Abstract

Simple SummaryThere is little available evidence concerning smoking behaviors among breast cancer (BC) patients. This large study addresses smoking-related issues at BC diagnosis and smoking cessation in women with a history of BC. This study suggests that (i) tobacco mention is missing from electronic health records in approximately one-third of patients; (ii) tobacco is not assessed nor addressed systematically during the BC care pathway, and this information depends on the practitioner’s specialty; (iii) approximately one-third of patients stop smoking in BC follow-up. These findings call to consider BC treatment and follow-up as a window of opportunity to promote smoking cessation.Breast cancer (BC) is the most commonly diagnosed type of cancer and the leading cause of cancer deaths in women. Smoking is the principal modifiable risk factor for cancers and has a negative influence on long-term survival. We conducted a retrospective study on consecutive BC survivors seen at follow-up consultations between 3 June and 30 October 2019 at Institut Curie, Paris, France. Smoking behaviors were evaluated prospectively via interviewer-administered questionnaires. The aim of this study was to describe smoking-related patient care at diagnosis and smoking cessation patterns in women with a history of BC. A total of 1234 patients were included in the study. Smoking status at diagnosis was missing from electronic health records in 32% of cases, including 13% of patients who smoke. Only 20% of the 197 patients currently smoking at diagnosis recalled having a discussion about smoking with a healthcare professional. Radiotherapists and surgeons were more likely to talk about complications than other practitioners. The main type of information provided was general advice to stop smoking (n = 110), followed by treatment complications (n = 48), while only five patients were referred to tobaccologists. Since diagnosis, 33% (n = 65) of the patients currently smoking had quit. Patients who quit had a lower alcohol consumption, but no other factor was associated with smoking cessation. The main motivation for tobacco withdrawal was the fear of BC relapse (63%). This study highlights room for improvement in the assessment of smoking behavior. Our data raise important perspectives for considering BC treatment and follow-up as a window of opportunity for smoking cessation.

Highlights

  • Breast cancer (BC) is a public health problem worldwide, with an estimated 2.1 million new cases and 627,000 deaths from BC in 2018 [1]

  • We investigated the prevalence of smoking, and of assessments and counseling at BC diagnosis, the prevalence of smoking cessation after BC diagnosis, and the reasons for quitting, and the methods used by patients to quit smoking

  • We found that approximately one-third of the BC patients who were currently smoking at diagnosis subsequently stopped smoking

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Summary

Introduction

Breast cancer (BC) is a public health problem worldwide, with an estimated 2.1 million new cases and 627,000 deaths from BC in 2018 [1]. In 2016, Gram et al [8] reported that one in six BC cases in patients who smoke could have been avoided if the patients concerned had not been actively smoking. This association may depend on smoking duration, lifetime exposure to tobacco, or the age at which the patient began smoking [5,7,9,10]. Passive smoking seems to increase BC significantly, albeit to a lesser extent than active smoking [5,7,8,10,12]

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