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| Alcohol, tobacco and breast cancer - collaborative reanalysis of individual data from 53 epidemiological studies, including 58515 women with breast cancer and 95067 women without the disease |
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| Author(s): Beral V, Hamajima N, Hirose K, Rohan T, Calle EE, Heath CW, Coates RJ, Liff JM, Talamini R, Chantarakul N, Koetsawang S, Rachawat D, Morabia A, Schuman L, Stewart W, Szklo M, Bain C, Schofield F, Siskind V, Band P, Coldman AJ, Gallagher RP, Hislop TG, Yang P, Kolonel LM, Nomura AMY, Hu J, Johnson KC, Mao Y, De Sanjose S, Lee N, Marchbanks P, Ory HW, Peterson HB, Wilson HG, Wingo PA, Ebeling K, Kunde D, Nishan P, Hopper JL, Colditz G, Gajalakshmi V, Martin N, Pardthaisong T, Solpisornkosol S, Theetranont C, Boosiri B, Chutivongse S, Jimakorn P, Virutamasen P, Wongsrichanalai C, Ewertz M, Adami HO, Bergkvist L, Magnusson C, Persson I, Chang-Claude J, Paul C, Skegg DCG, Spears GFS, Boyle P, Evstifeeva T, Daling JR, Hutchinson WB, Malone K, Noonan EA, Stanford JL, Thomas DB, Weiss NS, White E, Andrieu N, Bremond A, Clavel F, Gairard B, Lansac J, Piana L, Renaud R, Izquierdo A, Viladiu P, Cuevas HR, Ontiveros P, Palet A, Salazar SB, Arsitizabal N, Cuadros A, Tryggvadottir L, Tulinius H, Bachelot A, Le MG, Peto J, Franceschi S, Lubin F, Modan B, Ron E, Wax Y, Friedman GD, Hiatt RA, Levi F, Bishop T, Kosmelj K, Primic-Zakelj M, Ravnihar B, Stare J, Beeson WL, Fraser G, Bulbrook RD, Cuzick J, Duffy SW, Fentiman IS, Hayward JL, Wang DY, McMichael AJ, McPherson K, Hanson RL, Leske MC, Mahoney MC, Nasca PC, Varma AO, Weinstein AL, Moller TR, Olsson H, Ranstam J, Goldbohm RA, van den Brandt PA, Apelo RA, Baens J, de la Cruz JR, Javier B, Lacaya LB, Ngelangel CA, La Vecchia C, Negri E, Marubini E, Ferraroni M, Gerber M, Richardson S, Segala C, Gatei D, Kenya P, Kungu A, Mati JG, Brinton LA, Hoover R, Schairer C, Spirtas R, Lee HP, Rookus MA, van Leeuwen FE, Schoenberg JA, McCredie M, Gammon MD, Clarke EA, Jones L, Neil A, Vessey M, Yeates D, Appleby P, Banks E, Bull D, Crossley B, Goodill A, Green J, Hermon C, Key T, Langston N, Lewis C, Reeves G, Collins R, Doll R, Peto R, Mabuchi K, Preston D, Hannaford P, Kay C, Rosero-Bixby L, Gao YT, Jin F, Yuan JM, Wei HY, Yun T, Zhiheng C, Berry G, Cooper Booth J, Jelihovsky T, MacLennan R, Shearman R, Wang QS, Baines CJ, Miller AB, Wall C, Lund E, Stalsberg H, Shu XO, Zheng W, Katsouyanni K, Trichopoulou A, Trichopoulos D, Dabancens A, Martinez L, Molina R, Salas O, Alexander XE, Anderson K, Folsom AR, Hulka BS, Bernstein L, Enger S, Haile RW, Paganini-Hill A, Pike MC, Ross RK, Ursin G, Yu MC, Longnecker MP, Newcomb P, Bergkvist L, Kalache A, Farley TMM, Holck S, Meirik O |
| Source: BRITISH JOURNAL OF CANCER Volume: 87 Issue: 11 Pages: 1234-1245 Published: NOV 18 2002 |
| Times Cited: 234 References: 73 |
| Abstract: Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58515 women with invasive breast cancer and 95067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19 - 1.45, P < 0.00001) for an intake of 35 - 44 g per day alcohol, and 1.46 (1.33 - 1.61, P < 0.00001) for greater than or equal to 45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1 % per 10 g per day, P < 0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers= 1.03, 95% CI 0.98 - 1.07, and for current smokers=0.99, 0.92 - 1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver. (C) 2002 Cancer Research UK. |
| Document Type: Article |
| Language: English |
| Reprint Address: Beral, V (reprint author), Radcliffe Infirm, Canc Res UK Epidemiol Unit, Gibson Bldg,Woodstock Rd, Oxford OX2 6HE, England |
Addresses:
1. Radcliffe Infirm, Canc Res UK Epidemiol Unit, Oxford OX2 6HE, England
2. Aichi Res Inst, Nagoya, Japan
3. Emory Univ, Atlanta, GA USA
4. Aviano Cancer Ctr, Pordenone, Italy
5. Mahidol Univ, Bangkok, Thailand
6. Johns Hopkins Univ, Breast Tumor Collaborat Stud, Baltimore, MD USA
7. Univ Queensland, Brisbane, Australia
8. Central Inst Cancer Res, Berlin, Germany
9. Catalan Inst Oncol, Barcelona, Spain
10. Univ Melbourne, Ctr Genet Epidemiol, Melbourne, Australia
11. Chennai Cancer Inst, Madras, India
12. Chiang Mai Univ, Chiang Mai, Thailand
13. Chulalongkorn Univ, Bangkok, Thailand
14. Danish Cancer Soc, Aalborg, Denmark
15. Karolinska Inst, Dept Med Epidemiol, Stockholm, Sweden
16. Deutches Krebsforschungszentr, Heidelberg, Germany
17. Univ Otago, Dunedin, New Zealand
18. Eur Inst Oncol, Milan, Italy
19. INSERM, French Multictr Breast Stud, Villejuif, France
20. Girona Cancer Registry, Girona, Spain
21. Hosp Gen Mexico City, Mexico City, Mexico
22. Hosp Univ, Cali, Colombia
23. Icelandic Cancer Soc, Reykjavik, Iceland
24. INSERM, Inst Gustav Roussey, Villejuif, France
25. Internatl Agcy Res Cancer, Lyon, France
26. Israel Chaim Sheba Med Ctr, Tel Hashomer, Israel
27. Inst Univ Med Soc Prevent, Lausanne, Switzerland
28. Cancer Res UK Genet Epidemiol Lab, Leeds, England
29. Inst Oncol, Ljubljana, Slovenia
30. Cancer Res UK Dept Math Statist Epidemiol, London, England
31. London Sch Hygeine Trop Med, London, England
32. Univ Hosp, Lund, Sweden
33. Maastricht Univ, Maastricht, Netherlands
34. Univ Philippines, Manila, Philippines
35. Ist Mario Negri, Milan, Italy
36. Ist Nazionale Tumor, Div Statist Med Biometria, Milan, Italy
37. Ist Statist Med Biometria, Milan, Italy
38. Montpellier Cancer Ctr, Montpellier, France
39. INSERM, Montpellier, France
40. Nairobi Ctr Res Reproduct, Nairobi, Kenya
41. Natl Univ Singapore, Singapore, Singapore
42. Netherlands Cancer Inst, Amsterdam, Netherlands
43. NSW Cancer Council, Sydney, NSW Australia
44. Dpt Publ Health & Primary Care, Oxford, England
45. Cancer Res UK Epidemiol Unit, Oxford, England
46. Radiat Effects Res Fdn, Hiroshima, Japan
47. Royal Coll Gen Practitioners, Oral Contracept Study, London, England
48. Univ Costa Rica, San Jose, Costa Rica
49. Shanghai Cancer Inst, Shanghai, Peoples R China
50. Shanghai Inst Planned Parenthood Res, Shanghai, Peoples R China
51. Dept Publ Health, Sydney, Australia
52. Tianjin Cancer Inst, Tianjin, Peoples R China
53. Dept Publ Health Sci, Toronto, ON Canada
54. Tromso Univ, Tromso, Norway
55. Univ Athens, Sch Med, Athens, Greece
56. Univ Chile, Santiago, Chile
57. Univ Edinburgh, Edinburgh, Midlothian Scotland
58. Univ N Carolina, Sch Publ Hlth, Chapel Hill, NC USA
59. Univ Nottingham, Nottingham, England
60. Univ So Calif, Los Angeles, CA USA
61. WHO, Geneva, Switzerland
62. Albert Einstein Coll Med, New York, NY USA
63. Amer Canc Soc, Atlanta, GA 30329 USA
64. Univ Hawaii Manoa, Canc Res Ctr, Honolulu, HI 96822 USA
65. Brigham & Womens Hosp, Channing Lab, Harvard Med Sch, Boston, MA USA
66. Loma Linda Univ, Loma Linda, CA 92350 USA
67. NCI, Bethesda, MD 20892 USA
68. New Jersey State Dept Hlth, Trenton, NJ 08625 USA
69. Columbia Univ, Sch Publ Hlth, New York, NY USA
70. Vanderbilt Univ, Nashville, TN USA
71. Univ Minnesota, Sch Publ Hlth, Minneapolis, MN 55455 USA
72. Univ Wisconsin, Comprehens Canc Ctr, Madison, WI 53706 USA
73. Ctr Dis Control & Prevent, Atlanta, GA USA
74. Canc Res UK MRC BHF, Epidemiol Studies Unit, Oxford, England
75. Canc Res UK MRC BHF, Clin Trial Serv Unit, Oxford, England |
| Publisher: NATURE PUBLISHING GROUP, MACMILLAN BUILDING, 4 CRINAN ST, LONDON N1 9XW, ENGLAND |
| Subject Category: Oncology |
| IDS Number: 625MH |
| ISSN: 0007-0920 |
| DOI: 10.1038/sj.bjc.6600596 |
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