American Journal of Epidemiology Vol. 130, No. 2: 213-220
Copyright © 1989 by The Johns Hopkins University School of Hygiene and Public Health
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CIGARETTE SMOKING AND BREAST CANCER: CASE-CONTROL STUDIES OF PREVALENT AND INCIDENT CANCER IN THE CANADIAN NATIONAL BREAST SCREENING STUDY
1Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia Vancouver, British Columbia, Canada
2Department of Preventive Medicine and Biostatistics, Faculty of Medicine, University of Toronto Toronto, Ontario, Canada
3National Cancer Institute of Canada Epidemiology Unit, Faculty of Medicine, University of Toronto Toronto, Ontario, Canada
Reprint requests to Dr Anthony B. Miller, Department of Preventive Medicine and Biostatistics, Faculty of Medicine, McMurrich Building, University of Toronto, Toronto, Ontario, Canada M5S 1A8
Two case-control studies of Canadian women aged 40–59 years are reported investigating the relation of cigarette smoking with initial visit (prevalent) and subsequent visit (incident) breast cancer detection, respectively, within the Canadian National Breast Screening Study. The analysis of prevalent breast cancer (1982–1985), which involved 254 cases and 762 controls, showed no evidence of an elevated risk for women with a history of cigarette smoking, with odds ratios of 0.9 (95% confidence interval (Cl) 0.6–1.5) and 1.2 (95% Cl 0.8%1.8) in premenopausal and postmenopausal subjects, respectively. Similarly, in the incident breast cancer analysis (1981–1987) based on 317 cases and 951 controls, women with a history of cigarette smoking had odds ratios of 1.2 (95% Cl 0.8–2.0) and 1.2 (95% Cl 0.9–1.7) in the premenopausal and postmenopausal categories, respectively. No evidence of dose response or of elevated risk in exsmokers or current smokers was found in either study. These results persisted despite adjustment for several important variables. The present data demonstrate no association between smoking and prevalent or incident breast cancer in either menopausal category, contradicting the authors' previous finding of a positiveassociation with premenopausal prevalent disease earlier in this screening study. The relation of smoking and breast cancer remains controversial. Further study is required to determine whether an association truly does not exist or whether smoking might have both protective and harmful effects that are mediated through different pathways, thus accounting for the paradoxical findings in the literature to date.
breast neoplasma; mass screening; risk; smoking
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