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Eng VA, David SP, Li S, et al. The association between cigarette smoking, cancer screening, and cancer stage: a prospective study of the women's health initiative observational cohort. BMJ Open. 2020;10(8):e037945doi: 10.1136/bmjopen-2020-037945.
Eng, V. A., David, S. P., Li, S., Ally, M. S., Stefanick, M., & Tang, J. Y. (2020). The association between cigarette smoking, cancer screening, and cancer stage: a prospective study of the women's health initiative observational cohort. BMJ open, 10(8), e037945. https://doi.org/10.1136/bmjopen-2020-037945
Eng, Victor A, et al. "The association between cigarette smoking, cancer screening, and cancer stage: a prospective study of the women's health initiative observational cohort." BMJ open vol. 10,8 (2020): e037945. doi: https://doi.org/10.1136/bmjopen-2020-037945
Eng VA, David SP, Li S, Ally MS, Stefanick M, Tang JY. The association between cigarette smoking, cancer screening, and cancer stage: a prospective study of the women's health initiative observational cohort. BMJ Open. 2020 Aug 13;10(8):e037945. doi: 10.1136/bmjopen-2020-037945. PMID: 32796021; PMCID: PMC7430331.
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BMJ Open. 2020 Aug 13;10(8):e037945. doi: 10.1136/bmjopen-2020-037945.

The association between cigarette smoking, cancer screening, and cancer stage: a prospective study of the women's health initiative observational cohort.

BMJ open

Victor A Eng, Sean P David, Shufeng Li, Mina S Ally, Marcia Stefanick, Jean Y Tang

Affiliations

  1. Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA.
  2. Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
  3. Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
  4. Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA [email protected].

PMID: 32796021 PMCID: PMC7430331 DOI: 10.1136/bmjopen-2020-037945

Abstract

OBJECTIVE: To assess the dose-dependent relationship between smoking history and cancer screening rates or staging of cancer diagnoses.

DESIGN: Prospective, population-based cohort study.

SETTING: Questionnaire responses from the Women's Health Initiative (WHI) Observational Study.

PARTICIPANTS: 89 058 postmenopausal women.

OUTCOME MEASURES: Logistic regression models were used to assess the odds of obtaining breast, cervical, and colorectal cancer screening as stratified by smoking status. The odds of late-stage cancer diagnoses among patients with adequate vs inadequate screening as stratified by smoking status were also calculated.

RESULTS: Of the 89 058 women who participated, 52.8% were never smokers, 40.8% were former smokers, and 6.37% were current smokers. Over an average of 8.8 years of follow-up, current smokers had lower odds of obtaining breast (OR 0.55; 95% CI 0.51 to 0.59), cervical (OR 0.53; 95% CI 0.47 to 0.59), and colorectal cancer (OR 0.71; 95% CI 0.66 to 0.76) screening compared with never smokers. Former smokers were more likely than never smokers to receive regular screening services. Failure to adhere to screening guidelines resulted in diagnoses at higher cancer stages among current smokers for breast cancer (OR 2.78; 95% CI 1.64 to 4.70) and colorectal cancer (OR 2.26; 95% CI 1.01 to 5.05).

CONCLUSIONS: Active smoking is strongly associated with decreased use of cancer screening services and more advanced cancer stage at the time of diagnosis. Clinicians should emphasise the promotion of both smoking cessation and cancer screening for this high-risk group.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: epidemiology; primary care; public health

Conflict of interest statement

Competing interests: None declared.

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