Women with breast cancer who smoke are nearly twice as likely as non-smokers to have tumors spread to their lungs, according to a study appearing in the June issue of Chest, the journal of the American College of Chest Physicians.

Breast cancer is the most common form of cancer and second most common cause of cancer death among women. After treatment, relapse in the form of secondary tumors (commonly in the lung, bone, liver, or brain) is often considered incurable.

Although smokers do not have a higher incidence of breast cancer, they do have an increased rate of death from the disease. Susan Murin and John Inciardi of the University of California at Davis Medical Center speculate that since the lung is a common target of spreading breast cancer and smoking causes a host of changes in the lung which may make it a more “fertile environment” for tumors, smoking may increase the risk of breast cancer spreading to the lung.

To test their hypothesis, Murin and Inciardi examined the hospital records of 87 patients diagnosed with primary breast cancer with secondary spread to their lungs. For each such patient, the authors also looked at two control patients of similar age and background who were diagnosed with primary breast cancer which had not spread. From the medical records the authors then identified which of the total of 261 subjects were smokers, and analyzed those data to determine if breast cancer patients who had spread of tumors to their lungs were more likely to have been smokers than those without secondary lung tumors.

Murin and Inciardi found that 38 percent of patients who had secondary lung cancer had at some point been smokers versus 29 percent of the patients whose cancer did not spread. Twenty-four percent of the patients who had secondary lung tumors spread from breast cancer were active smokers at the time of their initial diagnosis, versus 15.3 percent of those who never got spread of cancer to the lung.

Although their study was specific to the lung, Murin and Inciardi warn that smoking’s effect on the propensity for cancer to spread is not limited to the lung.

In an editorial accompanying the study, Glenn A. Lillington, M.D., and David P. L. Sachs, M.D. of Stanford University Medical Center say “this study, if confirmed by others, points to the desirability of providing effective treatment for tobacco dependence for those women who are still smoking at the time of breast cancer diagnosis.”

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