Smoking and Survival Among Kentucky Women Diagnosed With Invasive Cervical Cancer: 1995-2005

Increasing evidence suggests that smoking is associated with cervical cancer mortality. Most previous studies investigating this association have been small. There are no prior reports of population-based survival analyses of smoking and cervical cancer in American women. This population-based survival analysis determined the association between smoking and mortality in 2661 women diagnosed with invasive cervical cancer who were identified in the Kentucky Cancer Registry database between 1995 and 2005. This database was linked to state vital records and the National Death Index. The all cause and cervical cancer specific death rates of known current smokers and nonsmokers were compared using survival analysis with a standard Kaplan-Meier approach and a Cox proportional hazards models to adjust for confounding variables. Adjustments were made for age, ethnicity, rural residence, insurance source, cancer cell type, stage at diagnosis, and treatment received. Of the 2661 women diagnosed with cervical cancer, 48.1% were current smokers, 32.1% were nonsmokers, and 19.4% were undocumented as to smoking status. Multivariate analysis showed that compared to nonsmokers, women who were current smokers were 35% more likely to die of any cause (adjusted hazards ratio [aHR], 1.35; 95% confidence interval [CI], 1.17-1.56) and 21% more likely to die of cervical cancer (aHR, 1.21; 95% CI, 1.01-1.46). These findings are consistent with previous studies and strongly suggest that current smoking is associated with increased all cause and cervical cancer specific mortality.