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Alcohol and Breast Cancer PDF Print E-mail

October is Breast Cancer awareness month. Breast cancer is the most common female cancer in the United States. Breast cancer is the 2nd most common cause of cancer-related death i.e., after lung cancer. It is the leading cause of death in women between 45-55 years of age. Risk factors include age and gender, race and ethnicity, age at menarche, first live birth, and menopause, history of benign breast disease, lifestyle and dietary factors, reproductive and hormonal factors, family history and genetic factors, exposure to ionizing radiation, and environmental factors.

 

In 2007, the media reported on a presentation of findings of a study conducted by Kaiser-Oakland, California physicians that found an increase incidence of breast cancer in women who drank moderate amounts of alcohol. Although findings of this particular study have not been published yet, several studies have linked alcohol consumption to an increase risk of postmenopausal breast cancer. Two hypotheses of why this could be are: (1) through the estrogen pathway and (2) alcohol acting as a co-carcinogen.

 

Alcohol may be predominantly associated with breast cancers expressing hormone receptors. Approximately 60% of all breast cancers are hormone dependent. There are only 3 prospective studies that have examined the association of alcohol on breast cancer subdivided by receptor status: the Iowa Women’s Health Study, the Swedish Mammography Cohort study, and the Women’s Health study. In the Iowa Women’s Health Study, alcohol intake was most strongly associated with estrogen receptor (ER)-progesterone receptor (PR)- tumors. In contrast, in both the Swedish Mammography Cohort and Women’s Health studies, alcohol intake was associated with ER+PR+ and not with ER-PR- tumors.

A pooled estimate of the data from these 3 studies reported in the Women’s Health Study found a positive association for ER+PR+ tumors and not for ER-PR- and ER+PR- tumors. Hypotheses about how alcohol may act through hormone-dependent mechanisms and/or as a co-carcinogen exist but are unproven.

 

Interestingly, in the Women’s Health Study, red wine was not associated with an increase risk of breast cancer but beer, liquor, and white wine were.

 

These studies are examples of study designs that have known limitations that may include recall bias, selection bias, and confounding.

 

Please read the spotlight on Marcia Stefanick to learn more about study design, alcohol and hot flashes, why science cannot be explained in sound bytes, and what she is drinking.

 

Stay tuned for a future spotlight on Ellen Mahoney, general surgeon with a strong interest in breast cancer and why she is skeptical about the conclusion that alcohol is a risk factor for developing postmenopausal breast cancer in women.

 

Michels KB Mohllajee AP, Roset-Bahmanyar E, Beehler GP, Moysich KB. Diet and Breast Cancer. Cancer 2007;109(12 Suppl):2712-49.

 

Zhang SM, Lee IM, Manson JE, Cook NR, Willett WC, Buring JE. Alcohol Consumption and Breast Cancer Risk in the Women’s Health Study. Am J Epidemiol 2007;165:667-676.

 

Suzuki R, Ye W, Rylander-Rudquist T, Saji S, Colditz GA, Wolk A. Alcohol and Postmenopausal Breast Cancer Risk Defined by Estrogen and Progesterone Receptor Status: A Prospective Cohort Study. J Natl Cancer Inst 2005;7:1601-8.

 

Gapstur SM, Potter JD, Drinkard C, Folsom AR. Synergistic Effect between Alcohol and Estrogen Replacement Therapy on Risk of Breast Cancer Differs by Estrogen/Progesterone Receptor Status in the Iowa Women’s Health Study. Cancer Epid Biomarkers Prev 1995;4:313-8.

 
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