The Effect of Smoking on the Diagnosis of Breast Lump

Ameer Salah Tawfeeq
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Keywords : Smoking, Breast Lump,cancers in humans
Medical Journal of Babylon  11:2 , 2014 doi:1812-156X-11-2
Published :16 July 2014

Abstract

Background: It has been well-known that smoking is a risk factor for a variety of cancers in humans eg. Lung, stomach and urinary bladder cancers. Till now there has been no clear association between smoking and breast cancer. There is a well-established relationship between smoking and duct ectasia/ periductal mastitis. The presented study tries to spot the light on how smokers differ from nonsmokers regarding the diagnosis of breast lumps and the relative percentage of each diagnosis. Methods: A random sample of 114 patients with breast lumps (half of which were smokers and the other half non- smokers) had been studied prospectively and the diagnosis made by "triple assessment", when necessary excisional biopsy, then the diagnosis difference between the smoker and the nonsmoker group had been studied. The smokers had been smoking one packer or more each day. Results: All of the patients were females with age between 13 and 70 years (mean age 41). The diagnosis of the lumps in the smokers sample was as follows: fibroadenoma 20(35%), fibrocystic disease 16(28%), breast abscess 7(12.3%), carcinoma 7(12.3%), duct ectasia/ periductal mastitis 4(7%), galactocoele 3(5.3%), total number of patients 57. The diagnosis of the lumps in the non-smokers sample was as follows: fibroadenoma 18(31.6%), fibrocystic disease 16(28%), breast abscess 8(14%), duct ectasia/ periductal mastitis 6(10.5%), galactocoele 4(7%), carcinoma 2(3.5%), Pyllodes 1(1.8%), nonhodgkin lymphoma 1(1.8%), lipoma 1(1.8%), total number of patients 57. Conclusion: Reviewing the diagnosis of breast lumps in smokers and nonsmokers reveals two important facts: a significantly higher incidence of breast cancer has been found in the smokers. Another unexpected finding was that duct ectasia/ periductal mastitis was more common in the nonsmoker sample

Introduction

It has been well-known that smoking is a risk factor for a variety of cancers in humans eg. Lung, stomach and urinary bladder cancers [1-3]. Till now there has been no clear association between smoking and breast cancer in most of the presented studies previousely. On the other hand there is a well-established relationship between smoking and duct ectasia/ periductal mastitis[4,5]. The presented study tries to spot the light on how smokers differ from nonsmokers regarding the diagnosis of breast lumps and the relative percentage of each diagnosis. "Triple assessment" had been advocated to reach the diagnosis using its three pillars; history and examination, fine needle aspiration cytology and imaging (mammography and ultrasonography). In this way the diagnosis can be made in more than 99% of the cases [6-8].

Materials and methods

A random sample of 114 patients with breast lumps (half of which were smokers and the other half non- smokers) had been studied prospectively in the breast clinic of Al- Hilla teaching hospital between the 15th of January 2012 and the 23rd of march 2013   and the diagnosis made by "triple assessment", when necessary excisional biopsy, then the diagnosis difference between the smoker and the nonsmoker group had been studied.


Results

All of the patients were females with age between 13 and 70 years (mean age 41). The diagnosis of the lumps in the smokers sample was as follows: fibroadenoma 20(35%), fibrocystic disease 16(28%), breast abscess 7(12.3%), carcinoma 7(12.3%), duct ectasia/ periductal mastitis 4(7%), galactocoele 3(5.3%), total number of patients 57 (table 1). The diagnosis of the lumps in the non-smokers sample was as follows: fibroadenoma 18(31.6%), fibrocystic disease 16(28%), breast abscess 8(14%), duct ectasia/ periductal mastitis 6(10.5%), galactocoele 4(7%), carcinoma 2(3.5%), Pyllodes 1(1.8%), nonhodgkin lymphoma 1(1.8%), lipoma 1(1.8%), total number of patients 57(table 2)

Discussions

The main parameter that had been studied in presented study was smoking. Smoking did not seem to affect the diagnosis of most of the recorded pathologies. The significant difference between smokers and non-smokers was in the carcinoma cases as carcinoma has been diagnosed in 7(12.3%) of the smokers and in only 2(3.5%) of the non-smokers. This difference is regarded as substantial and needs an explanation. There are two possibilities for this. Either smoking is an important causative factor for breast cancer or there is something else that caused this significant difference. It is well-known that breast cancer incidence rises with age [9-11]. In Iraq smokers tend to be older women or the younger women deny their smoking habits for social reasons. In the presented study the mean age for the patients was 41 years but when went back to the records and calculated the mean age for smokers with breast lumps it was 52 years and this shows a significant difference in the mean age. Duct ectasia/periductal mastitis is known to be caused by smoking due to the arteriopathy that smoking causes or due to the growth of different forms of microorganisms that cause periductal mastitis followed by dilatation of the lactiferous ducts [12-14 ]. Surprisingly, in the presented study, the relative percentage of duct ectasia/ periductal mastitis has been found to be more in the non-smokers 6(10.5%) than the smokers 4(7%). This may be due to the presence of mastitis which is related to breast lactation in most of the cases [15-17 ].

Conclusions

Reviewing the diagnosis of breast lumps in smokers and nonsmokers reveals two important facts: a significantly higher incidence of breast cancer has been found in the smokers. Another unexpected finding was that duct ectasia/ periductal mastitis was more common in the non-smoker sample.

References

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