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A Prospective Study of Smoking and Risk of Breast Cancer in Young Adult Women

Departments of ¹ Nutrition and ² Epidemiology, Harvard School of Public Health, Boston, MA; ³ Harvard Center for Cancer Prevention, Boston, MA; ⁴ Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA; and ⁵ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA

Requests for reprints: Wael K. Al-Delaimy, Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115. Fax: (617) 432-2435. E-mail: wael{at}hsph.harvard.edu

Objective: To investigate the association between smoking and invasive breast cancers characterized by their estrogen receptor status in a large prospective study of mainly premenopausal women. Method: 112,844 women aged 25–42 years in 1989 were followed 10 years; questionnaire information on medical illnesses and risk factors was collected biennially and information on diet was collected in 1991 and 1995. During this period of follow-up (1,077,536 person-years), 1009 incident breast cancer cases were documented. Results: In the multivariate-adjusted models, smoking status was not significantly related to overall breast cancer risk: compared with never smokers, the relative risks (RRs) were 1.18 [95% confidence interval (CI) 1.02–1.36] for past smokers and 1.12 (95% CI 0.92–1.37) for current smokers. Increasing duration of smoking before the first pregnancy was associated with a greater risk of breast cancer, although little increase was seen in the highest category: compared with never smokers, RRs were 1.42 (95% CI 1.10–1.83) for 15–19 years of smoking and 1.10 (95% CI 0.80–1.52) for 20 years of smoking (P for trend = 0.01). Smoking was related most strongly to the risk of estrogen receptor-positive breast cancers. For women who had smoked for 20 years, the RR of estrogen receptor-positive cancer was 1.37 (95% CI 1.07–1.74) and the RR of estrogen receptor-negative cancer was 1.04 (95% CI 0.71–1.53). For smoking before age 15, the RRs were 1.49 (95% CI 1.03–2.17) for estrogen receptor-positive cancer and 1.19 (95% CI 0.69–2.08) for estrogen receptor-negative cancer. Conclusion: Our results suggest that longer duration of smoking may be related to the risk of estrogen receptor-positive breast cancer but possibly less so for estrogen receptor-negative breast cancer.

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