TY - JOUR
T1 - Smoking and alcohol drinking effect on radiotherapy associated risk of second primary cancer and mortality among breast cancer patients
AU - DiMarzio, Paola
AU - Peila, Rita
AU - Dowling, Oonagh
AU - Timony, Dennis M.
AU - Balgobind, Amrita
AU - Lee, Lucille N.
AU - Kostroff, Karen M.
AU - Ho, Gloria Y.F.
N1 - Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2018/12
Y1 - 2018/12
N2 - Background: Smoking and alcohol consumption are potential risk factors for breast cancer (BC) and may modify the risk of radiotherapy-associated second primary cancer (SPC) occurrence and total mortality. We explored the joint effect of smoking, or alcohol drinking, and radiotherapy on the risk of SPC and overall mortality among BC survivals. Methods: We conducted a cancer registry-based study of 10,676 BC cases (stage 0-III) with data on smoking and alcohol consumption at time of diagnosis and clinical and therapeutics characteristics. Multivariable Cox proportional hazard models were used to estimate Hazard Ratios [HRs] and 95% confidence interval [CI] of total and site-specific SPC and mortality adjusting for demographic and cancer related characteristics. Results: The SPC risk associated with radiotherapy was higher among ever-smokers than never-smokers (p for interaction = 0.04). Compared to never-smokers/unirradiated, the adjusted HR for ever-smokers/irradiated was 1.79 (95%CI, 1.43–2.23), and for never-smokers/irradiated was 1.31 (95%CI, 1.06–1.63). Analysis by cancer site showed that for ever-smokers/irradiated the risk for hematological, gastrointestinal, gynecological urological and lung/pulmonary cancer was significantly increased by two to five-fold. Mortality was significantly higher for ever-smokers/irradiated (HR = 1.25; 95%CI, 1.06–1.47), but was lower for never-smokers/irradiated (HR = 0.85; 95%CI, 0.73–0.99). Alcohol consumption did not alter the association between radiotherapy and SPC risk, but was associated with lower mortality risk. Conclusion: Patients who received radiotherapy and smoked before or at time of BC diagnosis have an increased risk for specific SPCs; drinking alcohol did not alter the effect of radiotherapy. Smoking significantly increased mortality risk reducing the protective effect of radiotherapy treatment.
AB - Background: Smoking and alcohol consumption are potential risk factors for breast cancer (BC) and may modify the risk of radiotherapy-associated second primary cancer (SPC) occurrence and total mortality. We explored the joint effect of smoking, or alcohol drinking, and radiotherapy on the risk of SPC and overall mortality among BC survivals. Methods: We conducted a cancer registry-based study of 10,676 BC cases (stage 0-III) with data on smoking and alcohol consumption at time of diagnosis and clinical and therapeutics characteristics. Multivariable Cox proportional hazard models were used to estimate Hazard Ratios [HRs] and 95% confidence interval [CI] of total and site-specific SPC and mortality adjusting for demographic and cancer related characteristics. Results: The SPC risk associated with radiotherapy was higher among ever-smokers than never-smokers (p for interaction = 0.04). Compared to never-smokers/unirradiated, the adjusted HR for ever-smokers/irradiated was 1.79 (95%CI, 1.43–2.23), and for never-smokers/irradiated was 1.31 (95%CI, 1.06–1.63). Analysis by cancer site showed that for ever-smokers/irradiated the risk for hematological, gastrointestinal, gynecological urological and lung/pulmonary cancer was significantly increased by two to five-fold. Mortality was significantly higher for ever-smokers/irradiated (HR = 1.25; 95%CI, 1.06–1.47), but was lower for never-smokers/irradiated (HR = 0.85; 95%CI, 0.73–0.99). Alcohol consumption did not alter the association between radiotherapy and SPC risk, but was associated with lower mortality risk. Conclusion: Patients who received radiotherapy and smoked before or at time of BC diagnosis have an increased risk for specific SPCs; drinking alcohol did not alter the effect of radiotherapy. Smoking significantly increased mortality risk reducing the protective effect of radiotherapy treatment.
KW - Alcohol
KW - Breast cancer
KW - Epidemiology
KW - Radiotherapy
KW - Second primary cancer
KW - Smoking
KW - Total mortality
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U2 - 10.1016/j.canep.2018.10.002
DO - 10.1016/j.canep.2018.10.002
M3 - Article
C2 - 30359894
AN - SCOPUS:85055150411
SN - 1877-7821
VL - 57
SP - 97
EP - 103
JO - Cancer Epidemiology
JF - Cancer Epidemiology
ER -