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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.
- epidemiology
- primary care
- public health
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Contributors VAE, SPD, MSA, MS, and JYT contributed to the study design and interpretation of data. VAE, SL, and JYT had full access to the data. SL performed the data extraction and analysis. VAE prepared the initial drafts of the manuscript with additional input from SPD, MS, and JYT. VAE and MSA designed the tables with additional input from SPD, SL, MS, and JYT. All authors contributed to the drafts and final version of the manuscript.
Funding This research was supported in part by the Stanford Medical School Medical Scholars Research Fellowship (V.E.).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Data used in this study are hosted by the Women’s Health Initiative and were fully deidentified and anonymised prior to receipt by the study authors. Eligible researchers may download the study protocol, study procedures, data collection forms, and deidentified participant data directly at the WHI online resource (https://www.whi.org/researchers/data/Pages/Home.aspx). Other researchers may download the publicly available data through BioLINCC (https://biolincc.nhlbi.nih.gov/studies/whict).