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Effect of Smoking on Breast Cancer by Adjusting for Smoking Misclassification Bias and Confounders Using a Probabilistic Bias Analysis Method Publisher



Pakzad R1 ; Nedjat S1 ; Yaseri M1 ; Salehiniya H2 ; Mansournia N3 ; Nazemipour M4 ; Mansournia MA1
Authors

Source: Clinical Epidemiology Published:2020


Abstract

Purpose: The aim of this study was to determine the association between smoking and breast cancer after adjusting for smoking misclassification bias and confounders. Methods: In this case–control study, 1000 women with breast cancer and 1000 healthy controls were selected. Using a probabilistic bias analysis method, the association between smoking and breast cancer was adjusted for the bias resulting from misclassification of smoking secondary to self-reporting as well as a minimally sufficient adjustment set of confounders derived from a causal directed acyclic graph (cDAG). Population attributable fraction (PAF) for smoking was calculated using Miettinen’s formula. Results: While the odds ratio (OR) from the conventional logistic regression model between smoking and breast cancer was 0.64 (95% CI: 0.36–1.13), the adjusted ORs from the probabilistic bias analysis were in the ranges of 2.63–2.69 and 1.73–2.83 for non-differential and differential misclassification, respectively. PAF ranges obtained were 1.36–1.72% and 0.62–2.01% using the non-differential bias analysis and differential bias analysis, respectively. Conclusion: After misclassification correction for smoking, the non-significant negative-adjusted association between smoking and breast cancer changed to a significant positive-adjusted association. © 2020 Pakzad et al.
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