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Passive Smoking Exposure and Female Breast Cancer Mortality

Daniel Wartenberg, Eugenia E. Calle, Michael J. Thun, Clark W. Heath, Jr., Cathy Lally, Tracey Woodruff

Affiliations of authors: D. Wartenberg, Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, Piscataway, NJ; E. E. Calle, M. J. Thun, C. W. Heath, Jr., C. Lally, American Cancer Society, Atlanta, GA; T. Woodruff, Office of Policy, U.S. Environmental Protection Agency, Washington, DC.

Correspondence to: Daniel Wartenberg, Ph.D., Environmental and Occupational Health Sciences Institute, 170 Frelinghuysen Rd., Piscataway, NJ 08854 (e-mail: dew@eohsi.rutgers.edu).

Background: Several studies have reported positive associations between environmental tobacco smoke (ETS) and increased risk of breast cancer. However, studies of active smoking and risk of breast cancer are equivocal and in general do not support a positive association. To try to resolve this paradox, we examined the association between breast cancer mortality and potential ETS exposure from spousal smoking in an American Cancer Society prospective study of U.S. adult women. Methods: We assessed breast cancer death rates in a cohort of 146 488 never-smoking, single-marriage women who were cancer free at enrollment in 1982. Breast cancer death rates among women whose husbands smoked were compared with those among women married to men who had never smoked. Cox proportional hazards modeling was used to control for potential risk factors other than ETS exposure. Results: After 12 years of follow-up, 669 cases of fatal breast cancer were observed in the cohort. Overall, we saw no association between exposure to ETS and death from breast cancer (rate ratio [RR] = 1.0; 95% confidence interval [CI] = 0.8–1.2). We did, however, find a small, not statistically significant increased risk of breast cancer mortality among women who were married before age 20 years to smokers (RR = 1.2; 95% CI = 0.8–1.8). Conclusions: In contrast to the results of previous studies, this study found no association between exposure to ETS and female breast cancer mortality. The results of our study are particularly compelling because of its prospective design as compared with most earlier studies, the relatively large number of exposed women with breast cancer deaths, and the reporting of exposure by the spouse rather than by proxy.