Research published in the online journal Breast Cancer Research suggests that if a woman succumbs to breast cancer her daughters or sisters are over 60 percent more likely to die within five years if they develop the disease.

Mikael Hartman from the Karolinska Institute in Stockholm, Sweden led an international team, identifying 2,787 mother-daughter pairs and 831 sister pairs among women with breast cancer diagnosed between 1961 and 2001 from Sweden's national Multi-Generation Register.

They found that a woman's breast cancer prognosis predicts the survival of her first-degree relatives with breast cancer. Mothers surviving breast cancer after five years, had daughters with a 91 percent chance of surviving the disease. But only 87 percent of daughters whose mothers had died within five years survived. Being sister to a woman who had died of breast cancer within five years gave a 70 percent chance of survival from breast cancer, whereas chances improved to 88 percent if she had survived. Overall, a poor prognosis for a woman gave first-degree relatives a 60-80 percent higher chance of breast cancer mortality within the five-year timeframe.

Access to health care in Sweden is good irrespective of socio-economic status, so these factors are unlikely to have biased the findings. Women with a mother or sister who has had breast cancer are also likely to be more aware of the disease, making delays in seeking treatment unlikely. As well as genetics, other risk factors such as obesity and hormone replacement therapy probably play a role in the incidence and outcome of breast cancer. Dr Hartman says the findings are relevant to women with newly diagnosed breast cancer, and to those treating them. The next step will be to understand what is inherited; tumor biology, response to therapy or vigilance of the immune system.

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What they found is that three out of four employees who worked in an establishment where smoking was permitted had detectable levels of NNK compared to fewer than half of the unexposed workers. In addition, exposure to tobacco smoke was associated with a three-fold increase in levels of the carcinogen. The study also notes that the amount of NNK in employees exposed to tobacco smoke went up in direct relationship to the number of hours workedby 6 percent an hour on averagegiving the researchers confidence that the levels (of NNK) reported in this study do, indeed, reflect workplace exposure.

The investigators also note that their research supports the notion that the risks of secondhand tobacco smoke in the workplace are borne disproportionately by an already vulnerable group. Employees who participated in their study are typical of foodservice workers nationwide in that the majority were women, under age 30, had relatively low household incomes, and more than one third of them lacked health insurance.

This is already a population that tends to have fewer resources to deal with health problems than many other groups so the least we can do is protect them from harmful cigarette smoke, Stark said.For young women in particular, secondhand smoke can increase the risk of having breast cancer and of giving birth prematurely or having low-birth weight babies.

In their analysis of the legal and liability issues raised by workplace smoking hazards Legal Risks to Employers Allowing Smoking in the Workplace Ashe and her colleagues said employees harmed by secondhand smoke already are using worker compensation laws, state and federal disability laws and an employer's legal responsibility to provide a safe workplace to take action against secondhand smoke. While in the past such cases have not always met with success, the study notes that as the scientific evidence mounts, employers will increasingly be on the losing end.

Employers are always talking about high costs of insurance and the need to reduce their potential liabilities, Ashe said. Voluntarily banning smoking and supporting state and local legislation mandating smoke-free workplaces is a relatively cheap and easy way of removing a cumbersome and costly liability.

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