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LETTER: Breast cancer's link to secondhand smoke  

It's time to take action. Everywhere I go I see pink for Breast Cancer Awareness Month. The easiest thing for the city of Indianapolis to do in the fight against breast cancer is to make all workplaces smoke free. Studies have shown long-term exposure to secondhand smoke increases the risk of developing breast cancer in nonsmokers by 27 percent. This risk increases to 68 percent for younger, pre-menopausal women.

The City-County Council has the opportunity to step forward in the fight against cancer. Make our city a healthy city for all by making all workplaces smoke free.

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• Smoking May Increase Risk of Breast Cancer 

Researchers from the Mayo Clinic have reported that women who have smoked 100 or more cigarettes in their life have a significantly increased risk of developing breast cancer. The details of this study were published in the September-October 2009 issue of The Breast Journal.[1]

Although both active and passive smoking are known to increase the risk of lung cancer, findings for breast cancer have been mixed. A recent review of published studies suggests that both active and passive smoking may increase the risk of breast cancer—particularly premenopausal breast cancer. The following observations were made from this review of 19 studies:

* Passive smoking increased the risk of breast cancer by 27%.

* Among premenopausal women, passive smoking increased risk of breast cancer by 68%. . . .

[1] Croghan IT, Pruthi S, Hays JT, et al. The role of smoking in breast cancer development: An analysis of a Mayo Clinic cohort. The Breast Journal. 2009; 15: 489-495.

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The Role of Smoking in Breast Cancer Development: An Analysis of a Mayo Clinic Cohort  

Abstract: The purpose of this study was to assess the predictive value of smoking history on breast cancer diagnosis in a referral clinic population. We conducted a case–control study using clinical data collected on 8,097 female patients (1,225 breast cancer cases and 6,872 controls) seen in the Mayo Clinic Breast Clinic between August 1, 1993 and November 31, 2003. Breast cancer patients and noncancer patients significantly differed with respect to age at time of the index visit (p < 0.001), number of pregnancies (p = 0.006), number of live births (p = 0.002), vital status at last known follow-up (p < 0.001), current menstruation (p < 0.001), age at menopause (p < 0.001), history of hysterectomy (p < 0.001), use of oral contraception (p = 0.05), duration of oral contraception use (p = 0.001), use of other exogenous hormones (p < 0.001), duration of exogenous hormone use (p = 0.05), breast pain at time of index visit (p = 0.002), smoking status (p < 0.001), and use of five or more alcoholic beverages per week (p = 0.002). After adjustment for these baseline characteristics, having a personal history of smoking was found to be predictive of breast cancer diagnosis (odds ratios [OR] = 1.25, p = 0.004). Other positive predictors for breast cancer diagnosis were: age (OR = 1.02, p < 0.001), history of hysterectomy (OR = 0.66, p < 0.001), prior use of oral contraception for more than 11 years (OR = 2.10, p < 0.001), and prior use of other exogenous hormones/estrogen (OR = 1.81, p < 0.001). In this referral practice having a personal history of smoking is predictive of breast cancer diagnosis. Further studies are needed to further explore this relationship.

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• Nearly any lifetime smoking ups breast cancer risk  

Women taking the next puff of a cigarette might consider this: smoking 100 or more cigarettes may substantially increase their odds of developing breast cancer, researchers report.

Previous studies linked regular exercise, limiting alcohol intake, and avoiding postmenopausal obesity as lifestyle changes that can reduce women's odds of developing breast cancer, notes Dr. Ivana T. Croghan and colleagues in The Breast Journal.

The current study provides new evidence that "a woman smoker can reduce her risk of breast cancer by stopping smoking as soon as possible," Croghan commented to Reuters Health via email.

Croghan's group compared smoking history and other breast cancer risk factors among 1,225 women who developed breast cancer and 6,872 who did not during the first year after their initial visit to the Mayo Clinic Breast Clinic. . . .

SOURCE: The Breast Journal, September/October 2009

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Relationship Between Potentially Modifiable Lifestyle Factors and Risk of Second Primary Contralateral Breast Cancer Among Women Diagnosed With Estrogen Receptor-Positive Invasive Breast Cancer  

Conclusion: Our population-based study adds to the limited available literature and suggests that obesity, smoking, and alcohol consumption influence contralateral breast cancer risk, affording breast cancer survivors three means of potentially reducing this risk.

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Obesity, Alcohol Consumption And Smoking Increase Risk Of Second Breast Cancer 

It is well known that survivors of breast cancer have a much higher risk of developing a second breast cancer than women in the general population have of developing a first breast cancer. However, little is known about what lifestyle factors may make survivors more vulnerable to a second cancer.

A new study by researchers at Fred Hutchinson Cancer Research Center, published online Sept. 8 in the Journal of Clinical Oncology, has found that obesity, alcohol use and smoking all significantly increase the risk of second breast cancer among breast cancer survivors.

"We found that obese women had a 50 percent increased risk, women who consumed at least one alcoholic drink per day had a 90 percent increased risk, and women who were current smokers had a 120 percent increased risk of developing a second breast cancer," said lead author Christopher I. Li, M.D., Ph.D., an associate member of the Public Health Sciences Division at the Hutchinson Center. Li, an epidemiologist, primarily studies what causes breast cancer and how it can be prevented.

His study adds to a small but growing body of evidence that obesity (a body mass index of 30 kg/m2 or more), alcohol consumption (consuming at least seven drinks a week) and current smoking may be important risk factors for second breast tumors. The research also suggests that current smokers who imbibe at least seven drinks a week may be at particularly high risk of second breast cancer.

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• Second Breast Cancer: 3 Lifestyle Risks 

The study, published in the advance online edition of the Journal of Clinical Oncology, focused on women with estrogen receptor-positive (ER-positive) breast cancer. Most breast cancers are ER-positive, which means the tumors grow when exposed to the hormone estrogen.

Data came from more than 1,000 Seattle-area breast cancer patients, including 365 women who developed a second breast cancer in their opposite breast.

The women were interviewed about their smoking and drinking; their BMI (body mass index) was noted in their medical records.

The odds of developing a second breast cancer in the opposite breast were greater for obese women, for women who drank at least seven alcoholic beverages per week, and current smokers.

"We found that obese women had a 50% increased risk, women who consumed at least one alcoholic drink per day had a 90% increased risk, and women who were current smokers had a 120% increased risk of developing a second breast cancer," researcher Christopher Li, MD, PhD, says in a news release.

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Breast Cancer: Risk Increases For Smokers And Overweight Women 

A recent study published in the Journal of Cancer Epidemiology has reinforced the correlation between being overweight, smoking and breast cancer. What makes this study unique is how test subjects were not diagnosed for BRCA1 and BRCA2 gene mutations, which predispose women to breast cancer.

Instead, women with such gene mutations were excluded to allow researchers to concentrate on lifestyle factors such as smoking, exercise, nutrition and weight. All women analyzed in the study were direct ancestors of the first French colonists.

"To our knowledge, this is the first study conducted on a sample of women without BRCA1 and BRCA2 gene mutations, which are often found in French-Canadian women," says lead researcher Vishnee Bissonauth, a graduate of the Université de Montréal's Department of Nutrition and a researcher at the Sainte-Justine University Hospital Research Center.

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Weight History, Smoking, Physical Activity and Breast Cancer Risk among French-Canadian Women Non-Carriers of More Frequent BRCA1/2 Mutations 

Our study showed that more than 9 pack-years of smoking had a significant positive association with breast cancer risk among both pre- and postmenopausal women; however, this result does not support our previous report of a reduced risk of breast cancer in carriers of BRCA gene mutations who had smoked more than 4 pack-years [28]. The weaker breast cancer risk in these subjects may have been associated with lower levels of circulating estrogens [29]. In contrast, a recent case-control study among Polish women indicated an increased risk of invasive breast cancer with the consumption of ≥10 cigarettes/d among both premenopausal (OR = 2.55; 95% CI: ) and postmenopausal (OR = 1.78; 95% CI: ) women [30]. Likewise, another recent study [31] suggested that BRCA mutation carriers who smoked had 2.3-fold (95% CI: ) and 2.6-fold (95% CI: ), respectively, greater risk of breast cancer. Cigarette smoke contains compounds that damage DNA, and the repair of such damage may be impaired in women with germline mutations. Some genotoxic carcinogens in tobacco smoke are mammary carcinogens in rodents [32]. The enzymatic machinery required for their metabolic activation is present in human mammary epithelial cells [33], and there is evidence of carcinogen-DNA adducts in human mammary tissue [34, 35], some of which may be smoking-related.

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560,000 died of cancer in 2006, but death rate continues slow fall since 1990s 

The U.S. cancer death rate fell again in 2006, a new analysis shows, continuing a slow downward trend that experts attribute to declines in smoking, earlier detection and better treatment.

About 560,000 people died of cancer that year, according to an American Cancer Society report released Wednesday. The new numbers show the death rate fell by less than 2 percent, but since that decline was better than the previous year, the cancer society applauded the progress.

Others said the change was not a big deal.

"The improvement was modest," said Dr. Michael Goodman, an Emory University researcher who specializes in cancer statistics. . . .

The explanation for why the death rate has fallen depends on the type of cancer. For example, better screening has improved deaths from colon cancer. Treatment advances are more of a factor in leukemia death rates. And smoking cessation is the main reason behind improvements in male lung cancer deaths.

"What we call 'cancer' is really a great variety of different conditions," Goodman said.

Lung cancer accounted for nearly 30 percent of cancer deaths in 2006.

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Hormone pills for menopause may make lung cancer more deadly, women's health study suggests  

There's more troubling news about hormone therapy for menopause symptoms: Lung cancer seems more likely to prove fatal in women who are taking estrogen-progestin pills, a study suggests.

Hormone users who developed lung cancer were 60 percent more likely to die from the disease as women who weren't taking hormones, according to results reported Saturday.

The new findings mean that smokers should stop taking hormones, and those who have not yet started hormones should give it careful thought, said Dr. Rowan Chlebowski of Harbor-UCLA Medical Center in Los Angeles. He led the analysis and presented results at a meeting of the oncology society in Florida.

It's the latest finding from the Women's Health Initiative, a federal study that gave 16,608 women either Prempro or dummy pills. The study was stopped in 2002 when researchers saw more breast cancers in those on Prempro, the estrogen-progestin pill made by Wyeth Pharmaceuticals. They continue to follow what happens to women in the study.

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HRT Ups Death Risk for Women With Lung Cancer  

The current use of combined hormone replacement therapy (HRT) is associated with a higher risk of dying for women diagnosed with non-small cell lung cancer, a new study shows.

The risk was highest in current smokers, less high in former smokers and least high in women who never smoked, say researchers reporting Saturday at the annual meeting of the American Society of Clinical Oncology (ASCO), in Orlando, Fla.

"This is a major concern," said study lead author Dr. Rowan Chlebowski, a medical oncologist with the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. "In current smokers, one in 100 experience avoidable death from non-small cell lung cancer. Women almost certainly shouldn't be using both combined hormone replacement therapy and tobacco at the same time," he said at a Saturday ASCO news briefing.

"We want to do everything we can to prevent lung cancer," added Dr. Jeffrey Crawford, chief of medical oncology at Duke Comprehensive Cancer Center in Durham, N.C. "But if you're a current or former smoker, in particular, this is another reason not to consider hormone replacement therapy."

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• Wyeth’s Menopause Hormones Increase Risk of Lung Cancer Deaths 

Wyeth’s hormone replacement therapy, a menopause treatment whose use has declined after being linked to heart attack, stroke and breast cancer, increases the risk of death from lung tumors, a study found.

After five years on Wyeth’s Prempro, a combination of the hormones estrogen and progestin, 67 women died from non-small cell lung cancer, compared with 39 on placebo, the research showed. Results of the trial, which examined women age 50 to 79 and included current and former smokers, were presented today at the American Society of Clinical Oncology meeting in Orlando.

Sales of the pills plunged in 2002 after a U.S. study linked the therapy to breast cancer and cardiovascular risks. As many as 6 million women took the menopause treatments before the study curbed use. The products generated $1.1 billion last year, down from more than $2 billion in 2001.

“This is a new finding that tells us women who smoke shouldn’t take estrogen and progestin for menopause symptoms,” said Rowan Chlebowski, the study author and a researcher at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, in an interview.

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Pink Pack: Smoking and breast cancer 

New research concludes that after years of studies, there is finally evidence that cigarette smoke increases the risk of breast cancer - sometimes many years after the fact.

The researchers conducted a meta-analysis that looked at various studies and thousands of patients over the years. . . .

Studies continue to show that girls are more likely to smoke than boys their age.

If you would like a Pink Pack that shows you how to do a self breast exam, click here.

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Smoking - even second-hand - increases breast cancer risk 

Young women who smoke - as well as those who are routinely exposed to second-hand smoke - face a significantly higher risk of developing breast cancer later in life, according to a new study.

"Individual women have, on average, a one-in-seven chance of developing breast cancer. If they smoke, they will increase that risk to one-in-four or one-in-five," Anthony Miller, associate director of the Dalla Lana School of Public Health at the University of Toronto, said in an interview.

"The risk is about the same for passive smoke, particularly for a girl growing up in a house where there is a smoker," he said.

Dr. Miller is a member of an expert panel that reviewed the extensive scientific evidence on the link between smoking and breast cancer.

They produced a densely scientific, 75-page report that features a number of clear conclusions, including:

Smoking increases the risk of breast cancer in both premenopausal and postmenopausal women by 50 to 70 per cent.

(A woman's risk of breast cancer rises sharply at menopause. About 70 per cent of breast cancer cases occur after 50.)

Exposure to second-hand smoke increases the risk of breast cancer in premenopausal women by 60 to 70 per cent.

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