RESPONSE: Re: Active Smoking, Household Passive Smoking, and Breast Cancer: Evidence From the California Teachers Study

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Abstract
We thank Dr. Johnson for his thoughtful comments regarding our analysis of active smoking and passive household smoking and breast cancer in the California Teachers Study (CTS). To further evaluate the influence of active smoking with respect to a first full-term pregnancy, Dr. Johnson suggested presenting our risk estimates among nulliparous women only and also stratified by the number of years of pre-partum smoking. In response, we have conducted these analyses and present the results below. As can be seen in Table 1 , the patterns of risk estimates for active smoking among nulliparous women are similar to those reported for the full sample of women in our original analysis ( 1 ). Table 1 also shows our risk estimates for parous women stratified by how long a woman smoked before her first full-term pregnancy. These analyses are suggestive of a stronger smoking effect among women with longer smoking histories before their first pregnancy. However, the number of cases among women who smoked for less than 5 years pre-partum was small. When we restricted the analyses to postmenopausal breast cancers, the results were essentially the same (data not shown). The difference in risk estimates between those who smoked pre-partum for shorter compared to longer periods of time are not as dramatic as those reported by Johnson et al. in their recent research ( 2 ).

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