Active, but not passive cigarette smoking was inversely associated with mammographic density

Cancer Causes Control. 2010 Feb;21(2):301-11. doi: 10.1007/s10552-009-9462-4.


Purpose: The opposing carcinogenic and antiestrogenic properties of tobacco smoke may explain why epidemiologic studies have not consistently reported positive associations for active smoking and breast cancer risk. A negative relation between mammographic density, a strong breast cancer risk factor, and active smoking would lend support for an antiestrogenic mechanism.

Methods: We used multivariable linear regression to assess the associations of active smoking and secondhand smoke (SHS) exposure with mammographic density in 799 pre- and early perimenopausal women in the Study of Women's Health Across the Nation (SWAN).

Results: We observed that current active smoking was associated with 7.2% lower mammographic density, compared to never active smoking and no SHS exposure (p = 0.02). Starting to smoke before 18 years of age and having smoked > or =20 cigarettes/day were also associated with statistically significantly lower percent densities. Among nulliparous women having smoked > or =20 cigarettes/day was associated with 23.8% lower density, compared to having smoked < or = 9 cigarettes/day (p<0.001).

Conclusions: Our findings support the hypothesis that tobacco smoke exerts an antiestrogenic effect on breast tissue, but counters the known increased risk of breast cancer with smoking prior to first full-term birth. Thus, our data suggest that the antiestrogenic but not the carcinogenic effects of smoking may be reflected by breast density.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Asian Continental Ancestry Group / statistics & numerical data
  • Breast / pathology*
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / etiology
  • Estrogen Antagonists / adverse effects
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Humans
  • Linear Models
  • Mammography / methods*
  • Middle Aged
  • Multivariate Analysis
  • Parity
  • Pregnancy
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • Smoking / adverse effects*
  • Surveys and Questionnaires
  • Tobacco Smoke Pollution / adverse effects*
  • Women's Health / ethnology


  • Estrogen Antagonists
  • Tobacco Smoke Pollution