Smoking and Survival in Male Breast Cancer Patients

Background: Although evidence regarding an association between female breast cancer survival and smoking has been elucidated, little is known about smoking and breast cancer survival in males. We aimed to determine if smoking affects survival in male patients, overall, by smoking intensity, and stratified by race/ethnicity.

Methods: We linked data from the 1996-2007 Florida Cancer Data System, the Florida Agency for Health Care Administration and US census.  Inclusion criteria were males ≥18 years, diagnosed with breast cancer and residing in Florida (n=1,573). To analyze the association between smoking and survival, we performed sequential multivariate Cox proportional hazard regression models with progressive adjustment for main confounders.

Results:  Compared to never smokers, worse survival was found in current (hazard ratio=1.63; 95%CI=1.23-2.16) smokers with a non-significant trend seen among former smokers (1.26; 0.99-1.59). Compared to those who never smoked, those who smoked 1 pack/day or more had worse survival (2.48; 1.59-3.87) with a significant linear trend (p<0.001). In the stratified models, among Whites, current (1.88; 1.44-2.44) and former (1.31; 1.04-1.65) smokers had worse survival than never smokers. Worse survival was also found among non-Hispanics for current (1.73; 1.31-2.28) and former (1.31; 1.04-1.66) smokers than for never smokers.

Discussion: Moderate to heavy smoking increased survival risk in male breast cancer patients. Current and former smoking was associated with worse survival in White, non-Hispanic patients when compared to never smoking. Survival risk did not change for Blacks and Hispanics regardless of smoking status. Nonetheless, all male breast cancer patients should be advised to quit smoking.