Study: Smoking before or after a breast cancer diagnosis associated with poorer breast cancer survival
|At a glance||Questions for your doctor|
This study is about:
How cigarette smoking before and/or after a diagnosis of breast cancer affects breast cancer survival and other smoking-related diseases.
Why is this study important?
While experts may not have enough evidence to confirm a direct relationship between smoking and breast cancer, the 2014 Report of the Surgeon General on the health consequences of smoking suggested that smoking may cause breast cancer. Beyond the risk of breast cancer, cigarette smoking is an important public health issue. It increases the risk of heart disease, stroke, lung cancer, overall diminished health, and causes more than 480,000 deaths in the U.S. each year.
- Women who smoked one year before their breast cancer diagnosis were more likely to die of breast cancer than women who never smoked.
- Women who quit smoking after their breast cancer diagnosis were less likely to die from breast cancer than women who continued to smoke after diagnosis.
What does this mean for me?
While no studies directly implicate cigarette smoking as a cause of breast cancer, this study found that smoking appears to affect breast cancer mortality. Researchers saw a benefit for women who quit smoking after their breast cancer diagnosis; that is promising, showing that quitting smoking, even later rather than sooner, can improve health.
Additionally, cigarette smoking has harmful health effects throughout the body. Women and men who smoke should get whatever help they need to quit.
Fact Sheet: Health Effects of Cigarette Smoking
Passarelli MN, Newcomb, PA, Hampton JM, et al. “Cigarette Smoking Before and After Breast Cancer Diagnosis: Mortality From Breast Cancer and Smoking-Related Diseases.” Journal of Clinical Oncology. Published online first on January 25, 2016.
FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
IN DEPTH REVIEW OF RESEARCH
Previous research linked cigarette smoking before breast cancer diagnosis to lower breast cancer survival but little is known about how smoking after a breast cancer diagnosis affects breast cancer survival.
In January 2016, Michael Passarelli and colleagues from the University of California, San Francisco and other institutions published a study in the Journal of Clinical Oncology about how smoking before and after a breast cancer diagnosis affects breast cancer survival.
Researchers of this study wanted to know:
Whether an association exists between breast cancer survival and smoking before or after a diagnosis of breast cancer.
Population(s) looked at in the study:
About 21,000 women from the Collaborative Breast Cancer Study (CBCS) participated in this study and:
- had invasive breast cancer.
- were between the ages of 20-79.
- were from Wisconsin, New Hampshire, and Massachusetts.
The women were asked several key questions about smoking: whether they had smoked at least 100 cigarettes during their lifetime, when they started, how long they had been smoking, the average number of cigarettes they smoked each day, whether they had smoked one year before they were diagnosed with breast cancer, if they currently smoked, and (for the women who had quit) the age they quit.
About 15,000 women from the CBCS study were invited to participate in the Collaborative Women’s Longevity Study (CWLS). The women who completed the survey were all breast cancer survivors and were an average of 6 years post-breast cancer diagnosis. This questionnaire asked the women for information about their post-diagnosis exposures and health events.
- Women who smoked one year before their breast cancer diagnosis had a 25% increased risk of dying from their breast cancer than women who never smoked. About 14% of women who had never smoked died from breast cancer compared to about 17% of women who smoked one year before they were diagnosed.
- Women who smoked one year before their breast cancer diagnosis were:
- 14 times more likely to die of respiratory cancer than women who had never smoked. Less than .5% of women who had never smoked died from respiratory cancer compared to about 4% of women who smoked one year before they were diagnosed with breast cancer.
- 2 times more likely to die of cardiovascular disease than women who had never smoked. About 6.5% of women who had never smoked died from cardiovascular disease compared to about 8% of women who smoked one year before they were diagnosed with breast cancer.
- Women who smoked one year before their breast cancer diagnosis were:
- Women who quit smoking after their breast cancer diagnosis had a 33% decreased risk of dying from breast cancer than women who continued to smoke after diagnosis. This means that women who quit smoking post breast cancer diagnosis were more likely to survive than the women who kept smoking.
- 10% of women in the study reported that they kept smoking after their diagnosis. These women had a 72% increased risk of dying from breast cancer than women who never smoked. Using the data from the CWLS population, about 5% of women who had never smoked died from breast cancer compared to about 8% of women who were still smoking.
Conducting a study based on responses from a self-reported questionnaire has limitations. It is possible that some women may not have accurately presented their smoking status. The study design allowed only one opportunity to follow up with the smoking status of women after diagnosis; because the study represents only a snapshot, it may not have been entirely accurate.
Nor did this study take into account the hormone receptor status of breast tumors, or whether or not women had a mutation in or another gene that increases cancer risk; whether these factors combined with smoking affect breast cancer survival—and to what extent—is unknown.
This research provides evidence that smoking affects breast cancer survival before and after a breast cancer diagnosis, and showing that quitting after breast cancer diagnosis has benefits. However, according to the study authors, “Regardless of a diagnosis of breast cancer, smokers should undergo recommended respiratory and cardiovascular disease surveillance to reduce smoking-related survival.”
The National Comprehensive Cancer Network (NCCN) brings together a panel of experts who create guidelines for cancer detection, prevention, treatment and survivorship. NCCN has the following guidelines for smoking cessation in people diagnosed with cancer.
- Combining medications and behavioral therapy leads to the best results for smoking cessation.
- The two most effective medications are combination nicotine replacement therapy or varenicline (Chantix).
- Behavior therapy with multiple counseling sessions is most effective. At minimum, patients should have access to brief counseling. Quitlines can be helpful, especially for patients with few resources.
- Smoking status should be documented in patient health records and updated regularly to indicate changes in smoking status, quit attempts made and the types of interventions tried.
- Smoking relapse and brief slips are common and can be managed. Providers should discuss this and provide guidance and support to encourage continued efforts to quit smoking. Smoking slips do not necessarily indicate a need to try alternative methods. It may take more than one quit attempt with the same therapy to achieve long-term cessation.
- Smoking cessation should be offerred as a part of cancer treatment and continued throughout their entire care care.
- Tobacco use by household members is associated with relapse. Individuals in the smoker's household should be encouraged to stop using tobacco products.
- There is not enough evidence to recommend the use of e-cigarettes for smoking cessation.
- I have smoked for a long time and I am having trouble quitting. What can I do?
- I have smoked for a long time—how will quitting now make a difference to my health?
- I want to quite but I'm afraid of gaining weight. Are there any options for quitting that lower the chances that I will gain weight?
- A member of my family smokes. Will the secondhand smoke exposure affect me?
- What other actions can reduce my breast cancer risk?
The following are studies focused on smoking cessation.
- NCT03819231: Mindfulness Training Plus Oxytocin (MOXY). The purpose of this study is to examine the effects of mindfulness training and a drug called oxytocin on smoking. Oxytocin is a naturally occurring hormone in the brain and throughout the body. It is also an FDA-approved drug to help induce labor in pregnant women.
- NCT03808818: Implementing a Virtual Tobacco Treatment for Cancer Patients in Community Oncology Practices. This trial studies how well smoking cessation treatment plans work in tobacco-dependent cancer patients when delivered virtually as part of their cancer care in community oncology practices. Virtual information and counseling sessions may help cancer patients quit smoking.
- NCT04409236: Quit2Heal Smartphone App in Helping Cancer Patients Quit Smoking. This study compares the Quit2Heal smoking cessation smartphone app to the QuitGuide app in helping cancer patients quit smoking. Both apps provide tools to cope with urges, guides for quitting, help in quitting and stay tobacco-free, and suggestions for selecting drgs that aid in smoking cessation.
Additional studies for smoking cessation are available through the National Institutes of Health Clinicaltrials.gov website.
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