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      Cigarette smoking and breast cancer risk: a population-based study in Sweden

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          Abstract

          In a Swedish population-based case–control study, smoking showed no convincing association with risk of postmenopausal breast cancer – regardless of timing or level of smoking exposure – either overall or among subgroups.

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          Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women.

          T J Key, P N Appleby, G K Reeves … (2003)
          Obesity is associated with increased breast cancer risk among postmenopausal women. We examined whether this association could be explained by the relationship of body mass index (BMI) with serum sex hormone concentrations. We analyzed individual data from eight prospective studies of postmenopausal women. Data on BMI and prediagnostic estradiol levels were available for 624 case subjects and 1669 control subjects; data on the other sex hormones were available for fewer subjects. The relative risks (RRs) with 95% confidence intervals (CIs) of breast cancer associated with increasing BMI were estimated by conditional logistic regression on case-control sets, matched within each study for age and recruitment date, and adjusted for parity. All statistical tests were two-sided. Breast cancer risk increased with increasing BMI (P(trend) =.002), and this increase in RR was substantially reduced by adjustment for serum estrogen concentrations. Adjusting for free estradiol reduced the RR for breast cancer associated with a 5 kg/m2 increase in BMI from 1.19 (95% CI = 1.05 to 1.34) to 1.02 (95% CI = 0.89 to 1.17). The increased risk was also substantially reduced after adjusting for other estrogens (total estradiol, non-sex hormone-binding globulin-bound estradiol, estrone, and estrone sulfate), and moderately reduced after adjusting for sex hormone-binding globulin, whereas adjustment for the androgens (androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and testosterone) had little effect on the excess risk. The results are compatible with the hypothesis that the increase in breast cancer risk with increasing BMI among postmenopausal women is largely the result of the associated increase in estrogens, particularly bioavailable estradiol.
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            Cigarette smoking and the risk of breast cancer in women: a review of the literature.

            Paul Terry, Thomas Rohan (2002)
            Animal experiments and in vitro studies have shown that compounds found in tobacco smoke, such as polycyclic hydrocarbons, aromatic amines, and N-nitrosamines, may induce mammary tumors. The findings of smoking-specific DNA adducts and p53 gene mutations in the breast tissue of smokers also support the biological plausibility of a positive association between cigarette smoking and breast cancer, as does the detection of carcinogenic activity in breast fluid. However, epidemiological studies conducted over the past few decades have variably shown positive, inverse, or null associations. To help reconcile the discrepant findings, epidemiologists have paid increasing attention to measures of exposure to tobacco smoke that might be of the greatest etiological importance, to aspects of the smoker that might modify the association between smoking and breast cancer risk, and to the potentially different associations that might exist with different types of breast tumors, such as those with and without estrogen or progesterone receptors. Overall, the results of these studies suggest that smoking probably does not decrease the risk and indeed suggest that there may be an increased breast cancer risk with smoking of long duration, smoking before a first full-term pregnancy, and passive smoking. These findings require confirmation in future studies, as do suggestions of increased risk among women with certain genotypes.
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              Carcinogenic and endocrine disrupting effects of cigarette smoke and risk of breast cancer.

              Anne M. Deschamps, Leah Band, Nhu D. Le … (2002)
              Results of epidemiological studies, assessing the relation between smoking and breast cancer, have been inconclusive. Our aim was to assess the carcinogenic and possibly antioestrogenic effects of cigarette smoke on risk of breast cancer. We sent a questionnaire to 1431 women younger than age 75 years who had breast cancer and were listed on the population-based British Columbia cancer registry between June 1, 1988, and June 30, 1989. We also sent questionnaires to 1502 age-matched controls, randomly selected from the 1989 provincial voters list. We obtained information on all known and suspected risk factors for breast cancer, and on lifetime smoking, alcohol consumption, and occupational history. We assessed the effect of smoking separately for premenopausal and postmenopausal women, adjusting for confounding variables. 318 premenopausal women and 340 controls replied. Risk of breast cancer was significantly increased (adjusted odds ratio 1.69, 95% CI 1.13-2.51) in women who had been pregnant and who started to smoke within 5 years of menarche, and in nulliparous women who smoked 20 cigarettes daily or more (7.08, 1.63-30.8) and had smoked for 20 cumulative pack-years or more (7.48, 1.59-35.2). Postmenopausal women (700 breast cancer and 685 controls) whose body-mass index increased from age 18 to current and who started to smoke after a first fullterm pregnancy had a significantly reduced risk of breast cancer (0.49, 0.27-0.89). Our results suggest that cigarette smoke exerts a dual action on the breast, with different effects in premenopausal and postmenopausal women. Our observations reinforce the importance of smoking prevention, especially in early adolescence, and draw attention to the timing of exposure in relation to susceptibility and refractory windows in the design of studies to investigate associations between environmental carcinogens or putative endocrine disruptors and risk of breast cancer.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Br J Cancer
                Title: British Journal of Cancer
                Publisher: Nature Publishing Group
                ISSN (Print): 0007-0920
                ISSN (Electronic): 1532-1827
                Publication date (Electronic): 02 October 2007
                Publication date Collection: 30 October 2007
                Publication date (Print): 05 November 2007
                Volume: 97
                Issue: 9
                Pages: 1287-1290
                Affiliations
                [1 ]Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet Stockholm 171 76, Sweden
                [2 ]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet Stockholm 171 77, Sweden
                Author notes
                [* ]Author for correspondence: cecilia.magnusson@ 123456ki.se
                Article
                Publisher Item ID: 6604007
                DOI: 10.1038/sj.bjc.6604007
                PMC ID: 2360473
                PubMed ID: 17912245
                SO-VID: 3b4ee6f7-4b2a-4c77-8229-76e4a5a07bf8
                Copyright © Copyright 2007, Cancer Research UK
                History
                Date received : 20 June 2007
                Date revision received : 29 August 2007
                Date accepted : 03 September 2007
                Categories
                Subject: Epidemiology

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer,aetiology,smoking,alcohol consumption,epidemiology
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer, aetiology, smoking, alcohol consumption, epidemiology

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