Research table: Smoking and breast cancer survival

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Growing evidence suggests smoking is linked to a lower chance of survival for women with breast cancer.

A pooled analysis of data from about 10,000 women treated for breast cancer found smoking was linked to an increased risk of [1]:

• Breast cancer recurrence (a return of breast cancer)
• Breast cancer-specific mortality (death from breast cancer)
• Overall mortality (death from any cause, not necessarily breast cancer)

The more women smoked, the higher these risks [1].  

Learn more about smoking and breast cancer survival.

Learn about smoking and breast cancer risk.

Learn about the strengths and weaknesses of different types of studies.

Study selection criteria: Prospective cohort studies with at least 900 participants, pooled analyses and meta-analyses.

All studies measured smoking after breast cancer diagnosis.

Table note: Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.   

Study	Study Population (number of participants)	Follow-up (years)	Breast Cancer Mortality in Current Smokers Compared to Never Smokers, RR (95% CI)
Prospective cohort studies
Nurses’ Health Study [2]	5,031	8	1.02 (0.83-1.24)
Collaborative Breast Cancer and Women’s Longevity Study [3]	4,562	6	1.72 (1.13-2.60)
Life After Cancer Epidemiology [4]	2,265	12	2.01 (1.27-3.18)
Parada et al. [5]	1,508	18	1.08 (0.77-1.51)
U.S. Health and Functioning in Women study [6]	975	11	1.38 (0.99-1.91)
Pooled and meta-analyses
California Breast Cancer Survivorship Consortium [7]	12,210		1 or fewer packs of cigarettes per day: 1.22 (1.01-1.47) More than 1 pack of cigarettes per day: 1.63 (1.11-2.38)
After Breast Cancer Pooling Project [1,8]	9,975		1.61 (1.28-2.03)*
Duan et al. [9]	12 studies		1.30 (1.16-1.45)

*Among women who had estrogen receptor-positive breast cancers, current smokers did not have an increased risk of late recurrence (5 or more years after diagnosis) compared to never smokers, 1.30 (0.94-1.81).

References

1. Pierce JP, Patterson RE, Senger CM, et al. Lifetime cigarette smoking and breast cancer prognosis in the after breast cancer pooling project. J Natl Cancer Inst. 106(1):djt359, 2014.
2. Holmes MD, Murin S, Chen WY, Kroenke CH, Spiegelman D, Colditz GA. Smoking and survival after breast cancer diagnosis. Int J Cancer. 120(12):2672-7, 2007.
3. Passarelli MN, Newcomb PA, Hampton JM, et al. Cigarette smoking before and after breast cancer diagnosis: mortality from breast cancer and smoking-related diseases. J Clin Oncol. 34(12):1315-22, 2016.
4. Braithwaite D, Izano M, Moore DH, et al. Smoking and survival after breast cancer diagnosis: a prospective observational study and systematic review. Breast Cancer Res Treat. 136(2):521-33, 2012.
5. Parada H Jr, Bradshaw PT, Steck SE, et al. Postdiagnosis changes in cigarette smoking and survival following breast cancer. JNCI Cancer Spectr. 1(1): pkx001, 2017.
6. Izano M, Satariano WA, Hiatt RA, Braithwaite D. Smoking and mortality after breast cancer diagnosis: the health and functioning in women study. Cancer Med. 4(2):315-24, 2015.
7. Wu AH, Gomez SL, Vigen C, et al. The California Breast Cancer Survivorship Consortium (CBCSC): prognostic factors associated with racial/ethnic differences in breast cancer survival. Cancer Causes Control. 24(10):1821-36, 2013.
8. Nechuta S, Chen WY, Cai H, et al. A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor-positive breast cancer prognosis. Int J Cancer. 138(9):2088-97, 2016.
9. Duan W, Li S, Meng X, Sun Y, Jia C. Smoking and survival of breast cancer patients: A meta-analysis of cohort studies. Breast. 33:117-124, 2017.

Updated 04/19/23