title: Smoking at time of diagnosis and breast cancer-specific survival: new findings and systematic review with meta-analysis.
abstract: BACKGROUND
  In women with breast cancer who smoke, it is unclear whether smoking could impair their survival from the disease.
  
  
  METHODS
  We examined the relation of smoking at diagnosis to breast cancer-specific and overall survival among 5,892 women with invasive breast cancer treated in one Canadian center (1987 to 2008). Women were classified as never, former or current smokers. Current smokers were further classified according to total, intensity and duration of smoking. Deaths were identified through linkage to population mortality data. Cox proportional-hazards multivariate models were used. A systematic review with meta-analysis combines new findings with published results.
  
  
  RESULTS
  Compared with never smokers, current smokers at diagnosis had a slightly, but not statistically significant, higher breast cancer-specific mortality (hazard ratio = 1.15, 95% confidence interval (CI): 0.97 to 1.37). Among current smokers, breast cancer-specific mortality increased with total exposure to, intensity and duration of smoking (all Ptrend <0.05). Compared to never smokers, breast cancer-specific mortality was 32 to 56% higher among heavy smokers (more than 30 pack years of smoking, more than 20 cigarettes per day or more than 30 years of smoking). Smoking at diagnosis was associated with an increased all-cause mortality rate. A meta-analysis of all studies showed a statistically significant, 33% increased mortality from breast cancer in women with breast cancer who are smokers at diagnosis compared to never smokers (hazard ratio = 1.33, 95% CI: 1.12 to 1.58).
  
  
  CONCLUSIONS
  Available evidence to date indicates that smoking at diagnosis is associated with a reduction of both overall and breast cancer-specific survival. Studies of the effect of smoking cessation after diagnosis on breast cancer-specific outcomes are needed.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bérubé
authors.forename: Julie
authors.initials: J
authors.lastname: Lemieux
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maunsell
authors.forename: Jacques
authors.initials: J
authors.lastname: Brisson
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality*; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D006801:Humans; D009026:Mortality / Q000639:trends*; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012907:Smoking; D013997:Time Factors
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