Alcohol and Postmenopausal Breast Cancer Risk Defined by Estrogen and Progesterone Receptor Status: A Prospective Cohort Study

Suzuki, Reiko; W, Ye; Rylander-Rudqvist, Tove; Saji, Shigehira; Colditz, Graham A.; Wolk, Alicja

doi:10.1093/jnci/dji341

Cited by 115 publications

(111 citation statements)

References 34 publications

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“…Epidemiology relatively high prevalence of exogenous estrogen ever-users ($20-45%), [31][32][33] versus our 11% at baseline. Further investigation of this effect is warranted.…”

Section: Discussionmentioning

confidence: 74%

“…32,59 Our results for ERþ tumors in overweight women (BMI ! 25) do not support a previous report that the positive association between alcohol consumption and the development of ERþ tumors was confined to women with BMI <25.…”

Section: Discussionmentioning

confidence: 85%

“…However, effect modification has been suggested by several previous studies, [31][32][33] which had a Among all subjects except past drinkers. 3 Additionally adjusted with energy-adjusted intake of folate (quintiles).…”

Section: Discussionmentioning

confidence: 94%

“…25,26 Epidemiological studies have evaluated whether the impact of alcohol intake on breast cancer risk may vary by folate intake [27][28][29][30] or use of exogenous hormone replacement therapy. [31][32][33] To our knowledge, however, no large prospective study has investigated whether the association between alcohol intake and breast cancer risk is modified by the intake of dietary isoflavones, which are plant-derived estrogen-like compounds with estrogenic and/or anti-estrogenic activity, 34 although these agents have attracted attention as substitutes for exogenous hormones.…”

mentioning

confidence: 99%

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Alcohol consumption‐associated breast cancer incidence and potential effect modifiers: the Japan Public Health Center‐based Prospective Study

Suzuki¹,

Iwasaki

Inoue³

et al. 2010

Intl Journal of Cancer

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Epidemiological studies have evaluated whether the impact of alcohol intake on breast cancer risk is modified by use of exogenous estrogens, folate intake, body weight and smoking status, but results have been inconsistent. Further, effect modification by intake of isoflavones and alcohol-induced facial flushing, which are prevalent in Asian populations, have not been investigated. We investigated the association between alcohol intake and breast cancer risk and whether the association is modified by these factors among 50,757 premenopausal and postmenopausal women (aged 40-69 years) in the population-based Japan Public Health Center-based Prospective Study. Alcohol consumption and other related factors were assessed using self-reported questionnaires. Through to the end of 2006, 572 patients were identified. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated by hazard ratios derived from Cox proportional hazards regression models. Compared with never-drinkers, regular alcohol drinkers (>150 g of ethanol/week) had a higher risk of the development of breast cancer; the multivariable-adjusted RRs were 1.75 (95% CI 5 1.16-2.65; p trend 5 0.035) for overall, 1.78 (95% CI 5 1.09-2.90) for premenopausal and 1.21 (95% CI 5 0.53-2.75) for postmenopausal women. There was no statistical evidence for effect modification by menopausal status, use of exogenous estrogens, intakes of isoflavone and folate, body weight, alcohol-induced facial flushing or smoking (All p interactions ! 0.15). Excessive alcohol intake was associated with an increase in the risk of breast cancer in this population. There was no statistical evidence for effect modification.Alcohol-related carcinogenesis of the breast has been identified in a number of animal and epidemiological studies, and confirmed by the International Agency for Research on Cancer (IARC) working group, 1,2 the Second Expert Report from the World Cancer Research Fund, 3 and meta-analyses. 4,5 Apparently consistent with this, the steep increase in the incidence of breast cancer in Japan over the last 3 decades 6 has coincided with an upward trend in alcohol consumption, 7 although other explanations may include increased height, early menarche, low birthrate or late first birth. [8][9][10][11] Nevertheless, a recent qualitative review 12 of 11 epidemiological studies conducted in Japanese women suggested that the association remains inconclusive, albeit that one prospective study in 35,844 women, including 151 cases, reported a positive association. 13 Proposed mechanisms of ethanol-associated breast carcinogenesis include both hormone-dependent 14-19 as well as hormone-independent carcinogenic pathways, such as the induction of carcinogenesis, mutagenesis and DNA damage by acetaldehyde, a toxic ethanol metabolite; reactive oxygen species and an effect on one carbon metabolism, which is involved with folate level and vitamin B intake. [20][21][22][23][24] Although the results of a meta-analysis 5 supported both pathways by showing a positive association for estr...

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“…Epidemiology relatively high prevalence of exogenous estrogen ever-users ($20-45%), [31][32][33] versus our 11% at baseline. Further investigation of this effect is warranted.…”

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

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Alcohol consumption‐associated breast cancer incidence and potential effect modifiers: the Japan Public Health Center‐based Prospective Study

Suzuki¹,

Iwasaki

Inoue³

et al. 2010

Intl Journal of Cancer

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“…10 Only few studies have specifically addressed a possible interaction between alcohol and hormone use on the risk of breast cancer in large populations. [11][12][13][14] These studies have consistently found the combined effect of alcohol and hormones to be stronger than the effect of either one of them alone. [11][12][13][14] However, in a pooled analysis, the association between alcohol and breast cancer was not modified by hormone use 6 and no interaction between alcohol and hormone use has been reported in several case-control studies.…”

mentioning

confidence: 90%

Interactions between intakes of alcohol and postmenopausal hormones on risk of breast cancer

Rod

Grønbæk

2007

Intl Journal of Cancer

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Alcohol and postmenopausal hormone use are well-established modifiable risk factors for breast cancer. Alcohol may decrease the metabolic clearance of estradiol, whereby the risk of breast cancer associated with hormone use may depend on blood alcohol levels. The objective is to determine whether alcohol interacts with hormone use on risk of breast cancer. The 5,035 postmenopausal women who participated in the Copenhagen City Heart Study were asked about their alcohol intake and hormone use at baseline in 1981-1983 and were followed until 2002 in the Danish cancer registry, with <0.1% loss to follow-up. Proportional hazard models were used to analyze data. During follow-up, 267 women developed breast cancer. Alcohol consumption was associated with a small increased risk of breast cancer (hazard ratio 5 1.11 per drink/day, 95% CI: 0.99-1.25). Women who used hormones also had a higher risk of breast cancer (HR 5 2.00, 95% CI: 1.52-2.61) compared to nonhormone users. We found an interaction between these 2 factors; those who had an intake of more than 2 drinks per day and took hormones had a risk of 4.74 (95% CI: 2.61-8.59) for breast cancer compared to abstainers who did not use hormones. Alcohol was not associated with breast cancer among women who did not use hormones (HR 5 0.98 per drink/ day, 95% CI: 0.82-1.78). In conclusion, the interaction between alcohol and hormone use should, if confirmed in other studies, have an impact both on the prescription of hormones and on sensible drinking limits for postmenopausal women. ' 2007 Wiley-Liss, Inc.Key words: breast cancer; alcohol intake; hormone use; menopausal status Breast cancer is the most common cancer in women and the most frequent cause of death among women below the age of 70 in most developed countries. 1 The association between alcohol intake and breast cancer has been studied in several cohort and case-control studies and the evidence has been summarized in reviews and meta-analyses. [2][3][4][5][6] The results suggest a small, but consistent increase in the risk of breast cancer with increasing alcohol intake. Although the increased risk of breast cancer associated with alcohol intake is relatively low, the association and shape of the risk function are of great importance because of the seemingly lack of a threshold, the large number of women drinking a small amount of alcohol and the high incidence of the disease. Together with alcohol, postmenopausal hormone is one of the important modifiable risk factors for breast cancer. In a number of studies, hormone use has been shown to imply a 20-100% increased risk of breast cancer, depending on type of hormone and length of therapy. [7][8][9] Both alcohol and hormones seem to influence breast cancer risk through their ability to affect circulating levels of steroid hormones, especially estrogens. Hence, among postmenopausal women who take estradiol orally, a more than 3-fold higher serum estradiol has been observed in those who drink alcohol as compared to those who abstain. 10 Only few studies have specif...

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Recreational Physical Activity and Risk of Postmenopausal Breast Cancer Based on Hormone Receptor Status

Bardia

Hartmann²,

Vachon³

et al. 2006

Arch Intern Med

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Background: Physical activity is a potentially modifiable breast cancer risk factor. There is considerable recent evidence to suggest that risk factors for breast cancer differ based on its subtype, particularly estrogen receptor (ER)/progesterone receptor (PR) status, but this has been less well studied for physical activity. The objective of this study was to examine the association of physical activity with breast cancer incidence based on ER/PR status of the tumor. Methods:The Iowa Women's Health Study is a prospective cohort study of 41 836 postmenopausal women. Recreational physical activity was self-reported on the baseline questionnaire, and 3 levels (high, medium, and low) were defined. Breast cancer incidence and ER/PR status, through 18 years of follow-up, were ascertained by linkage with the Iowa Surveillance, Epidemiology, and End Results Cancer Registry. Cox proportional hazards models were used to estimate multivariate relative risks (RRs) and 95% confidence intervals (CIs) of breast cancer, adjusting for other breast cancer risk factors.Results: During 554 819 person-years of follow-up, 2548 incident cases of breast cancer were observed. Compared with low physical activity, high physical activity

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Alcohol and Postmenopausal Breast Cancer Risk Defined by Estrogen and Progesterone Receptor Status: A Prospective Cohort Study

Abstract: The observed association between risk of developing postmenopausal ER+ breast cancer and alcohol drinking, especially among those women who use postmenopausal hormones, may be important, because the majority of breast tumors among postmenopausal women overexpress ER.

Cited by 115 publications

References 34 publications

Alcohol consumption‐associated breast cancer incidence and potential effect modifiers: the Japan Public Health Center‐based Prospective Study

Alcohol consumption‐associated breast cancer incidence and potential effect modifiers: the Japan Public Health Center‐based Prospective Study

Interactions between intakes of alcohol and postmenopausal hormones on risk of breast cancer

Recreational Physical Activity and Risk of Postmenopausal Breast Cancer Based on Hormone Receptor Status

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