Association of smoking intensity with survival in patients with breast cancer
Methods: Data were obtained from 1996-2007 linkage of the Florida Cancer Data System Registry with the Florida Agency for Health Care Administration database. Our sample included female ≥18 years old, diagnosed with breast cancer, and residing in the state of Florida (n=127,754). Smoking intensity was defined by self-reported <1, 1-2, or >2 packs of cigarettes/day. To analyze the association between smoking intensity and survival, we performed univariate and multivariate Cox regression models. The multivariate models were adjusted with demographics; stage, grade, and histology of the tumor; hormonal status; treatments; and 31 comorbidities.
Results: The majority of the sample was White (90%), non-Hispanic (90%), and had a localized tumor (59%). In the univariate analysis, compared with never smoked, worse survival was seen for those who smoked 1-2 packs/day (hazard ratio [HR] 1.18; P<.001) and >2 packs/day (HR 1.69; P<.001). In the multivariate analysis, those who smoked 1-2 packs/day (hazard ratio [HR] 1.10; P<.001) and >2 packs/day (HR 1.40; P<.001) had worse survival compared with never smoked. Conclusion: Taking considerable confounders into account, smoking is associated with worse survival in female breast cancer patients; this effect is exacerbated with increased smoking intensity. Breast cancer patients who self-report smoking should be encouraged to quit or cut back. Smoking cessation strategies and education should be provided to these patients.
Learning Areas:Chronic disease management and prevention
Clinical medicine applied in public health
Compare the outcome of cancer survivors based on smoking intensity. Discuss the importance of including the extensive confounding variables in the multivariate model. Describe the importance of providing smoking cessation strategies and education to cancer survivors who smoke.
Qualified on the content I am responsible for because: I have been working as a scientist on this federally funded grant regarding the association of breast and lung cancer with lifestyle health behaviors, such as smoking, on survival. I have written several papers on cancer screening and predictors of cancer survival.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.