Izano Monika, Satariano William A, Hiatt Robert A, Braithwaite Dejana
Department of Epidemiology and Biostatistics, University of California, San Francisco, California; School of Public Health, University of California, Berkeley, California.
Cancer Med. 2015 Feb;4(2):315-24. doi: 10.1002/cam4.359. Epub 2014 Dec 16.
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.
我们在美国女性健康与功能（HFW）研究中，对一组乳腺癌女性患者进行了研究，以探讨吸烟对乳腺癌及其他原因导致的长期死亡率的影响。共有975名年龄在40 - 84岁之间、被诊断为乳腺癌的女性参与研究，在美国进行了为期11年的中位随访。使用Cox比例风险模型研究了乳腺癌诊断后头几个月报告的个人吸烟状况和吸烟强度对乳腺癌及其他原因导致的死亡风险的影响。在这项研究中，既往吸烟与其他原因导致的死亡风险增加相关（风险比[HR]=1.47，95%置信区间[CI]：1.13 - 1.90），且随着吸烟强度增加风险翻倍（<50包年[py]的HR：1.36，95% CI：1.03 - 1.79；≥50 py的HR：2.45，95% CI：1.41 - 4.23）。当前吸烟（HR = 2.45，95% CI：1.81 - 3.32）以及每增加10 py的吸烟量（HR = 1.16，95% CI：1.11 - 1.22）与其他原因导致的死亡风险在统计学上显著增加相关。当前吸烟对其他原因导致的死亡风险的影响随着疾病分期进展和体重指数（BMI）增加而降低。乳腺癌特异性死亡率与当前吸烟≥50 py相关（HR = 2.36，95% CI：1.26 - 4.44），以及每增加10 py的吸烟量（HR = 1.07，95% CI：1.01 - 1.14）。当前吸烟而非既往吸烟与局部疾病女性的乳腺癌特异性死亡风险增加相关（HR = 2.32，95% CI：1.32 - 4.09），但在区域和远处疾病女性中无此关联（HR = 1.10，95% CI：0.73 - 1.68）。我们的研究结果表明，乳腺癌诊断时当前吸烟可能与乳腺癌特异性死亡及其他原因导致的死亡风险增加相关，而既往吸烟与其他原因导致的死亡风险增加相关。诊断时戒烟可能会使乳腺癌女性患者预后更好。
