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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

Beral, V; Hamajima, N; Hirose, K; Rohan, T; Calle, EE; Heath, CW; Coates, RJ; Liff, JM; Talamini, R and Chantarakul, N, et al. (2002) In British Journal of Cancer 87(11). p.1234-1245
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... (More)
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. (Less)
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collaborative analysis, smoking, tobacco, breast cancer, alcohol
in
British Journal of Cancer
volume
87
issue
11
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1234 - 1245
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Nature Publishing Group
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  • wos:000179819900009
  • pmid:12439712
  • scopus:0037132383
ISSN
1532-1827
DOI
10.1038/sj.bjc.6600596
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English
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@article{0ef84e33-6f7f-49b7-b55f-fd7a9629343a,
  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 &lt; 0.00001) for an intake of 35 - 44 g per day alcohol, and 1.46 (1.33 - 1.61, P &lt; 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&lt;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 &lt; 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.},
  author       = {Beral, V and Hamajima, N and Hirose, K and Rohan, T and Calle, EE and Heath, CW and Coates, RJ and Liff, JM and Talamini, R and Chantarakul, N and Koetsawang, S and Rachawat, D and Morabia, A and Schuman, L and Stewart, W and Szklo, M and Bain, C and Schofield, F and Siskind, V and Band, P and Coldman, AJ and Gallagher, RP and Hislop, TG and Yang, P and Kolonel, LM and Nomura, AMY and Hu, J and Johnson, KC and Mao, Y and De Sanjose, S and Lee, N and Marchbanks, P and Ory, HW and Peterson, HB and Wilson, HG and Wingo, PA and Ebeling, K and Kunde, D and Nishan, P and Hopper, JL and Colditz, G and Gajalakshmi, V and Martin, N and Pardthaisong, T and Solpisornkosol, S and Theetranont, C and Boosiri, B and Chutivongse, S and Jimakorn, P and Virutamasen, P and Wongsrichanalai, C and Ewertz, M and Adami, HO and Bergkvist, L and Magnusson, C and Persson, I and Chang-Claude, J and Paul, C and Skegg, DCG and Spears, GFS and Boyle, P and Evstifeeva, T and Daling, JR and Hutchinson, WB and Malone, K and Noonan, EA and Stanford, JL and Thomas, DB and Weiss, NS and White, E and Andrieu, N and Bremond, A and Clavel, F and Gairard, B and Lansac, J and Piana, L and Renaud, R and Izquierdo, A and Viladiu, P and Cuevas, HR and Ontiveros, P and Palet, A and Salazar, SB and Arsitizabal, N and Cuadros, A and Tryggvadottir, L and Tulinius, H and Bachelot, A and Le, MG and Peto, J and Franceschi, S and Lubin, F and Modan, B and Ron, E and Wax, Y and Friedman, GD and Hiatt, RA and Levi, F and Bishop, T and Kosmelj, K and Primic-Zakelj, M and Ravnihar, B and Stare, J and Beeson, WL and Fraser, G and Bulbrook, RD and Cuzick, J and Duffy, SW and Fentiman, IS and Hayward, JL and Wang, DY and McMichael, AJ and McPherson, K and Hanson, RL and Leske, MC and Mahoney, MC and Nasca, PC and Varma, AO and Weinstein, AL and Möller, Torgil and Olsson, Håkan and Ranstam, Jonas and Goldbohm, RA and van den Brandt, PA and Apelo, RA and Baens, J and de la Cruz, JR and Javier, B and Lacaya, LB and Ngelangel, CA and La Vecchia, C and Negri, E and Marubini, E and Ferraroni, M and Gerber, M and Richardson, S and Segala, C and Gatei, D and Kenya, P and Kungu, A and Mati, JG and Brinton, LA and Hoover, R and Schairer, C and Spirtas, R and Lee, HP and Rookus, MA and van Leeuwen, FE and Schoenberg, JA and McCredie, M and Gammon, MD and Clarke, EA and Jones, L and Neil, A and Vessey, M and Yeates, D and Appleby, P and Banks, E and Bull, D and Crossley, B and Goodill, A and Green, J and Hermon, C and Key, T and Langston, N and Lewis, C and Reeves, G and Collins, R and Doll, R and Peto, R and Mabuchi, K and Preston, D and Hannaford, P and Kay, C and Rosero-Bixby, L and Gao, YT and Jin, F and Yuan, JM and Wei, HY and Yun, T and Zhiheng, C and Berry, G and Cooper Booth, J and Jelihovsky, T and MacLennan, R and Shearman, R and Wang, QS and Baines, CJ and Miller, AB and Wall, C and Lund, E and Stalsberg, H and Shu, XO and Zheng, W and Katsouyanni, K and Trichopoulou, A and Trichopoulos, D and Dabancens, A and Martinez, L and Molina, R and Salas, O and Alexander, XE and Anderson, K and Folsom, AR and Hulka, BS and Bernstein, L and Enger, S and Haile, RW and Paganini-Hill, A and Pike, MC and Ross, RK and Ursin, G and Yu, MC and Longnecker, MP and Newcomb, P and Bergkvist, L and Kalache, A and Farley, TMM and Holck, S and Meirik, O},
  issn         = {1532-1827},
  keyword      = {collaborative analysis,smoking,tobacco,breast cancer,alcohol},
  language     = {eng},
  number       = {11},
  pages        = {1234--1245},
  publisher    = {Nature Publishing Group},
  series       = {British Journal of Cancer},
  title        = {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},
  url          = {http://dx.doi.org/10.1038/sj.bjc.6600596},
  volume       = {87},
  year         = {2002},
}