Abstract PO-205: Association of pre-diagnostic cigarette smoking and alcohol consumption with mortality in Black breast cancer survivors
Authors: Zeinomar Nur , Amin Saber , Qin Bo , Lin Yong , Xu Baichen , Chanumolu Dhanya , Omene Coral O , Pawlish Karen S , Demissie Kitaw , Ambrosone Christine , Hong Chi-Chen , Bandera Elisa V 
Published: January 2022

Abstract
Purpose: There is limited data about how lifestyle factors are associated with breast cancer (BC) prognosis in Black women, as the majority of evidence is based on studies conducted in White women. Given the 40% increased risk of death for Black women diagnosed with BC compared to White women, and the differences in prevalence of these modifiable risk factors between racial groups, better understanding how these factors, among others, are associated with survival in Black women is necessary to address existing cancer health disparities. The purpose of this study is to examine the association of pre-diagnostic cigarette smoking and alcohol consumption with survival in a cohort of Black breast cancer survivors. Methods: We studied 1895 women enrolled in the Women's Circle of Health Follow-up Study, a population-based cohort study of Black BC survivors in New Jersey enrolled within 10 months of diagnosis. Smoking and alcohol consumption history, along with information on potential covariates were collected during in-person interviews. We evaluated the association between pre-diagnostic cigarette smoking (status, duration, intensity, pack-years) and alcohol consumption (average number of total drinks/week) and all-cause and BC- specific mortality using Cox Proportional Hazards models and Fine and Gray competing risk models, adjusted for confounders. Results: During 12,019 person years of follow-up (median 5.9, maximum: 14.8 years), we observed 290 deaths, of which 175 were breast-cancer related deaths. Currently smoking, particularly in regular drinkers, was associated with worse survival. Compared to never smokers, current smokers had 56% increased risk for all-cause mortality (hazard ratio (HR):1.56, 95% confidence interval (CI): 1.17-2.07), and this was higher for current smokers with pack years above the median (HR: 1.80, 95% 1.30-2.5). While the multiplicative interaction of smoking and alcohol was not statistically significant, compared to non-regular drinkers who never smoked, current smokers who regularly drank had a 72% increased risk of all-cause mortality (HR:1.72, 95% CI: 1.11-2.67), whereas the association for current smokers that were not regular drinkers was less substantial (HR: 1.41, 95% CI: 0.95-2.09). We observed similar associations for BC-specific mortality, with a 60% increased risk of BC-specific mortality (HR: 1.6, 95% CI: 0.92-2.78) for current smokers who regularly drank, but no association for current smokers who were not regular drinkers. We did not observe an association for smoking and BC-specific mortality or for alcohol consumption and all-cause or BC-specific mortality. However, self-reported alcohol drinking was low in this population (only 12% of women reported consuming &gt;3 drinks/week). Conclusion: In a population based-study of Black BC survivors, smoking prior to a BC diagnosis was associated with worse overall survival, particularly in women who also regularly consumed alcohol.
Citation Format: Nur Zeinomar, Saber Amin, Bo Qin, Yong Lin, Baichen Xu, Dhanya Chanumolu, Coral O Omene, Karen S Pawlish, Kitaw Demissie, Christine Ambrosone, Chi-Chen Hong, Elisa V Bandera. Association of pre-diagnostic cigarette smoking and alcohol consumption with mortality in Black breast cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-205.