抽菸對乳癌的影響超乎想像


  【24drs.com】抽菸對乳癌的影響可能超乎原本的預期。針對乳癌風險較高之健康婦女進行的一篇大型前瞻研究證實,如同之前所報導的,抽菸及體適能與癌症風險有關,另外也發現,抽菸的影響程度大於以往的研究結果。
  
  這篇研究結果發表於美國臨床腫瘤協會(ASCO)2011年會揭幕前的記者會簡報,報告指出,抽菸者除了侵犯性乳癌風險高於非抽菸者之外,也和抽菸菸齡有關,隨著菸齡增加。
  
  第一作者、Stephanie R. Land博士解釋,抽菸菸齡15-35年的婦女,乳癌風險比從未抽菸者高出34%,抽菸至少35年婦女的風險高出59%,而抽菸菸齡小於15年者的乳癌風險沒有增加。
  
  賓州匹茲堡大學公衛研究所生物統計系研究副教授Land博士表示,直到最近才確認抽菸和乳癌風險增加的關聯,我們的研究顯示,其影響更甚於之前的研究發現。因此,對於已經被認為是乳癌高風險的婦女,抽菸的危害比其他一般人口嚴重。
  
  ASCO理事長、簡報共同主持人George W. Sledge Jr.醫師指出,該研究原本是要探討一種可預防乳癌的治療,但是,發現一個相當重要的結果,就是生活型態因素頗為重要。放眼未來,在許多案例我們可能得想想,或許需減少藥物使用,或許只需藉由這些婦女每天的一些簡單改變,可能就可以預防癌症。
  
  Land博士指出,這是第三篇大型前瞻研究指出抽菸和乳癌之間的強烈關聯,但是是第一篇指出高風險婦女的風險超乎預期。
  
  之前一篇將近80,000名停經婦女的大型研究發現,目前有抽菸習慣者的乳癌風險增加16%,已經戒菸者的風險增加9%;另一篇研究發現,目前有抽菸者和已經戒菸者的乳癌死亡率風險比未曾抽菸者高出39%。
  
  Land博士等人發現,除了乳癌之外,長期抽菸者的肺癌風險(P< .001)和大腸癌風險(P< .001)也顯著高於非抽菸者或那些菸齡短暫者。
  
  Land博士等人在「National Surgical Adjuvant Breast and Bowel Project's Breast Cancer Prevention Trial」這項研究之中分析了乳癌、子宮內膜癌、肺癌和大腸癌等侵犯性癌症的風險,研究對象是11,064名乳癌風險較高的婦女,這些分析本來是要探討tamoxifen和其他風險因素。
  
  研究對象自我報告抽菸飲酒和體能活動狀況,研究開始時,54%的婦女表示體能活動程度低或者不運動,45.7%是中度到重度活動,20.5%不曾飲酒,65.8%每天喝不到1杯,13.3%每天喝超過1杯,此外,12.8%目前有抽菸習慣。
  
  追蹤中位數8.7年,追蹤後發現有395名婦女診斷有乳癌、66人有肺癌、35人有大腸癌、74 人有子宮內膜癌。
  
  不意外地,抽菸與肺癌及大腸癌風險較高有關,抽菸達35年以上婦女的大腸癌風險是未曾抽菸婦女的5倍;抽菸達15-35年者的風險則是高出7%。肺癌風險甚至更高,每天抽菸超過1包達35年以上的婦女,風險是未曾抽菸者的30倍;每天抽菸不到1包、達35年以上者,肺癌風險增加13倍。作者們發現,體能活動程度低與子宮內膜癌風險增加72%有關,但是體能活動和其他癌症風險並未顯著相關。
  
  和之前其他研究結果不同的是,飲酒和乳癌風險無關,且大腸癌風險似乎較低;未曾飲酒婦女的大腸癌風險降低21%,每天喝1杯者的大腸癌風險減少65%。其他癌症方面無顯著差異,每天喝超過1杯和癌症風險增加無關。
  
  Land博士指出,之前有些研究發現飲酒與癌症風險的關聯,結果上有這些差異的原因可能是這篇試驗沒有納入重度飲酒者。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6529&x_classno=0&x_chkdelpoint=Y
  

Impact of Smoking on Breast Cancer Risk Greater Than Thought

By Roxanne Nelson
Medscape Medical News

May 24, 2011 — The impact of smoking on breast cancer might be larger than previously assumed. A large prospective study of healthy women at higher risk for breast cancer confirmed — as had been previously reported — the cancer risk associated with smoking and fitness, but found that the impact of smoking was even greater than had been demonstrated in other studies.

The results of the study, which were presented at a press briefing held in advance of the American Society of Clinical Oncology (ASCO) 2011 Annual Meeting, found that not only was the risk for invasive breast cancer higher in smokers than in nonsmokers, but that it increased according to years of cigarette smoking.

Lead author Stephanie R. Land, PhD, explained that women who smoked for between 15 and 35 years had a 34% higher risk for breast cancer than women who never smoked. Women who smoked for at least 35 years had a 59% higher risk, whereas those who smoked for less than 15 years had no increased risk for breast cancer.

"An increase in breast cancer risk associated with cigarette smoking had not been established until recently," said Dr. Land, who is research associate professor, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania. "Our study demonstrated larger effects than were reported in those recent studies. This might suggest that for women who are already at high risk for breast cancer, smoking is even more dangerous than for other women in the population."

George W. Sledge Jr., MD, ASCO president and comoderator of the briefing, noted that the study was "originally developed to look at a treatment that would prevent breast cancer, but certainly one of the major outcomes of this study is the incredible importance of lifestyle factors."

"Going forward," he added, "we may need to perhaps think less about drugs in many cases, but think a great deal about whether we might prevent cancer just by making simple changes in what a woman does on a day-to-day basis."

More Evidence for Breast, Colon, and Lung Cancer Risk

Dr. Land pointed out that this is the third large prospective study to report a strong association between smoking and breast cancer, and the first to show additional risk in women who are already at higher risk for the disease.

As previously reported by Medscape Medical News, one large study of nearly 80,000 postmenopausal women found that current smokers had a 16% increase in breast cancer risk and that former smokers had a 9% increase in risk.

A second study found that current and former smokers had a 39% higher rate of dying from breast cancer than women who had never smoked.

Dr. Land and colleagues found that in addition to breast cancer, long-term smokers had significantly higher risks for lung cancer (P < .001) and colon cancer (P < .001) than nonsmokers or those who had shorter smoking histories.

Heavier Smoking Equals Increased Risk

As part of the National Surgical Adjuvant Breast and Bowel Project's Breast Cancer Prevention Trial, Dr. Land and colleagues analyzed the risk for invasive cancer of the breast, endometrium, lung, and colon in 11,064 women at elevated risk for breast cancer. The analyses accounted for assignment to tamoxifen and considered other known factors that contribute to risk.

Participants self-reported cigarette smoking, alcohol use, and physical activity. At baseline, 54% of women reported low levels of physical activity or inactivity, 45.7% reported moderate to heavy physical activity, 20.5% reported being nondrinkers, 65.8% reported consuming no more than 1 drink daily, and 13.3% reported consuming more than 1 drink per day. In addition, 12.8% reported current use of tobacco.

After a median of 8.7 years of follow-up, 395 women had been diagnosed with breast cancer, 66 with lung cancer, 35 with colon cancer, and 74 with endometrial cancer.

Cigarette smoking was associated with a higher risk for colon cancer and, not surprisingly, lung cancer. The risk for colon cancer was up to 5-fold higher in women who had smoked for 35 years than in women who had never smoked; the risk was 7% greater for those smoked for 15 to 35 years.

The risk for lung cancer was even greater; women who smoked more than 1 pack of cigarettes per day for more than 35 years had a risk that was 30 times higher than those who had never smoked. Women who smoked less than 1 pack per day for more than 35 years had a 13-fold increase in lung cancer risk.

The authors found that low physical activity was associated with a 72% increased risk for endometrial cancer, but physical activity was not significantly associated with the risk for other cancers.

Does Alcohol Lower Colon Cancer Risk?

Additional findings, in contrast to results from some other studies, were that alcohol use was not associated with breast cancer risk and that it appeared to lower the risk for colon cancer. Women who consumed no alcohol had a 21% lower risk for colon cancer, whereas those who had up to 1 drink per day had a 65% reduced risk for colon cancer. No significant difference was observed for other cancers, and more than 1 drink per day was not associated with an increased cancer risk.

Some previous studies have found associations between alcohol consumption and cancer risk, Dr. Land noted, suggesting that one reason for the differences in results might be the lack of heavy drinkers enrolled in this trial.

Dr. Land has disclosed no relevant financial relationships. Coauthor Donald Lawrence Wickerham, MD, reports serving as a consultant or in an advisory role for Lilly, and receiving honoraria from AstraZeneca.

American Society of Clinical Oncology (ASCO) 2011 Annual Meeting: Abstract 1505. To be presented June 6, 2011.

    
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