Investigators explore impact of cigarette smoking and alcohol consumption on Black breast cancer survivors

Investigators from Rutgers Cancer Institute of New Jersey, the state's only National Cancer Institute-designated Comprehensive Cancer Center, together with RWJBarnabas Health, found that a higher risk of mortality in Black breast cancer survivors is associated with a history of cigarette smoking along with regular alcohol consumption at the time of diagnosis.

The work, led by Nur Zeinomar, Ph.D., MPH, associate member of the Cancer Prevention and Control Program at Rutgers Cancer Institute, along with senior author Elisa V. Bandera, MD, Ph.D. of Rutgers Cancer Institute, Rutgers School of Public Health and Rutgers Robert Wood Johnson Medical School, is published in JAMA Network Open.

There is limited data about how lifestyle factors are associated with breast cancer prognosis in Black women, as the majority of evidence is based on studies in white breast cancer survivors.

Maintaining a healthy lifestyle, which includes limited alcohol consumption and avoiding smoking, has been associated with improved survival following a breast cancer diagnosis. In this population-based cohort study of 1,926 Black breast cancer survivors, researchers found that those who smoked at the time of breast cancer diagnosis had a 52 percent increased risk for death due to any cause, compared with those who never smoked.

This association was most pronounced for women with greater 'pack-years' of smoking and who regularly consumed alcohol, suggesting that smoking at the time of diagnosis is associated with a higher risk of mortality among Black breast cancer survivors, report the authors.

"Our findings add to the evidence of the detrimental health impacts of smoking and underscore the need of tailored and targeted survivorship care for breast cancer survivors, particularly Black women and those with heavier levels of smoking," notes Dr. Zeinomar, who is also an assistant professor of medicine at Rutgers Robert Wood Jonson Medical School.

"According to the American Cancer Society, there is a 40 percent increased risk of death for Black women diagnosed with breast cancer compared to non-Hispanic white women, thus better understanding how these modifiable risk factors are associated with prognosis is important for clinical recommendations and management following a breast cancer diagnosis."

The authors note limitations of the study include limited information on cigarette smoking and alcohol consumption after diagnosis, as well as data on other types of smoking including passive smoking and e-cigarette use. Additionally, both alcohol consumption and smoking could potentially be underreported as both exposures in the study were based on self-reporting. The investigators say future studies should examine the role of continued smoking after a cancer diagnosis as well as smoking cessation in breast cancer survivorship.