Tobacco Dependence in Breast Cancer Patients Scheduled for Mastectomy/Reconstructive Surgery Trial of Varenicline (Chantix)

Inclusion Criteria:

• MSK patients recently diagnosed with breast cancer as per EMR or clinicians judgment with treatment plan to include mastectomy and/or breast reconstruction;
• Self-reported average of 10 cigarettes daily during the previous year AND at least 1 pack of cigarettes smoked within the last 7 days.
• Breast surgery scheduled at MSKCC > 14 days from enrollment;
• Advised to quit smoking and willing to receive smoking cessation counseling and treatment;

Exclusion Criteria:

• Patients less than 18 years of age because the safety and efficacy of varenicline have not yet been tested in children;
• Evidence of any known or suspected medical contraindications for use of varenicline (e.g., recent (within past two months) cardiovascular instability (including myocardial infarction or unstable angina; uncontrolled hypertension, significant neurological sequelae of cerebrovascular disease, or severe congestive heart failure (New York Heart Association class III or IV), severe chronic obstructive pulmonary disease; uncontrolled gastrointestinal, hepatic, or endocrine disease; or severe renal impairment.
• Self-reported use of other tobacco products (pipe, cigar, smokeless tobacco) or marijuana in last 30 days;
• Self-reported evidence of significant psychiatric history (e.g., schizophrenia, unstable bipolar disorder, panic disorder, untreated major depression) sufficient, in the investigators' judgment, to preclude participation in the clinical trial;
• Self-reported evidence of recent substance abuse or heavy alcohol use (> 14 drinks weekly) in the last 6 months;
• Self-reported evidence of recent (in the past 30 days) or planned use of nicotine replacement therapy (NRT) or other FDA approved cessation pharmacotherapy (bupropion);
• Pre-menopausal women who are pregnant as per EMR
• Women who are breast-feeding as per self-report.