The Association between Smoking and Mortality in Women with Breast Cancer: A Real-World Database Analysis

SIMPLE SUMMARY: The association between smoking status and breast cancer mortality in Asian populations has not been extensively studied. In this study, we aimed to investigate the association between smoking status and mortality risk in women diagnosed with breast cancer between 2011 and 2017 using a real-world population database. Women with breast cancer with a history of smoking had a 1.25-fold higher (95% C.I.: 1.08–1.45; p = 0.0022) risk of overall mortality and a 1.22-fold higher (95% C.I.: 1.04–1.44; p = 0.0168) risk of cancer-specific mortality compared with non-smokers. Smokers who did not have comorbidities showed a significantly higher overall nmortality risk (HR: 1.20; 95% CI: 1.01–1.43; p = 0.0408) than non-smokers among women with breast cancer. Additionally, among women with breast cancer who had a history of smoking, current smokers had a 1.57-fold higher risk (95% CI: 1.02–2.42; p = 0.0407) of overall mortality compared with ever smokers. It was shown that a current smoking status is significantly associated with an increase in overall and cancer-specific mortality risk in women with breast cancer. Among women diagnosed with breast cancer, those who quit smoking had a lower mortality risk than current smokers. Our results underscore the importance of smoking cessation for women with BC. ABSTRACT: Smoking increases the cancer-specific and overall mortality risk in women with breast cancer (BC). However, the effect of smoking cessation remains controversial, and detailed research is lacking in Asia. We aimed to investigate the association between smoking status and mortality in women with BC using the population-based cancer registry. The Taiwan Cancer Registry was used to identify women with BC from 2011 to 2017. A total of 54,614 women with BC were enrolled, including 1687 smokers and 52,927 non-smokers. The outcome, mortality, was identified using Taiwan’s cause-of-death database. The association between smoking status and mortality was estimated using Cox proportional regression. Women with BC who smoked had a 1.25-fold higher (95% C.I.: 1.08–1.45; p = 0.0022) risk of overall mortality and a 1.22-fold higher (95% C.I.: 1.04–1.44; p = 0.0168) risk of cancer-specific mortality compared with non-smokers. The stratified analysis also indicated that women with BC who smoked showed a significantly higher overall mortality risk (HR: 1.20; 95% CI: 1.01–1.43; p = 0.0408) than women with BC who did not smoke among women without comorbidities. Additionally, current smokers had a 1.57-fold higher risk (95% CI: 1.02–2.42; p = 0.0407) of overall mortality compared with ever smokers among women with BC who smoked. It was shown that a current smoking status is significantly associated with an increase in overall and cancer-specific mortality risk in women with BC. Quitting smoking could reduce one’s mortality risk. Our results underscore the importance of smoking cessation for women with BC.