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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Breast Cancer Risk Among Women Who Start Smoking as Teenagers

Inger T. Gram, Tonje Braaten, Paul D. Terry, Annie J. Sasco, Hans-Olov Adami, Eiliv Lund and Elisabete Weiderpass
Inger T. Gram
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Tonje Braaten
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Paul D. Terry
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Annie J. Sasco
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Hans-Olov Adami
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Eiliv Lund
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Elisabete Weiderpass
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DOI:  Published January 2005
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Tables

  • Table 1.

    Selected characteristics of the participants (N = 102,098) in the Norwegian-Swedish Cohort Study, 1991-2000

    CharacteristicsNorwaySwedenTotal
    Age at enrollment, median (range)41 (34-50)40 (30-50)40 (30-50)
    Number of women54,32147,777102,098
    Person-years of follow-up493,832430,936924,768
    Median follow-up time in years9.69.39.3
    Number of invasive breast cancers*6935471,240
    Crude breast cancer incidence rate†140127134
    Age-adjusted breast cancer incidence rate‡131127127
    Age at breast cancer diagnosis, median (range)48 (36-57)49 (30-58)48 (30-58)
    Smoking status at cohort enrollment§
        Current (%)29.326.628.0
        Past (%)38.832.736.0
        Passive (%)∥22.924.223.5
        Never (%)9.016.512.5
    • ↵* Incident cases of breast cancer during follow-up through 2000.

    • ↵† Number of incident cases per 100,000 woman-years.

    • ↵‡ Per 100,000 woman-years, adjusted to World Standard population.

    • ↵§ χ2 test for differences between Sweden and Norway, P < 0.001.

    • ↵∥ Women who never smoked, but lived with smokers during childhood or at cohort enrollment.

  • Table 2.

    Distribution of selected characteristics of study population (N = 102,098) at cohort enrollment, given as mean (±SD) and (%), by smoking status, Norwegian-Swedish Cohort Study, 1991-2000

    CharacteristicsCurrent smokers (n = 28,624)Past smokers (n = 36,701)Passive smokers (n = 24,030)Never smokers (n = 12,743)P*
    Age (y)40.5 ± 5.040.1 ± 4.9†40.6 ± 5.2‡40.1 ± 5.5<0.001
    Age at diagnosis (y)48.6 ± 5.247.4 ± 5.2†48.0 ± 5.447.9 ± 5.50.04
    Education (y)11.4 ± 2.912.1 ± 3.1†12.6 ± 3.2‡13.2 ± 3.2<0.001
    Age at menarche (y)13.1 ± 1.413.1 ± 1.3†13.1 ± 1.413.1 ± 1.30.98
    Postmenopausal (%)7.24.2†4.3‡3.6<0.001
    Age at menopause (y)42.4 ± 4.741.9 ± 4.7†42.8 ± 4.743.0 ± 4.30.09
    Family history of breast cancer (%)§4.94.84.94.90.41
    Parous (%)87.990.0†88.0‡84.90.001
    Age at first birth (y)22.9 ± 4.224.0 ± 4.4†24.5 ± 4.2‡25.4 ± 4.20.001
    No. of children2.0 ± 1.12.0 ± 1.1†2.1 ± 1.1‡2.0 ± 1.20.001
    Ever hormonal contraceptive use (%)76.776.8†68.3‡65.4<0.001
    Teetotalers (%)15.016.7†25.1‡v33.0<0.001
    Alcohol consumption (g/d)∥4.6 ± 6.54.2 ± 5.6†3.3 ± 4.2‡2.9 ± 3.6<0.001
    Mean physical activity score¶3.0 ± 0.93.1 ± 0.9†3.1 ± 0.9‡3.2 ± 0.9<0.001
    BMI** at enrollment23.1 ± 3.523.2 ± 3.4†23.5 ± 3.6‡23.0 ± 3.30.02
    • ↵* Differences between current and never smoking groups.

    • ↵† Differences between current and past smoking groups (P < 0.001).

    • ↵‡ T-test/χ2 test for differences between passive and never smoking groups (P ≤ 0.01).

    • ↵§ Among mother or sister(s).

    • ↵∥ Among drinkers.

    • ↵¶ Leisure time physical activity in the year preceding cohort enrollment (scored as 1-5, low to high level).

    • ↵** BMI: the weight in kilograms divided by the square of the heights in meters.

  • Table 3.

    Multivariate RRs with 95% CI of breast cancer according to various measures of smoking exposures among current and ever smokers smoking at least 20 years compared with never smokers (n = 12,743) and the corresponding figures restricted to nondrinkers, with 3,834 never smokers as reference group, Norwegian-Swedish Cohort Study, 1991-2000

    Exposure measuresStudy population
    Nondrinkers
    Current smokers (n = 28,624)
    Ever smokers 20+ y (n = 26,724)
    Current smokers (n = 4,043)
    Ever smokers 20+ y (n = 3,778)
    Multivariate*Multivariate*Multivariate*Multivariate*
    Cases (n)RR† (95% CI)Cases (n)RR‡ (95% CI)Cases (n)RR§ (95% CI)Cases (n)RR∥ (95% CI)
    Never smokers1371.00 (ref.)1371.00 (ref.)341.00 (ref.)341.00 (ref.)
    Smoking initiation
    Age (y)
        20+1081.02 (0.78-1.35)841.16 (0.86-1.57)161.14 (0.59-2.19)131.35 (0.67-2.71)
        15-192161.15 (0.91-1.47)2591.23 (0.97-1.55)261.30 (0.72-2.33)341.35 (0.78-2.32)
        10-14361.51 (1.00-2.28)491.48 (1.03-2.13)52.46 (0.90-6.68)72.20 (0.92-5.30)
    P = 0.07¶P = 0.03¶P = 0.15¶P = 0.11¶
    Before/around menarche
        No2821.10 (0.88-1.38)2941.20 (0.96-1.51)381.26 (0.75-2.12)411.37 (0.82-2.29)
        Yes721.30 (0.94-1.80)921.39 (1.03-1.87)71.52 (0.63-3.66)111.66 (0.79-3.49)
    P = 0.13¶P = 0.03¶P = 0.28¶P = 0.13¶
    Before first birth*
        No910.99 (0.72-1.37)780.98 (0.70-1.62)171.36 (0.66-2.79)120.97 (0.44-2.12)
        Yes2131.18 (0.92-1.52)2571.27 (1.00-1.62)261.46 (0.81-2.64)371.75 (1.02-2.99)
    P = 0.14¶P = 0.03¶P = 0.20¶P = 0.03¶
    No. of cigarettes per day
        1-91350.96 (0.74-1.25)1381.10 (0.85-1.43)231.33 (0.74-2.67)281.70 (1.03-3.12)
        10+2251.28 (1.01-1.63)2541.34 (1.06-1.70)241.25 (0.69-2.26)261.15 (0.65-2.05)
    P = 0.03¶P = 0.01¶P = 0.60¶P = 0.89¶
    No. of years smoked
        1-19680.93 (0.68-1.28)-101.07 (0.49-2.32)-
        20-24961.09 (0.81-1.45)1581.13 (0.88-1.45)100.96 (0.44-2.10)221.32 (0.73-2.38)
        25+1961.26 (0.98-1.63)2341.36 (1.06-1.74)271.63 (0.90-2.94)321.53 (0.87-2.68)
    P = 0.05¶P = 0.02¶P = 0.15¶P = 0.13¶
    No. of pack-years
        0-141620.95 (0.74-1.20)1531.01 (0.85-1.40)271.28 (0.73-2.26)291.61 (0.93-2.78)
        15-19901.28 (0.96-1.72)1141.35 (1.02-1.77)81.11 (0.50-2.49)121.26 (0.63-2.53)
        20+1081.48 (1.14-1.96)1251.46 (1.11-1.93)121.54 (0.72-3.29)131.22 (0.59-2.53)
    P = 0.001††P < 0.02††P = 0.31††P = 0.57††
    Latency (y)
        1-19480.75 (0.52-1.08)120.88 (0.47-1.66)101.33 (0.62-2.87)21.27 (0.29-5.49)
        20-241161.20 (0.91-1.58)1251.13 (0.86-1.47)100.70 (0.30-1.63)151.02 (0.52-2.02)
        25+1961.27 (0.98-1.64)2551.37 (1.07-1.76)271.67 (0.93-3.02)371.74 (1.01-3.02)
    P = 0.02††P < 0.05††P = 0.41††P = 013††
    • ↵* Adjusted for age at enrollment, menopausal status, number of children, age at first birth, hormonal contraceptive use, BMI (and alcohol consumption for the analysis among all women).

    • ↵† Based upon a model with 446 cases.

    • ↵‡ Based upon a model with 478 cases.

    • ↵§ Based upon a model with 74 cases.

    • ↵∥ Based upon a model with 82 cases.

    • ↵¶ Trend test between levels of smoking categories including never smokers.

    • ** Among parous women.

    • ↵† Trend test between levels of smoking categories excluding never smokers.

  • Table 4.

    Multivariate RR estimates for breast cancer with 95% CI based upon 478 cases among women who have smoked for at least 20 years compared with never smokers within two (high/low) risk levels of breast cancer risk factors, Norwegian-Swedish Cohort Study, 1991-2000

    Confounding variablesCases (n = 478)Multivariate adjusted* (95% CI)P†
    Age group at enrollment (y)30-442531.25 (0.93-1.70)0.82
    45-502251.19 (0.86-1.65)
    Age at menarche (y)<131450.93 (0.63-1.36)0.08
    13+3331.42 (1.08-1.85)
    Menopausal status‡Pre2761.21 (0.91-1.61)0.74
    Post1981.31 (0.92-1.88)
    ParityNo651.18 (0.68-2.06)0.86
    Yes4131.25 (0.98-1.58)
    Age at first birth (y)§<252551.31 (0.93-1.85)0.59
    25+1581.15 (0.82-1.61)
    Family history of breast cancer in the mother or sistersNo4321.23 (0.97-1.55)0.82
    Yes461.35 (0.65-2.79)
    Hormonal contraceptive useEver3581.21 (0.93-1.56)0.76
    Never1201.30 (0.86-1.96)
    BMI≤23.93281.30 (0.99-1.70)0.50
    >23.91501.10 (0.75-1.62)
    Consumption of alcoholNondrinkers821.43 (0.87-2.33)0.50
    Drinkers3961.18 (0.92-1.51)
    • ↵* Adjusted for age at enrollment, menopausal status, number of children, age at first birth, hormonal contraceptive use, and consumption of alcohol where applicable.

    • ↵† Test for heterogeneity between strata Wald χ2 statistics.

    • ↵‡ Missing numbers due to equivocal menopausal status.

    • ↵§ Among parous women.

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Cancer Epidemiology Biomarkers & Prevention: 14 (1)
January 2005
Volume 14, Issue 1
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Breast Cancer Risk Among Women Who Start Smoking as Teenagers
Inger T. Gram, Tonje Braaten, Paul D. Terry, Annie J. Sasco, Hans-Olov Adami, Eiliv Lund and Elisabete Weiderpass
Cancer Epidemiol Biomarkers Prev January 1 2005 (14) (1) 61-66;

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Breast Cancer Risk Among Women Who Start Smoking as Teenagers
Inger T. Gram, Tonje Braaten, Paul D. Terry, Annie J. Sasco, Hans-Olov Adami, Eiliv Lund and Elisabete Weiderpass
Cancer Epidemiol Biomarkers Prev January 1 2005 (14) (1) 61-66;
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