Black Women Who Smoke When Diagnosed With Breast Cancer Have Worse Outcomes
Published on February 2, 2023
Smoking cigarettes at the time of a breast cancer diagnosis was linked to a higher risk of dying from any cause among Black women who live in New Jersey, according to a study.
The research was published online on Jan. 24, 2023, by the journal JAMA Network Open. Read “Association of Cigarette Smoking and Alcohol Consumption With Subsequent Mortality Among Black Breast Cancer Survivors in New Jersey.”
Smoking, alcohol, and breast cancer risk
Both smoking and drinking alcohol are known breast cancer risk factors.
Smoking has been linked to a number of diseases in addition to breast cancer. In pre-menopausal women, smoking is linked to a higher risk of developing breast cancer. In post-menopausal women, research suggests there is a link between very heavy second-hand smoke exposure and developing breast cancer.
Research also consistently shows that drinking beer, wine, and liquor increases a woman’s risk of hormone receptor-positive breast cancer. Alcohol can increase levels of estrogen and other hormones associated with hormone receptor-positive breast cancer. Alcohol also may increase breast cancer risk by damaging DNA in cells.
Women who have three alcoholic drinks a week have about a 23% higher risk of developing breast cancer than women who don’t drink at all. Experts estimate that the risk of breast cancer goes up another 10% for each additional drink women regularly have each day.
Still, it’s unclear if these links between smoking and drinking and breast cancer risk are different depending on a woman’s race or ethnicity because most of the studies mainly included white women.
In this study, the researchers wanted to look at smoking, drinking, and breast cancer risk in Black women only.
About the study
The researchers analyzed information from 1,926 Black women who are part of the Women’s Circle of Health Follow-Up Study. This study is ongoing and is looking at how obesity and other health issues affect breast cancer survival and health-related quality of life in Black women with a history of breast cancer in New Jersey.
The average age of the women in the study when they were diagnosed with breast cancer was 54.4 years. About 70% of the women were diagnosed with estrogen receptor-positive breast cancer.
The researchers followed the women for about seven years.
The women were diagnosed with breast cancer between June 6, 2005, and May 21, 2019. During the first home visit by researchers, the women completed a questionnaire that asked about:
family history of breast cancer
pregnancy history
use of hormone replacement therapy (HRT)
medical history
medicines they take
alcohol consumption
smoking history
exercise
diet
The researchers also measured the women’s weight, height, body composition, and blood pressure.
The researchers classified a woman as a smoker if she said she smoked at least one cigarette a day for one year. A woman was considered a current smoker if she said she was smoking when she was diagnosed with breast cancer.
Among the women in the study:
16.5% said they smoked at the time they were diagnosed with breast cancer
24.3% said they were former smokers
59.2% said they never smoked
The researchers also calculated what they called pack-years. The researchers estimated pack-years by multiplying the number of packs of cigarettes a woman smoked each day by the number of years a woman smoked.
The researchers also looked at how much alcohol the women drank each week. The researchers defined one serving of alcohol as:
12 ounces of beer
6 ounces of wine
1.5 ounces of liquor
Of the women in the study, 41.5% of them said they were regular drinkers in the year before being diagnosed with breast cancer. Among the regular drinkers:
70.6% said they had three drinks or fewer each week
28.3% said they had more than three drinks each week
The researchers noted that women considered current smokers had more drinks each week than former smokers or women who never smoked:
19.9% of current smokers had more than three drinks each week
14.3% of former smokers had more than three drinks each week
8.4% of women who never smoked had more than three drinks each week
During follow-up, 337 of the women died:
55.5% died from breast cancer
11.6% died from another type of cancer
9.5% died from heart or vascular disease
3.6% died from an infection, including COVID-19
3% died from a respiratory condition
1.5% died from kidney failure
1.5% died from a metabolic disorder, diabetes, or an obesity-related condition
1.5% died from pregnancy complications
12.5% died from other causes
The researchers’ analysis found a link between women who smoked when they were diagnosed with breast cancer and a higher risk of dying from any cause. Women who were smokers when they were diagnosed were 52% more likely to die from any cause than women who never smoked.
Current smokers who smoked 10 or more pack-years were 84% more likely to die from any cause. There was no link between mortality and current smokers who smoked fewer than 10 pack-years.
Current smokers also had a higher risk of dying from breast cancer: They were 27% more likely to die from breast cancer than women who had never smoked.
The researchers found no links between drinking in the year before being diagnosed with breast cancer and dying from any cause, including breast cancer.
The researchers also wanted to see if women who both smoked and drank alcohol had any increase in risk.
Current smokers who were regular drinkers were 69% more likely to die from any cause and 67% more likely to die from breast cancer than non-smokers who were regular drinkers.
“Our…study suggests that smoking at the time of a breast cancer diagnosis is associated with an increased risk of all-cause mortality, particularly for women who also drank and had 10 or more pack-years of smoking,” the researchers wrote. “Future studies among Black breast cancer survivors are warranted to understand the role of smoking and alcohol in prognosis, including its role in recurrence and mortality due to breast cancer and by tumor subtype, as well as factors associated with continued smoking.”
What this means for you
If you’re a Black woman with a history of breast cancer, this study offers some important information. You can’t change your smoking history, but if you’re a current smoker, you can take steps to quit now. Doing so may save your life.
Black women who were heavy smokers had a much higher risk of dying from any cause and a higher risk of dying from breast cancer. If you’re a smoker who also drinks alcohol regularly, you have an even higher risk of dying from any cause, including breast cancer.
We know that smoking is a habit that’s very hard to break. Fortunately, there’s a lot of help available:
The American Lung Association offers a free online smoking cessation program.
The American Cancer Society also has a guide on how to quit smoking. You also can call the American Cancer Society at 1-800-227-2345 to get support and free advice on how to stop smoking from trained counselors.
There are medicines to help you quit. You can take a pill, chew gum, or wear a patch on your skin. Ask your doctor if one of these might be right for you.
Acupuncture and meditation may help ease cigarette cravings.
It’s easier if you have a friend who’s also quitting or who can cheer you on when you’re feeling you can’t make it on your own.
Join the conversation at Stop Smoking Support, where you can talk with members of the Breastcancer.org community about quitting smoking.