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The decline in exposure probably reflects decreased smoking prevalence and amounts smoked, and restrictions on smoking in work-places.
The risk increased with increasing amounts smoked, earlier age at starting smoking, or longer duration of smoking.
We did not examine amounts smoked in this analysis.
All smoking-related risk estimates increased with both the number of years smoked and the amounts smoked daily.
However, in addition to the plausibility of the findings, the dose-response seen by the number of at-risk alleles or genotypes and amounts smoked support the causality of the findings.
The hospital-based study showed a decreased risk of breast cancer with increasing amounts smoked (relative risk for 15 or more cigarettes per day was 0.82, 95% confidence interval 0.60-1.13) while the screening study showed an increased risk (relative risk for 15 or more cigarettes per day was 2.90, 95% confidence interval 1.16-7.25).
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Ever smoking, current smoking, and amount smoked all contributed independent risk.
Proxy respondents have been shown to accurately report cigarette smoking status, including duration of smoking and amount smoked (Kolonel et al. 1977; Rogot and Reid 1975).
We did not record data on our database for pack-years, as we wished to investigate the separate roles of daily amount smoked and duration of smoking.
The risk of tobacco smoking depends on cumulative exposure to carcinogens in tobacco smoke, and therefore varies with the amount smoked, duration of smoking and time since cessation (in ex-smokers), as well as with the type of cigarette smoked.
Several found that risk increased with pack-years of smoking, but this cumulative measure combines amount smoked with duration of smoking (14, 18, 19).
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