Smoking and survival among Kentucky women diagnosed with invasive cervical cancer: 1995–2005

Abstract

Objectives To determine whether smokers with cervical cancer were more likely to die from cervical cancer compared with non smokers after adjusting for confounding factors. Methods A population-based survival analysis was conducted among 2661 women diagnosed with invasive cervical cancer and reported to the Kentucky Cancer Registry from 1995–2005 and linked with state vital records and the National Death Index through 12/31/2005. A standard Kaplan – Meier approach was used in this survival analysis and Cox Proportional Hazards modeling was used to estimate adjusted hazard [aHR] ratios and 95% confidence intervals [CI] for smoking and survival for all cause and cervical cancer specific cause of death. Results Almost half of women diagnosed with cervical cancer (48.6%) were known to be current smokers based the medical record review and reporting to KCR. For another 19.4% no tobacco status was documented (missing) and 32.1% were known non smokers. After adjustment for age and stage at diagnosis, cell type, rural residence, race, insurance coverage, and treatment received, current smoker were 35% more likely to die of any cause (aHR = 1.35; 95% CI = 1.17–1.56) and 21% more likely to die of cervical cancer (aHR = 1.21; 95% CI = 1.01–1.46) compared with known non smoking cases. Conclusion These data strongly suggest that smoking reduces cervical cancer survival.