Active and passive cigarette smoking and mortality among Hispanic and non-Hispanic white women diagnosed with invasive breast cancer

Ann Epidemiol. 2015 Nov;25(11):824-31. doi: 10.1016/j.annepidem.2015.08.007. Epub 2015 Aug 28.


Purpose: Women who smoke at breast cancer diagnosis have higher risk of breast cancer-specific and all-cause mortality than nonsmokers; however, differences by ethnicity or prognostic factors and risk for noncancer mortality have not been evaluated.

Methods: We examined associations of active and passive smoke exposure with mortality among Hispanic (n = 1020) and non-Hispanic white (n = 1198) women with invasive breast cancer in the Breast Cancer Health Disparities Study (median follow-up of 10.6 years).

Results: Risk of breast cancer-specific (HR = 1.55, 95% CI = 1.11-2.16) and all-cause (HR = 1.68, 95% CI = 1.30-2.17) mortality was increased for current smokers, with similar results stratified by ethnicity. Ever smokers had an increased risk of noncancer mortality (HR = 1.68, 95% CI = 1.12-2.51). Associations were strongest for current smokers who smoked for 20 years or more were postmenopausal, overweight and/or obese, or reported moderate and/or high alcohol consumption; however, interactions were not significant. Breast cancer-specific mortality was increased two fold for moderate and/or high recent passive smoke exposure among never smokers (HR = 2.12, 95% CI = 1.24-3.63).

Conclusions: Findings support associations of active-smoking and passive-smoking diagnosis with risk of breast cancer-specific and all-cause mortality and ever smoking with noncancer mortality, regardless of ethnicity, and other factors. Smoking is a modifiable lifestyle factor and effective smoking cessation, and maintenance programs should be routinely recommended for women with breast cancer.

Keywords: Breast cancer; Ethnicity; Hispanic; Mortality; Native American ancestry; Smoking; Survival.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Alcohol Drinking / epidemiology
  • Body Mass Index
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / etiology*
  • Breast Neoplasms / mortality*
  • Case-Control Studies
  • Cause of Death
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Incidence
  • Middle Aged
  • Population Surveillance
  • Risk Factors
  • Smoking / adverse effects
  • Smoking Cessation
  • Surveys and Questionnaires
  • Survival
  • Tobacco Smoke Pollution / adverse effects*
  • Tobacco Smoke Pollution / statistics & numerical data
  • United States / epidemiology


  • Tobacco Smoke Pollution