It’s never a good idea to start smoking if you want to avoid getting breast cancer.
But if you’re going to smoke, it turns out that the time in your life when you start smoking makes a difference.
If you start smoking before puberty or in puberty and are smoking before your first pregnancy, you experience a greater risk of developing breast cancer than women who begin smoking at a later age.*
Why is this? Scientists theorize that structures in the breast aren’t fully developed until after childbirth. Early in life, epithelial tissue that lines structures in the breast may be exquisitely sensitive to damage from environmental exposures.
They also found that the number of cases of the disease was higher among women who started smoking before puberty.
Previous efforts at uncovering the role of smoking in the development of breast cancer proved confusing, and researchers realized they needed to track women who had smoked for a long time to see important trends.
Study Followed Smokers’ Experience Long Term
The new information comes from a lengthy study conducted by researchers at the American Cancer Society (ACS) who looked at the experience of tens of thousands of older women, many of whom had smoked intensely. The majority had passed through menopause. Researchers followed the women for nearly 14 years.
A lot of these people had smoked for more than 20 years before they signed up for the study, which gave the researchers a window into the long term effects of smoking on the breast.
That vantage point lead the researchers to develop new theories about the link between smoking and breast cancer. Smoking plays a role in triggering breast cancer but not in promoting it, they think. But it may take a long time for a smoker to develop breast cancer, some 20 years or more.
Smoking plays a much bigger role in the development of lung cancer than in breast cancer, explained Xifeng Wu, M.D., Ph.D., chair of the department of epidemiology at M.D. Anderson Cancer Center in Houston, Texas. The percentage of women smokers who develop breast cancer is much lower than those who get lung cancer.
For breast cancer, ACS researchers found that females who started smoking before their first menstrual cycle faced a 61 percent higher risk of developing the disease, according to Mia Gaudet, Ph.D., the ACS director of genetic epidemiology who directed the study.1
Women who started smoking after their first menstrual cycle also had a greater risk of being diagnosed with the disease. Risk was 45 percent higher if they started their cigarette habit 11 or more years before bearing a child.
Females who continued smoking for many years developed more serious cases of breast cancer than non smokers.
“These results should provide young ladies additional motivation to not begin to smoke,” Dr. Gaudet said.
Results of the ACS study were published online in an article, “Active Smoking and Breast Cancer Risk,” which appeared in the Journal of the National Cancer Institute in late February.
Data were drawn from the experience of 73,388 women, aged 50 to 74 at the time the study began. Many of the women had a history of smoking. At the time they joined, the women reported 8.2 percent of them were smoking; 35.6 percent had previously smoked; and 56.2 percent had never smoked.
Women who participated in the study were part of the ACS Cancer Prevention Study II (CPS-II) Nutrition Cohort.
While performing their analysis, ACS researchers looked back over medical records and surveys the women filled out every two years. The study group included 3,721 women who developed breast cancer.
Incidence of Breast Cancer In Smokers
Researchers calculated that the incidence of breast cancer was 24 percent higher in current smokers and 13 percent higher in former smokers in the study as compared to women who never smoked.
Current and former smokers participating in the study were also more likely to develop breast cancers that were sensitive to estrogen, or were estrogen receptor positive. Such women are often treated with anti-estrogen therapy.
To obtain their results, ACS researchers looked over their own data and pooled data from 14 other studies of 31,198 other breast cancer patients (a meta-analysis of a total of 991,100 women).
ACS Study Could Not Control For Second Hand Smoke
Those conducting the ACS study admitted they could not control for the influence that exposure to second hand smoke played in the lives of study subjects. In 2010, a controversial theory held that even premenopausal women who never smoked developed breast cancer after exposure to second hand smoke. A Canadian health panel endorsed the idea after looking at studies that took women’s lifetime histories of smoke exposure at home and work.2
In 2006, the U.S. surgeon general described the data associating secondhand smoke with breast cancer as “suggestive but not sufficient” to infer a causal relationship.
Although it casts no new light on the second hand smoke debate, the new ACS research does provide important new information about a divisive topic. Why? Proving that smoking increases your chances of getting breast cancer has remained elusive. Not all scientists agree that smoking drives up the risk of developing breast cancer. Some 130 studies and seven scientific reports failed to prove it, the ACS study reported.
Smoking Triggers Breast Cancer: Not An Easy Proof
The fact that women who smoke also tend to drink makes it difficult to prove the theory. Moreover, not all previous studies showed that smoking more cigarettes and smoking for more years drives up your chance of getting breast cancer.
But the ACS findings raise questions about one theory about smoking and breast cancer. That is that the impact of smoking on the start of a tumor may be obscured because smoking produces antiestrogenic effects. A pooled analysis by scientists cited in this ACS study revealed that women who were heavy smokers had higher circulating levels of estrogen. This hormone can fuel the growth of some breast tumors and for the women with such tumors, elevated levels of the estrogen raise concern.3
Smoking While Fighting Breast Cancer Complicates Treatment
Once a woman develops breast cancer, continuing to smoke complicates her efforts to combat the disease. Doctors warn women against smoking after they are diagnosed with breast cancer.
Smoking increases a patient’s risk of recurrence and of second cancers, according to Joel Dunnington, M.D., professor of radiology at M.D. Anderson Cancer Center. It can also interfere with important treatments, including breast reconstruction. Most plastic surgeons will not do breast reconstruction for a woman who smokes.
Women are asked to stop smoking for several months before undergoing reconstructive surgery, according to Orange, California breast surgeon Jay Harness, M.D., former president of the American Society of Breast Surgeons.4-12
He and other oncologists routinely refer breast cancer patients to programs designed to help them stop smoking, but he said “cigarettes are very addictive and that makes it difficult for the women to stop.”
British Text Messaging Ap Helped Smokers Quit
Knowing its importance, breast cancer patients continue to look for ways to stop smoking, especially when conventional approaches fail. Inspiration sometimes comes from research among smokers who do not suffer from breast cancer.
British scientists report they successfully used an electronic texting system to help smokers from the general population to quit. Those who got digital “support” were able quit at twice the rate of a group that did not.13 Their system conjures up images of an electronic nag.
Overall, researchers used cell phone texting options to communicate with 5800 people. The “TXT2STOP” program sent “supportive” messages to 2915 participants, prodding smokers to stay away from cigarettes. Some 2885 others got messages that did not nudge them to stop puffing on cigarettes.
For example, on the day they planned to quit smoking, participants targeted for “support” got this message: “This is it! – QUIT DAY, throw away all your fags. TODAY is the start of being QUIT forever, you can do it!”
If a smoker was tempted to light up again, he or she sent the message “CRAVE” to a phone number some got this message in return. “Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over.”
After a smoker managed to quit, the system sent this message: “TXT2STOP: Quick result! Carbon monoxide has now left your body!”; “Day4=Big day – cravings still strong? Don’t worry tomorrow will be easier! Keep your mind & hands busy. Save this txt so u can txt CRAVE to us at any time during the programme.”
When smokers reached six months without actively smoking, researchers tested whether they had avoided cigarettes and verified participants’ claims. Ditto for the group who had no digital nag. Those who got “supportive” messages quit at the rate of 10.7 percent, those who did not quit at a rate of 4.9 percent. Smokers participated in the study from October 2007 to June 2009.
Numerous other aps exist that send messages to people trying to quit smoking. Programs that use them also offer advice on nicotine replacement therapies, such as a long acting nicotine patch; and on the availability of two drugs proven to help smokers quit.
Mindfulness Training Assisted Smokers
A small randomized clinical trial at Yale University School of Medicine found that mindfulness training might be more effective in helping smokers quit than conventional methods.14 Eighty eight smokers entered the study and were divided into two groups. At the start, they smoked 20 cigarettes a day. On average all of them started smoking regularly at age 16 years and they attempted to quit at least five times before.
The first group received four weeks of “mindfulness training” techniques similar to those used in some types of yoga and described by Jon Kabat-Zinn.15 The second group completed four weeks of a smoking cessation program sponsored by the American Lung Association known as Freedom from Smoking (FFS). Scientists previously validated FFS as successful. Both groups in the study met twice a week.
None of the participants who used mindfulness techniques reported using either of two drugs known to assist in quitting, only two of those using Freedom From Smoking did so during treatment and followup.
A greater percentage of those who took mindfulness training smoked less and stayed off cigarettes for at least 17 weeks, compared to those in the other group.
Not everyone in the mindfulness group could conquer cigarettes without turning to nicotine replacement products. Three smokers using the techniques used nicotine replacement during treatment and four FFS smokers did so. Going without nicotine replacement was apparently harder the longer some of the smokers tried to quit. During followup, three participants on the mindfulness regimen relied on nicotine replacement, while eight FFS smokers did so.
Neither group was encouraged or discouraged from using nicotine replacement, researchers reported.
A small followup to the first Yale study, published in 2011, found that mindfulness exercises helped smokers with their cravings for cigarettes. Results of the second study, also done at Yale, were reported this year.16
Other researchers, based at University College in London, found that strong cravings for cigarettes could be reduced with yogic breathing exercises known as pranayama. But reductions were only achieved in a laboratory setting and more research is needed. Ninety six people participated in the study.17
* Risk is highest for women who start smoking before puberty.
** Risk also increased among women smokers who started smoking before, rather than after their menstrual periods started.
- M. Gaudet, S. Gapstur, J. Sun, W. Diver, L. Hannan, M. Thun. Active Smoking and Breast Cancer Risk: Original Cohort Data and Meta-analysisJ Natl Cancer Inst 2013 Apr 17;105(8):515-25 doi: 10.1093/jnci/djt023. Epub 2013 Feb 28.
- Johnson KC, Miller AB, Collishaw NE, et al. Active smoking and secondhand smoke increase breast cancer risk: the report of the Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk (2009). Tob Control 2011 Jan;20(1):e2. doi: 10.1136/tc.2010.035931.
- Key TJ, et al. Circulating sex hormones and breast cancer risk factors in premenopausal women: reanalysis of 13 studies. Br J Cancer 2011; 105(5):709-22.
- Wallace A. Can I Have Breast Reconstruction If I Am Or Was A Smoker? Available at http://abcnews.go.com/Health/OnCallPlusTreatment/story?id=3643771#.UbpCa-fVCSp. Accessed June 6, 2013.
- Algaithy ZK, Petit JY, Lohsiriwat V, Maisonneuve P, Rey PC, Baros N, Lai H, Mulas P, Barbalho DM, Veronesi P, Rietjens M. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? Eur J Surg Oncol. 2012 Feb;38(2):125-9. doi: 10.1016/j.ejso.2011.10.007. Epub 2011 Nov 6.
- Patel KM, Hill LM, Gatti ME, Nahabedian MY. Management of massive mastectomy skin flap necrosis following autologous breast reconstruction. Ann Plast Surg 2012 Aug;69(2):139-44. doi: 10.1097/SAP.0b013e3182250e23.
- de Blacam C, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, Houlihan MJ, Lee BT. High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg 2012 Mar;255(3):551-5. doi: 10.1097/SLA.0b013e318246c294.
- Lin KY, Blechman AB, Brenin DR. Implant-based, two-stage breast reconstruction in the setting of radiation injury: an outcome study. Plast Reconstr Surg 2012 Apr;129(4):817-23. doi: 10.1097/PRS.0b013e31824421d0.
- Hill JL, Wong L, Kemper P, Buseman J, Davenport DL, Vasconez HC. Infectious complications associated with the use of acellular dermal matrix in implant-based bilateral breast reconstruction. Ann Plast Surg 2012 May;68(5):432-4. doi: 10.1097/SAP.0b013e31823b6ac6.
- Decker MR, Greenblatt DY, Havlena J, Wilke LG, Greenberg CC, Neuman HB. Impact of neoadjuvant chemotherapy on wound complications after breast surgery. Surgery 2012 Sep;152(3):382-8. doi: 10.1016/j.surg.2012.05.001. Epub 2012 Jun 26.
- Barnett GC, West CM, Coles CE, Pharoah PD, Talbot CJ, Elliott RM, Tanteles GA, Symonds RP, Wilkinson JS, Dunning AM, Burnet NG, Bentzen SM. Standardized Total Average Toxicity score: a scale- and grade-independent measure of late radiotherapy toxicity to facilitate pooling of data from different studies. Int J Radiat Oncol Biol Phys. 2012 Mar 1;82(3):1065-74. doi: 10.1016/j.ijrobp.2011.03.015. Epub 2011 May 24.
- American Cancer Society. Cancer Treatment & Survivorship Facts & Figures 2012-2013. Regaining and Improving Health through Healthy Behavior. 2012; Education guide.
- Free C, Knight R, Robertson S, et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet 2011 June 30; 378(9785): 49-55. doi: 10.1016/S0140-6736(11)60701-0.
- Brewer JA, Mallik S, Babuscio TA, Nich C, Johnson HE, Deleone CM, Minnix-Cotton CA, Byrne SA, Kober H, Weinstein AJ, Carroll KM, Rounsaville BJ. Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug Alcohol Depend. 2011 Dec 1;119(1-2):72-80. doi: 10.1016/j.drugalcdep.2011.05.027. Epub 2011 Jul 1.
- Fintzy R, Jaffe A. Mindfulness, Meditation, and Addiction. Available at: http://www.psychologytoday.com/blog/all-about-addiction/201110/mindfulness-meditation-and-addiction. Accessed June 18, 2013.
- Elwafi HM, Witkiewitz K, Mallik S, Iv TA, Brewer JA. Mindfulness training for smoking cessation: Moderation of the relationship between craving and cigarette use. Drug Alcohol Depend. 2013 Jun 1;130(1-3):222-9. doi: 10.1016/j.drugalcdep.2012.11.015. Epub 2012 Dec 21.
- Shahab L, Sarkar BK, West R.The acute effects of yogic breathing exercises on craving and withdrawal symptoms in abstaining smokers. Psychopharmacology (Berl). 2013 Feb;225(4):875-82. doi: 10.1007/s00213-012-2876-9. Epub 2012 Sep 20.
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- Parsons A, Daley A, Begh R, Aveyard P. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. BMJ 2010;340: b5569.
- Do KA, Johnson MM, Lee JJ, et al. Longitudinal study of smoking patterns in relation to the development of smoking-related secondary primary tumors in patients with upper aerodigestive tract malignancies. Cancer 2004;101(12): 2837-42.
- Burke L, Miller LA, Saad A, Abraham J. Smoking behaviors among cancer survivors: an observational clinical study. J Oncol Pract 2009;5(1):6-9.