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Eur J Epidemiol. 2017 Aug;32(8):683-690. doi: 10.1007/s10654-017-0282-7. Epub 2017 Jul 14.

A possible dual effect of cigarette smoking on the risk of postmenopausal breast cancer.

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Department of Epidemiology, GROW- School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 616, 6200, MD, Maastricht, The Netherlands.
Department of Epidemiology, CAPHRI- School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands.


Smoking seems modestly associated with breast cancer, but the potential dual effect of smoking (with opposing properties: carcinogenic vs anti-estrogenic) is understudied. The relationship between smoking before and after menopause and risk of postmenopausal breast cancer was investigated in the Netherlands Cohort Study (NLCS). In the NLCS, 62,573 women aged 55-69 years provided information on smoking, dietary and other lifestyle habits in 1986. Follow-up for cancer incidence until 2007 (20.3 years) consisted of record linkages with the Netherlands Cancer Registry and the Dutch Pathology Registry PALGA. Multivariate case-cohort analyses were based on 2526 incident breast cancer cases and 1816 subcohort members with complete data on smoking. When smoking during pre- and postmenopausal periods was mutually adjusted for, breast cancer risk was significantly positively associated with premenopausal smoking pack-years, but inversely associated with postmenopausal smoking pack-years, both in a dose-dependent manner. In continuous analyses, the hazard ratios (95% CI) were 1.35 (1.10-1.65), and 0.47 (0.28-0.80) per increment of 20 premenopausal, and postmenopausal pack-years, respectively. The interaction between pre- and postmenopausal pack-years in relation to breast cancer risk was significant (P < 0.001). This study highlights the importance of distinguishing and adjusting for smoking in different life periods, and suggests dual effects of smoking on postmenopausal breast cancer risk.


Breast cancer; Cohort study; Menopause; Smoking

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