初産前の喫煙は乳癌のリスクアップに | 産婦人科専門医・周産期専門医からのメッセージ

産婦人科専門医・周産期専門医からのメッセージ

 第一線で働く産婦人科専門医・周産期専門医(母体・胎児)からのメッセージというモチーフのもと、専門家の視点で、妊娠・出産・不妊症に関する話題や情報を提供しています。女性の健康管理・病気に関する話題も併せて提供していきます。

 米国癌協会(ACS)は、喫煙による乳癌のリスクに関する解析結果を紹介しています。初産前の喫煙は乳癌のリスクが1.2ばいになるというものです。Journal of the National Cancer Institute誌オンライン版に掲載されています。

 以下のリンクで原文が見られます。
http://www.cancer.org/cancer/news/news/study-links-smoking-to-breast-cancer-risk


 Abstractを掲載しておきます。

Study Links Smoking to Breast Cancer Risk
Article date: February 28, 2013

By Stacy Simon

Researchers at the American Cancer Society have found an increased breast cancer risk among women who smoke, especially those who start smoking before they have their first child.

Although previous studies have looked at the possible relationship between breast cancer and smoking, they have not settled the controversy within the scientific community. Part of the reason is that while many studies have found a slight increase in risk overall, they have not found that smoking more cigarettes per day or smoking for more years increases the risk further, which is what might be expected.

In addition, findings about alcohol have complicated many of these studies. This is because alcohol is a known risk factor for breast cancer, and women who smoke are also more likely to drink alcohol. (The link between alcohol and breast cancer is one of the reasons the American Cancer Society recommends that women who drink limit themselves to no more than 1 drink per day.)

In the new study, published online February 28, 2013 in the Journal of the National Cancer Institute, researchers analyzed data from 73,388 women in the American Cancer Society’s Cancer Prevention Study II (CPS-II) Nutrition Cohort. A cohort is a study that follows a large group of people over time. During more than 13 years of follow-up, researchers counted 3,721 cases of invasive breast cancer. The rate of new cases was 24% higher in smokers than in nonsmokers and 13% higher in former smokers than in nonsmokers.

When the researchers looked specifically at risk based on alcohol status, they found that the increased risk in smokers was limited to current or former alcohol drinkers, and was not seen in those who never drank.

Risk increases more when smoking starts early

The risk of invasive breast cancer was highest in women who began smoking at an earlier age. When compared to women who never smoked, those who started smoking before their first menstrual cycle had a 61% higher risk, while those who started smoking after their first cycle, but 11 or more years before having a child, had a 45% higher risk.

The researchers also found that these results were supported by the findings of earlier cohort studies. When combining the results of 9 studies (including this one), they found a 12% increase in breast cancer risk among women who started smoking at a younger age, and a 21% increase in risk among women who started before the birth of their first child.

Mia Gaudet, PhD, American Cancer Society director of genetic epidemiology, said breast tissue is not fully developed until after a woman has her first child, and that makes it more sensitive to the harmful effects of tobacco.

Gaudet said, “The key message from this study should be additional motivation to young women to not start smoking.”

“From a biological standpoint, what is really intriguing is that early life exposures are important,” said Gaudet. “In the Cancer Prevention Study-3 we are recruiting younger women, which will allow us to further examine risk factors at an earlier age.”

Reasons to quit

The study did not look at whether quitting affects breast cancer risk in women who already smoke. However, there are many good reasons to quit. In the US, tobacco use is responsible for nearly 1 in 5 deaths; this equals about 443,000 early deaths each year. About half of all people who continue to smoke will end up dying from a tobacco-related disease.

Overall, the increase in breast cancer risk found in this study is not nearly as large as the known increase for some other cancers, such as lung cancer (where smoking is estimated to increase the risk in women by about 13 times). Most people know that smoking causes lung cancer, but tobacco use also increases the risk for cancers of the mouth, lips, nose and sinuses, voice box, throat, esophagus, stomach, pancreas, kidney, bladder, uterus, cervix, colon/rectum, and ovary, as well as acute myeloid leukemia. It also raises the risk of many other health problems, including heart and lung diseases.

If you smoke and want help quitting, see the American Cancer Society Guide to Quitting Smoking or call us at 1-800-227-2345.

Citation: Active Smoking and Breast Cancer Risk: Original Cohort Data and Meta-analysis. Published early online February 28, 2013 in the Journal of the National Cancer Institute. First author: Mia Gaudet, PhD, American Cancer Society, Atlanta, Ga.

Reviewed by: Members of the ACS Medical Content Staff


 英語が苦手な方のために日本語で解説しておきます。

 ACSが行うCancer Prevention Study II(CPS-II)の大規模試験から女性7万3388人のデータ解析を行ったところ、13年以上の追跡調査で確認された3721件の浸潤性乳癌において、喫煙者の乳癌リスクは24%、過去に喫煙していた者では13%、非喫煙者に比べて高かったというものです。

 浸潤性乳癌のリスクは喫煙開始年齢が低いほど高く、非喫煙者に比べ、初経前に吸い始めた者は61%、初経後に吸い始めた者でも第1子出産までに11年以上の喫煙歴がある女性は45%リスクが高くなりました。他8件の試験結果と併せても、喫煙開始年齢が低い女性は12%、第1子出産前から吸っている女性では21%リスクが増加することが分かりました。

 同学会は、第1子出産までは乳房組織が十分発達しておらず、乳房組織はたばこの悪影響により敏感であることがリスクの高さと関連しているとし、若い女性の喫煙習慣に注意を促しています。


 以下は私のコメントです。

 若い女性の喫煙習慣が不妊症のリスクと関連することを以前に紹介しましたが、乳がんのリスクとも関連するのですね。理由もある程度うなづけます。

 男性の場合には生活習慣病との関連が指摘されるのみのことが多いのですが、女性の場合には不妊症や乳がんとの関連も指摘されるようになると、少子化・晩婚化が叫ばれる現在では、ますます喫煙習慣に関する啓蒙活動は大切になりそうですね。



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