1.01-1.84]. Increased risks of dying were greater among those who had accumulated more pack-years of smoking (HR for 30+ pack-years compared with never smokers, 1.94; 95% CI, 1.41-2.66) and smoked more cigarettes per day (HR, 1.93; 95% CI, 1.37-2.73). All these associations were stronger among women with late-stage disease (HR for current versus never smokers, 1.58; 95% CI, 1.15-2.18). Time since quitting had little effect on survival after adjusting for lifetime smoking exposure. These results validate and extend recent findings and suggest that premorbid cigarette smoking is related to worse outcome in ovarian cancer patients.
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Affiliation(s)
- Christina M Nagle
- Cancer and Population Studies Group, Queensland Institute of Medical Research, P.O. Box Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia.
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Park SM, Lim MK, Shin SA, Yun YH. Impact of prediagnosis smoking, alcohol, obesity, and insulin resistance on survival in male cancer patients: National Health Insurance Corporation Study. J Clin Oncol 2006; 24:5017-24. [PMID: 17075121 DOI: 10.1200/jco.2006.07.0243] [Citation(s) in RCA: 229] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although many studies have demonstrated that smoking, alcohol, obesity, and insulin resistance are risk factors for cancer, the role of those factors on cancer survival has been less studied. PATIENTS AND METHODS The study participants were 14,578 men with a first cancer derived from a cohort of 901,979 male government employees and teachers who participated in a national health examination program in 1996. We obtained mortality data for those years from the Korean Statistical Office. We used a standard Poisson regression model to estimate the hazard ratio (HR) for survival in relation to smoking, alcohol, obesity, and insulin resistance before diagnosis. RESULTS Poor survival of all cancer combined (HR, 1.24; 95% CI, 1.16 to 1.33), cancer of the lung (HR, 1.45; 95% CI, 1.15 to 1.82), and cancer of the liver (HR, 1.36; 95% CI, 1.21 to 1.53) were significantly associated with smoking. Compared with the nondrinker, heavy drinkers had worse outcomes for head and neck (HR, 1.85; 95% CI, 1.23 to 2.79) and liver (HR, 1.25; 95% CI, 1.11 to 1.41) cancer, with dose-dependent relationships. Patients with a fasting serum glucose level above 126 mg/dL had a higher mortality rate for stomach (HR, 1.52; 95% CI, 1.25 to 1.84) and lung (HR, 1.48; 95% CI, 1.18 to 1.87) cancer. Higher body mass index was significantly associated with longer survival in head and neck (HR, 0.54; 95% CI, 0.39 to 0.74) and esophagus (HR, 0.44; 95% CI, 0.28 to 0.68) cancer. CONCLUSION Prediagnosis risk factors for cancer development (smoking, alcohol consumption, obesity, and insulin resistance) had a statistically significant effect on survival among male cancer patients.
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Affiliation(s)
- Sang Min Park
- Research Institute for National Cancer Control and Evaluation, National Cancer Center, 809 Madu-dong, Ilsan-gu, Goyang-si, Gyeonggi-do, 411-769, Korea
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Darbre PD. Metalloestrogens: an emerging class of inorganic xenoestrogens with potential to add to the oestrogenic burden of the human breast. J Appl Toxicol 2006; 26:191-7. [PMID: 16489580 DOI: 10.1002/jat.1135] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many compounds in the environment have been shown capable of binding to cellular oestrogen receptors and then mimicking the actions of physiological oestrogens. The widespread origin and diversity in chemical structure of these environmental oestrogens is extensive but to date such compounds have been organic and in particular phenolic or carbon ring structures of varying structural complexity. Recent reports of the ability of certain metal ions to also bind to oestrogen receptors and to give rise to oestrogen agonist responses in vitro and in vivo has resulted in the realisation that environmental oestrogens can also be inorganic and such xenoestrogens have been termed metalloestrogens. This report highlights studies which show metalloestrogens to include aluminium, antimony, arsenite, barium, cadmium, chromium (Cr(II)), cobalt, copper, lead, mercury, nickel, selenite, tin and vanadate. The potential for these metal ions to add to the burden of aberrant oestrogen signalling within the human breast is discussed.
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Affiliation(s)
- P D Darbre
- School of Biological Sciences, The University of Reading, UK.
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Ebbs S. Smoking and breast cancer. Int J Clin Pract 2005; 59:999-1000. [PMID: 16115170 DOI: 10.1111/j.1368-5031.2005.00654c.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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