Pierre Band

(WOMENSENEWS)–When Catherine Andrews was diagnosed with breast cancer, she thought of her mother, who had died of the disease, and the other women in her family who had also battled it. Andrews didn’t think about how she had smoked as a young woman–how the habit might have affected her breasts.

Now the mother of a 13-year-old daughter, Andrews, 53, is worried about how the girl’s habits will affect her own risk of developing the disease.

“She needs to be careful about her diet and never smoke and try to live a good healthy lifestyle,” said Andrews, of Mebane, N.C. “She’s already aware that smoking is a risk factor.”

Andrews, a member of the Breast Cancer Coalition of North Carolina, discussed her concerns in light of a Canadian report this fall that suggested girls who smoked during adolescence were at a higher risk than nonsmoking teens for developing breast cancer down the road. Although smoking has been conclusively linked to developing other types of cancer, it has not been definitively linked to breast cancer.

The report was authored by Quebec scientist Pierre Band of Health Canada, the nation’s federal health department. The study’s conclusions are based on comparisons made among a group of women in British Columbia. Researchers sent questionnaires and received replies from 318 breast cancer patients younger than 75 who were listed in a cancer registry between 1988 and 1989. They also heard from 340 women who did not have breast cancer.

Risk of breast cancer increased by approximately 70 percent among women who had been pregnant and who initiated smoking after a full-term pregnancy within five years of the start of menstruation, according to the study, which was published in the Oct. 5 issue of The Lancet. Menstruation typically begins around ages 11 to 13, though it can start as early as age 9 or as late as 16. The risk was found to be just as high among women who never bore children and who had smoked 20 cigarettes or more each day within five years of menarche.

Findings Suggest That Adolescence Is a Crucial Time for Breast Health

“I was not surprised by the results,” Band said. “The implication is that in order to keep their breasts healthy, young girls should not smoke. I think that public tobacco awareness campaigns should indicate that cigarette smoking carries a breast cancer risk.”

The findings also indicate that breast tissue during adolescence may be extremely vulnerable to changes from toxic carcinogens, he said.

Dr. Ruth Heimann, an associate professor of radiation and oncology and a breast cancer expert at the University of Chicago, echoed that sentiment.

“During adolescence when the breast is budding, there is much more cell division,” Heimann said. “So the carcinogenic compounds that are in cigarettes, maybe they have an effect.”

Approximately 180,000 women are diagnosed with breast cancer every year in the United States and about 40,000 die of the illness, Heimann said.

Many doctors have speculated that there could be a window of time during a young girl’s life in which her behavior could influence her risk for breast cancer “upwards or downwards,” said Dr. Rowan Chlebowski, a professor of medicine and an oncologist at the Los Angeles Research and Education Institute at Harbor-UCLA. “A modest change in what one does can change one’s risk as opposed to a fate thing,” he said.

Chlebowski added that the association between adolescent smoking and breast cancer risk was “an interesting observation.” Yet, he was not ready to recommend that the anti-smoking messages targeted toward young people include a note about breast cancer risk. “We would need a bit more information,” he said.

Rebecca Garcia, vice president of health sciences for the Susan G. Komen Breast Cancer Foundation in Dallas, also found the study worthwhile. Yet she too hesitates to recommend the teen-agers be warned.

“I don’t think at that age you want to alarm anyone and say, ‘Gee, be careful, you’re at risk,'” said Garcia. While that may be the perception because some younger patients are getting a great deal of media attention, Garcia said the numbers speak differently: The disease is actually on a 1.3 percent decline among women younger than age 40. Such media reports “make it seem much more prevalent than it is,” she said.

She, like other experts in the field, said further study was needed to establish whether there is a connection between smoking and breast cancer, but added that the Canadian study was provocative.

Study Hasn’t Affected Recommendations for Mammography

Breast cancer awareness typically doesn’t enter the minds of girls until they reach age 20, when physicians and breast cancer advocates encourage women to start conducting monthly breast self examinations.

Routine mammography to detect potential breast tumors is recommended beginning at age 40. Government agencies including the National Institutes of Health and the Centers for Disease Control and Prevention have not modified their mammography recommendations in light of the study’s results.

As the discussion continues about how to caution young girls about their possible risks for breast cancer, Andrews, the North Carolina breast cancer survivor anti-smoking advocate, said she is blunt with her daughter and keeps her fully informed.

“Of course she’s seen what can happen,” Andrews said. “She’s seen me without hair and going through chemo. Unfortunately, she’s been exposed to it at an early age of 3.”

Katrina Woznicki is a freelance writer in Washington.

For more information:

The National Breast Cancer Coalition:

Campaign for Tobacco Free Kids:

The Lancet–“Carcinogenic and endocrine disrupting effects of cigarette smoke and risk of breast cancer”: