Parada Humberto, Bradshaw Patrick T, Engel Lawrence S, Conway Kathleen, Steck Susan E, Teitelbaum Susan L, Neugut Alfred I, Santella Regina M, Gammon Marilie D
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California.
Cancer Epidemiol Biomarkers Prev. 2017 Feb;26(2):278-280. doi: 10.1158/1055-9965.EPI-16-0658. Epub 2016 Oct 7.
Environmental tobacco smoke (ETS) exposure is hypothesized to influence survival after breast cancer, but few studies have examined this association.
A population-based cohort of women (N = 1,508) diagnosed with first primary invasive or in situ breast cancer in 1996 to 1997 was interviewed shortly after diagnosis and again approximately 5 years later to assess ETS exposure, and women were followed for more than 18 years using the National Death Index; 597 deaths (237 associated with breast cancer) were identified. Multivariable Cox regression was used to estimate adjusted HRs and 95% confidence intervals (CI) for mortality among women with breast cancer as related to at-diagnosis and at-/postdiagnosis changes in ETS exposure.
There was little or no association between at-diagnosis ETS exposure and all-cause (HR = 1.04; 95% CI, 0.78-1.40) or breast cancer-specific (HR = 0.98; 95% CI, 0.63-1.52) mortality. Mortality was elevated among women who reported cessation in postdiagnosis ETS exposure up to 1 year before the follow-up assessment, for all-cause (HR = 1.81; 95% CI, 0.87-3.74) and breast cancer mortality (HR = 1.89; 95% CI, 0.68-5.24); however, estimates were imprecise.
We found little evidence of an association between at-diagnosis ETS exposure and mortality after breast cancer. Postdiagnosis cessation of ETS exposure was positively associated with mortality, although we could not rule out chance and reverse causation as possible explanations.
Exposure to ETS does not appear to influence mortality after breast cancer. Cancer Epidemiol Biomarkers Prev; 26(2); 278-80. ©2016 AACR.
环境烟草烟雾（ETS）暴露被认为会影响乳腺癌后的生存情况，但很少有研究探讨这种关联。
对1996年至1997年诊断为原发性侵袭性或原位乳腺癌的1508名女性进行基于人群的队列研究，在诊断后不久及大约5年后再次进行访谈以评估ETS暴露情况，并使用国家死亡指数对这些女性进行超过18年的随访；共识别出597例死亡（237例与乳腺癌相关）。采用多变量Cox回归估计与诊断时及诊断时/诊断后ETS暴露变化相关的乳腺癌女性死亡率的调整后风险比（HR）和95%置信区间（CI）。
诊断时的ETS暴露与全因死亡率（HR = 1.04；95% CI，0.78 - 1.40）或乳腺癌特异性死亡率（HR = 0.98；95% CI，0.63 - 1.52）之间几乎没有关联。在随访评估前1年内报告诊断后停止ETS暴露的女性中，全因死亡率（HR = 1.81；95% CI，0.87 - 3.74）和乳腺癌死亡率（HR = 1.89；95% CI，0.68 - 5.24）有所升高；然而，估计值并不精确。
我们几乎没有发现诊断时ETS暴露与乳腺癌后死亡率之间存在关联的证据。诊断后停止ETS暴露与死亡率呈正相关，尽管我们不能排除偶然性和反向因果关系作为可能的解释。
ETS暴露似乎不会影响乳腺癌后的死亡率。《癌症流行病学、生物标志物与预防》；26(2)；278 - 80。©2016美国癌症研究协会。
