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By Anne McIlroy, The Globe and Mail (Toronto)
Friday, October 4, 2002
Teenage girls almost double their risk of developing breast cancer if they
take up smoking within five years of their first menstrual periods, a new
Canadian study has found.
Even if they quit in their early 20s, the damage may already be done,
medical oncologist Pierre Band says.
"There is a critical time period where adolescent girls have an increased
susceptibility to cancer-causing agents that have the breast as the target,"
says Dr. Band, who recently joined Health Canada, but carried out the
breast-cancer research when he was head of epidemiology at the B.C. Cancer
Agency.
He and his colleagues used the B.C. cancer registry to track down and
interview 318 premenopausal women and 700 postmenopausal women who had been
treated for breast cancer. They compared them with a control group of women
who had not had the disease.
They discovered that women who started smoking regularly within five years
of starting their periods were 70 per cent more likely to develop breast
cancer before the age of 50 than non-smokers.
"There is never a good time to start smoking. But for women, the five years
after they have their first menstrual period is the most dangerous," said
Nhu Le, a researcher with the B.C. Cancer Agency.
The theory is that during puberty, the cells that make up the breast are
developing so rapidly they are more susceptible to damage caused by the
carcinogens in tobacco smoke.
Animal studies carried out by Irma Russo, a breast-cancer researcher in
Philadelphia, found this to be the case. Dr. Band and Dr. Le wanted to see
whether the same is true for humans. Their findings were published in
today's edition of the British medical journal, The Lancet.
"Our observations reinforce the importance of smoking prevention," Dr. Band
said.
Teens are already bombarded with information about the dangers of tobacco,
but one Ottawa high-school student who started smoking when she was in Grade
6 said yesterday that she found news of the study frightening. Now 16, she
has been smoking since she was 11.
"If I had known this I probably wouldn't have started," the teen said. She
asked not to be identified because her parents don't know she smokes half a
pack of cigarettes a day.
But another young woman who was smoking on the sidewalk outside her school
said new warnings about the dangers of smoking won't prevent young people
from taking up the habit.
"I knew the risks. I knew it is detrimental to my health," said the
17-year-old, who has been smoking for four years. She has promised herself
she will quit before she went to university.
"Great," she said with a shrug. "I am going to get breast cancer."
In Toronto, Kristina Dragnea, 20, said she smokes a little more than a pack
a week, a habit she began at age 14. While she is waiting to hear from
doctors about whether the lumps recently removed from her breasts are
cancerous, she still shrugs off the risks associated with smoking.
"People die when they die," she said. "I have to quit though, because my
father is giving me $100 if I do."
Said 19-year-old Jennifer Spanu, "I'm not planning on smoking for the rest
of my life." She has been smoking since she was 15 and now averages 10
cigarettes daily — far more when she goes to a bar. "But everybody gets
cancer," she added. "My grandmother is 84. She's been smoking for a long
time and she smokes a lot and she's still kicking it."
Mayu Toyoda, 21, who has been smoking for six years, said, "I'm conscious of
the effects of smoking, but I don't have the motivation to quit right now.
"I used to be the one telling my friends to quit, but soon enough I was
buying my own packs," she said. She now smokes half a pack on a usual day, a
full pack when she goes out for the night. "It sound naive, but somehow I
feel like I'm invincible to the statistics."
Linda MacLeod, 22, has been getting breast exams for two years because of a
history of breast cancer in her family. Still, she continues the habit she
started when she was 14, and buys a pack of cigarettes every three or four
days.
"It's not like I haven't tried quitting, I have," she said. "It's like the
New Year's resolution you never follow up on.
With the combined stresses of her courses as a Ryerson University business
student and work, Ms. MacLeod said she finds comfort in the routine and
relaxation offered by smoking.
Health Canada figures show that smoking among teenage girls rose rapidly
during the 1990s, but has been slowly declining in recent years. In 2001,
about 24 per cent of teenage girls reported that they smoked, compared with
21 per cent for teen boys.
Rob Cunningham with the Canadian Cancer Society said federal and provincial
governments are making progress in their efforts to reduce tobacco use, but
that this study adds to the evidence that more must be done.
"This adds weight to the need for action."
Previous experiments attempting to see whether there is a link between
breast cancer and smoking have drawn conflicting conclusions, perhaps, Dr.
Le said, because they didn't ask women when they had started smoking. This
is the first to investigate whether smoking during puberty might make a
difference in the incidence of breast cancer.
The stem cells in breast tissue grow and change rapidly during adolescence,
but breast cells don't fully develop until a woman has carried a baby to
term.
It has already been established that women who have babies at a young age
have a reduced risk of breast cancer, Dr. Le said, probably because the
cells in their breasts are fully mature and no longer as susceptible to
damage from cancer-causing chemicals.
The study found that it is much less dangerous, in terms of breast cancer,
for a woman to take up smoking after a first pregnancy.
In the case of overweight, postmenopausal women, smoking actually seems to
reduce their risk of breast cancer.
One explanation, Dr. Le said, is that although weight gain increases the
level of the female hormone estrogen in the body, the chemicals in cigarette
smoke may lower it. High levels of estrogen have been linked to a higher
risk of breast cancer.
Dr. Band cautioned postmenopausal women who have put on weight against
taking up smoking as a way to prevent breast cancer. He noted that lung
cancer kills more women every year than breast cancer and cardiovascular
disease is also a major health threat. Both are linked to smoking.
The study did not look at whether secondhand smoke is linked to breast
cancer. Nor did it examine whether the number of cigarettes smoked every day
made a difference.
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