Optimizing outcomes for women with breast cancer with prescriptions for smoking cessation

15 Aug 2018 2:05 PM | Anonymous

Digest Commentator: Joan L. Bottorff, PhD, RN, FCAHS, FAAN, School of Nursing and Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia’s Okanagan Campus

Edited by: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

Tobacco use has been established as a causal factor for a number of cancers and has been a primary focus for cancer prevention efforts.  However, less attention has been given to the risks of tobacco use among patients with cancer who continue to smoke. The evidence presented in the article by Passarelli and colleagues adds to the growing body of literature that we need to address continued smoking among those with cancer to reduce mortality and morbidity.  In this observational study, the authors followed up a sample of 20,691 breast cancer survivors in the United States to evaluate the association between smoking status before and after a breast cancer diagnosis, and mortality from breast cancer and smoking-related disease. Persistent smoking among survivors in this study was associated with a statistically significant 25% increase in relative risk of breast cancer death.  Women who continued to smoke also had a higher risk of death from respiratory cancer, noncancer respiratory disease, and cardiovascular disease. Women who quit smoking post-diagnosis had a 33% lower relative risk of death from breast cancer and other causes compared to those who continued to smoke, although this was not statistically significant.

What I liked about this article:  This is a large population based study that provides a solid evidence base for promoting smoking cessation.  Although the factors by which smoking effects tumor progression are not fully understood, the results not only point to the adverse outcomes for those with a history of breast cancer who continue to smoke but also obligate us all to offer smoking cessation to women with breast cancer.  Respectful, women-centred approaches to smoking cessation can serve as an important foundation for offering cessation support to women with breast cancer. This study suggests the time is now for prescribing and supporting smoking cessation with every woman with breast cancer who smokes at every visit in order to optimize survival and overall health. The findings of Passarelli et al. can help us advocate for the resources we need to augment resources for smoking cessation in clinical practice.

Article:  Passarelli, M.N., Newcomb, P.A., Hampton, J.M., Trentham-Dietz, A., Titus, L.J., Egan, K.M., Baron, J.A., & Willett, W.C. (2016).  Cigarette smoking before and after breast cancer diagnosis: Mortality from breast cancer

Journal website: http://jco.ascopubs.org/content/34/12/1315.full.pdf+html?sid=8fa86d13-4eaa-4135-8e87-2c87c6456da1

Author website: http://profiles.ucsf.edu/michael.passarelli


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