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Nomura T, Kawai M, Fukuma Y, Koike Y, Ozaki S, Iwasaki M, Yamamoto S, Takamatsu K, Okamura H, Arai M, Ootani S, Iwata H, Saji S. Alcohol consumption and breast cancer prognosis after breast cancer diagnosis: a systematic review and meta‑analysis of the Japanese Breast Cancer Society Clinical Practice Guideline, 2022 edition. Breast Cancer 2023:10.1007/s12282-023-01455-4. [PMID: 37029889 DOI: 10.1007/s12282-023-01455-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 04/09/2023]
Abstract
Alcohol consumption is internationally recognized as one of the compelling risk factors for breast cancer, but it does not necessarily correlate with the prognosis of breast cancer patients. Alcohol consumption in breast cancer patients was addressed in the 2022 Breast Cancer Clinical Practice Guidelines. A systematic review and meta-analysis of epidemiological studies on alcohol consumption and breast cancer recurrence, breast cancer-related mortality, all-cause mortality, and cardiovascular disease mortality in breast cancer patients was performed. The PubMed, Cochrane Library, and Ichushi-Web databases were searched for relevant publications reporting cohort or case-control studies published until March 2021. A total of 33 studies (32 cohort studies and 1 case-control study) met the eligibility criteria; 4638 cases of recurrence, 12,209 cases of breast cancer-specific mortality, and 21,945 cases of all-cause mortality were observed. With regard to breast cancer recurrence, 7 studies assessed pre-diagnosis alcohol consumption (relative risk (RR) 1.02, 95% confidence interval (95% CI) 0.77-1.37, p = 0.88) and 3 studies assessed post-diagnosis alcohol consumption (RR 0.96, 95% CI 0.85-1.10, p = 0.57), and no significant increase or decrease in risk was observed. With regard to breast cancer-related mortality, 19 studies assessed pre-diagnosis alcohol consumption (RR 1.02, 95% CI 0.93-1.11, p = 0.69), 9 studies assessed post-diagnosis alcohol consumption (RR 0.96, 95% CI 0.77-1.19, p = 0.70), and no significant increase or decrease in risk was observed. With regard to all-cause mortality, 18 studies assessed pre-diagnosis alcohol consumption (RR 0.90, 95% CI 0.82-0.99, p = 0.02), 8 studies assessed post-diagnosis alcohol consumption (RR 0.88, 95% CI 0.74-1.02, p = 0.08), and pre-diagnosis alcohol consumption was associated with a significantly decreased risk. With regard to cardiovascular disease mortality and alcohol consumption, 2 studies assessed it, and the RRwas 0.47 (95% CI 0.28-0.79, p = 0.005), showing that alcohol consumption was associated with a significantly decreased risk. The limitations of this study are that drinking status was mainly based on a questionnaire survey, which is somewhat inaccurate and has many confounding factors, and the cut-off value for the maximum alcohol intake in many studies was low, and it is possible that the actual intake was only an appropriate amount. In many countries, a standard drinking amount is set, and wise decisions are required.
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Affiliation(s)
- Tsunehisa Nomura
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
| | - Masaaki Kawai
- Department of Surgery I, Yamagata University Hospital, Yamagata, Japan
| | - Yuna Fukuma
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yoshikazu Koike
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Shinji Ozaki
- Department of Breast Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Motoki Iwasaki
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | | | - Kiyoshi Takamatsu
- Department of Obstetrics and Gynecology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Hitoshi Okamura
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Masami Arai
- Department of Clinical Genetics, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | | | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
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Hosio M, Urpilainen E, Hautakoski A, Marttila M, Arffman M, Sund R, Ahtikoski A, Puistola U, Läärä E, Karihtala P, Jukkola A. Association of antidiabetic medication and statins with survival from ductal and lobular breast carcinoma in women with type 2 diabetes. Sci Rep 2021; 11:10445. [PMID: 34001921 PMCID: PMC8129135 DOI: 10.1038/s41598-021-88488-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022] Open
Abstract
We investigated the survival of female patients with pre-existing type 2 diabetes (T2D) diagnosed with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of breast, in relation to the use of metformin, other antidiabetic medication (ADM) and statins. The study cohort consisted of 3,165 women (2,604 with IDC and 561 with ILC). The cumulative mortality from breast cancer (BC) and from other causes was calculated using the Aalen-Johansen estimator. The cause-specific mortality rates were analysed by Cox models, and adjusted hazard ratios (HRs) were estimated for the use of different medications. No evidence of an association of metformin use with BC mortality was observed in either IDC (HR 0.92, 95% confidence interval [CI] 0.64-1.31) or ILC (HR 0.68, 95% CI 0.32-1.46) patients, when compared to other oral ADMs. The mortality from other causes was found to be lower amongst the IDC patients using metformin (HR 0.64, 95% CI 0.45-0.89), but amongst ILC patients the evidence was inconclusive (HR 1.22, 95% CI 0.64-2.32). Statin use was consistently associated with reduced mortality from BC in IDC patients (HR 0.77, 95% CI 0.62-0.96) and ILC patients (HR 0.59, 95% CI 0.37-0.96), and also mortality from other causes in IDC patients (HR 0.81, 95% CI 0.67-0.96) and in ILC patients (HR 0.66, 95% CI 0.43-1.01). We found no sufficient evidence for the possible effects of metformin and statins on the prognosis of BC being different in the two histological subtypes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/complications
- Breast Neoplasms/mortality
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/complications
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/complications
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Female
- Follow-Up Studies
- Humans
- Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
- Hypoglycemic Agents/therapeutic use
- Middle Aged
- Prognosis
- Registries/statistics & numerical data
- Survival Analysis
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Affiliation(s)
- Mayu Hosio
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 22, 90029, Oulu, Finland.
| | - Elina Urpilainen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 23, 90029, Oulu, Finland
| | - Ari Hautakoski
- Research Unit of Mathematical Sciences, University of Oulu, PO Box 3000, 90014, Oulu, Finland
| | - Mikko Marttila
- Orion Corporation, Orionintie 1, PO Box 65, 02101, Espoo, Finland
| | - Martti Arffman
- Service System Research Unit, Finnish Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland
| | - Anne Ahtikoski
- Cancer and Translational Medicine Research Unit, Department of Pathology, Oulu University Hospital and University of Oulu, PO Box 50, 90029, Oulu, Finland
| | - Ulla Puistola
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 23, 90029, Oulu, Finland
| | - Esa Läärä
- Research Unit of Mathematical Sciences, University of Oulu, PO Box 3000, 90014, Oulu, Finland
| | - Peeter Karihtala
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 22, 90029, Oulu, Finland
- Department of Oncology, Helsinki University Comprehensive Cancer Center, P.O.Box 180, 00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Arja Jukkola
- Department of Oncology and Radiotherapy, Cancer Center Tampere, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Box 2000, 33521, Tampere, Finland
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Sun Q, Xie W, Wang Y, Chong F, Song M, Li T, Xu L, Song C. Alcohol Consumption by Beverage Type and Risk of Breast Cancer: A Dose-Response Meta-Analysis of Prospective Cohort Studies. Alcohol Alcohol 2021; 55:246-253. [PMID: 32090238 DOI: 10.1093/alcalc/agaa012] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 02/07/2023] Open
Abstract
AIMS Alcohol intake has been shown to increase the risk of breast cancer. However, the dose-response analysis of different alcoholic beverages (spirits, wine and beer) is not clear. Our meta-analysis aims to provide a dose-response estimation between different alcohols and breast cancer risk. METHODS Search of PubMed and Web of Science and manual searches were conducted up to 1 December 2018, and summary relative risks (RRs) and attributable risk percentage (ARP) for alcohol intake on the development of breast cancer were calculated. Dose-response meta-analysis modeled relationships between drinking type and breast cancer risk. Sources of heterogeneity were explored, and sensitivity analyses were conducted to test the robustness of findings. RESULTS In total, 22 cohort studies and 45,350 breast cancer cases were included. Current drinkers for ER+ had an increased risk compared with never drinkers. In dose-response analysis, there was a statistically significant linear trend with breast cancer risk increasing gradually by total alcohol and wine dose: when adding 10 g per day, the risk increased by 10.5% (RR = 1.10, 95%CI = 1.08-1.13) in total alcohol and 8.9% (RR = 1.08, 95%CI = 1.04-1.14) in wine. For postmenopausal women, the risk increases by 11.1% (RR = 1.11, 95%CI = 1.09-1.13) with every 10 g of total alcohol increase. Furthermore, the breast cancer alcohol-attributed percentage is higher in Europe than in North America and Asia. CONCLUSIONS The effect of drinking on the incidence of breast cancer is mainly manifested in ER+ breast cancer. Quantitative analysis showed total drinking had a significant risk for breast cancer, especially for postmenopausal women. However, for different alcohols, just wine intake has the similar results.
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Affiliation(s)
- Qiuyu Sun
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou 450001, Henan, China.,Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, 40 Daxue Road, Zhengzhou 450052, China
| | - Weihong Xie
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Yanli Wang
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou 450001, Henan, China.,Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, 40 Daxue Road, Zhengzhou 450052, China
| | - Feifei Chong
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou 450001, Henan, China.,Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, 40 Daxue Road, Zhengzhou 450052, China
| | - Mengmeng Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou 450001, Henan, China.,Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, 40 Daxue Road, Zhengzhou 450052, China
| | - Tiandong Li
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou 450001, Henan, China.,Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, 40 Daxue Road, Zhengzhou 450052, China
| | - Linping Xu
- Department of Teaching and Research, Henan Tumor Hospital, No. 127, Dongming Road, Zhengzhou 450003, Henan, China
| | - Chunhua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou 450001, Henan, China.,Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, 40 Daxue Road, Zhengzhou 450052, China
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Minami Y, Kanemura S, Kawai M, Nishino Y, Tada H, Miyashita M, Ishida T, Kakugawa Y. Alcohol consumption and survival after breast cancer diagnosis in Japanese women: A prospective patient cohort study. PLoS One 2019; 14:e0224797. [PMID: 31721806 PMCID: PMC6853331 DOI: 10.1371/journal.pone.0224797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/10/2019] [Indexed: 01/14/2023] Open
Abstract
Background It is unclear whether alcohol consumption may impact survival after breast cancer diagnosis. To clarify the association between pretreatment alcohol consumption and survival in breast cancer patients, a prospective patient cohort study was conducted. Methods The cohort comprised 1,420 breast cancer patients diagnosed during 1997–2013 at a single institute in Japan. Alcohol drinking and other lifestyle factors were assessed by questionnaire survey at the initial admission. The patients were followed until December 31, 2016. The crude associations of pretreatment alcohol intake with survival were evaluated by Kaplan-Meier analysis. The Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) controlled by confounders. Results During a median follow-up period of 8.6 years, 261 all-cause and 193 breast cancer-specific deaths were documented. Survival curves showed that ever-drinkers tended to have better survival than never-drinkers (breast cancer-specific survival, log-rank p = 0.0381). Better survival was also observed for light drinkers with an intake of <5.0 g per day. In the Cox model, ever-drinking was associated with a decreased risk of all-cause (HR: 0.75; 95% CI: 0.54–1.05) and breast cancer-specific death (HR: 0.68; 95% CI: 0.46–0.99). Light drinkers had a lower risk of breast cancer-specific death (frequency of drinking, HR = 0.57 for occasional or 1–2 times per week and 0.72 for 3–7 times per week; amount of alcohol consumed per day, HR = 0.57 for <5.0 g and 0.68 for ≥5.0 g compared with never-drinking). In terms of hormone receptor status, a significantly decreased risk of death associated with ever-drinking was observed among women with receptor-negative cancer (ER-/PR-, HR = 0.41; 95% CI: 0.20–0.84 for breast cancer-specific death). Conclusions Pretreatment, i.e., pre-diagnosis alcohol consumption is unlikely to have an adverse effect on survival after breast cancer diagnosis. Light alcohol consumption may have a beneficial effect on patient survival.
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Affiliation(s)
- Yuko Minami
- Division of Community Health, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, Natori, Miyagi, Japan
- Center for Preventive Medicine, Osaki Citizen Hospital, Osaki, Miyagi, Japan
- * E-mail:
| | - Seiki Kanemura
- Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, Natori, Miyagi, Japan
| | - Masaaki Kawai
- Department of Breast Surgery, Miyagi Cancer Center Hospital, Natori, Miyagi, Japan
| | - Yoshikazu Nishino
- Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, Natori, Miyagi, Japan
- Department of Epidemiology and Public Health, Kanazawa Medical University, 1–1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan
| | - Hiroshi Tada
- Department of Breast Surgery, Miyagi Cancer Center Hospital, Natori, Miyagi, Japan
| | - Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takanori Ishida
- Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoichiro Kakugawa
- Department of Breast Surgery, Miyagi Cancer Center Hospital, Natori, Miyagi, Japan
- Department of Surgery, Japanese Red Cross Sendai Hospital, Sendai, Miyagi, Japan
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Ma H, Malone KE, McDonald JA, Marchbanks PA, Ursin G, Strom BL, Simon MS, Sullivan-Halley J, Bernstein L, Lu Y. Pre-diagnosis alcohol consumption and mortality risk among black women and white women with invasive breast cancer. BMC Cancer 2019; 19:800. [PMID: 31409314 PMCID: PMC6693233 DOI: 10.1186/s12885-019-5991-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/29/2019] [Indexed: 11/22/2022] Open
Abstract
Background Alcohol consumption is associated with increased risk of breast cancer; however, its association with subsequent risk of breast cancer death is unclear. Methods We followed 4523 women with complete information on relevant risk factors for mortality; these women were 35 to 64 years of age when diagnosed with incident invasive breast cancer between 1994 and 1998. During follow up (median, 8.6 years), 1055 women died; 824 died from breast cancer. The information on alcohol consumption before diagnosis was collected shortly after breast cancer diagnosis (average: 5.1 months) during an in-person interview which used a structured questionnaire. Multivariable Cox proportional hazards regression models provided hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer-specific mortality, mortality due to causes other than breast cancer, and all-cause mortality associated with alcohol consumption from age 15 years until breast cancer diagnosis and during recent periods of time prior to breast cancer diagnosis. Results Average weekly alcohol consumption from age 15 years until breast cancer diagnosis was inversely associated with breast cancer-specific mortality (Ptrend = 0.01). Compared to non-drinkers, women in the highest average weekly alcohol consumption category (≥7 drinks/week) had 25% lower risk of breast cancer-specific mortality (HR = 0.75, 95% CI = 0.56–1.00). Breast cancer mortality risk was also reduced among women in the highest average weekly alcohol consumption category in two recent time periods (5-year period ending 2-years prior to breast cancer diagnosis, HR = 0.74, 95% CI = 0.57–0.95; 2-year period immediately prior to breast cancer diagnosis: HR = 0.73, 95% CI = 0.56–0.95). Furthermore, analyses of average weekly alcohol consumption by beverage type from age 15 years until breast cancer diagnosis suggested that wine consumption was inversely associated with breast cancer-specific mortality risk (wine Ptrend = 0.06, beer Ptrend = 0.24, liquor Ptrend = 0.74). No association with any of these alcohol consumption variables was observed for mortality risk due to causes other than breast cancer. Conclusions Overall, we found no evidence that alcohol consumption before breast cancer diagnosis increases subsequent risk of death from breast cancer.
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Affiliation(s)
- Huiyan Ma
- Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 East Duarte Rd, Duarte, CA, 91010, USA.
| | - Kathleen E Malone
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Jill A McDonald
- College of Health and Social Services, New Mexico State University, Las Cruces, NM, 88003, USA
| | | | - Giske Ursin
- Cancer Registry of Norway, Oslo Norway and Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Brian L Strom
- Rutgers, the State University of New Jersey, Newark, NJ, USA
| | - Michael S Simon
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA
| | - Jane Sullivan-Halley
- Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 East Duarte Rd, Duarte, CA, 91010, USA
| | - Leslie Bernstein
- Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 East Duarte Rd, Duarte, CA, 91010, USA
| | - Yani Lu
- Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 East Duarte Rd, Duarte, CA, 91010, USA
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DiMarzio P, Peila R, Dowling O, Timony DM, Balgobind A, Lee LN, Kostroff KM, Ho GYF. Smoking and alcohol drinking effect on radiotherapy associated risk of second primary cancer and mortality among breast cancer patients. Cancer Epidemiol 2018; 57:97-103. [PMID: 30359894 DOI: 10.1016/j.canep.2018.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Smoking and alcohol consumption are potential risk factors for breast cancer (BC) and may modify the risk of radiotherapy-associated second primary cancer (SPC) occurrence and total mortality. We explored the joint effect of smoking, or alcohol drinking, and radiotherapy on the risk of SPC and overall mortality among BC survivals. METHODS We conducted a cancer registry-based study of 10,676 BC cases (stage 0-III) with data on smoking and alcohol consumption at time of diagnosis and clinical and therapeutics characteristics. Multivariable Cox proportional hazard models were used to estimate Hazard Ratios [HRs] and 95% confidence interval [CI] of total and site-specific SPC and mortality adjusting for demographic and cancer related characteristics. RESULTS The SPC risk associated with radiotherapy was higher among ever-smokers than never-smokers (p for interaction = 0.04). Compared to never-smokers/unirradiated, the adjusted HR for ever-smokers/irradiated was 1.79 (95%CI, 1.43-2.23), and for never-smokers/irradiated was 1.31 (95%CI, 1.06-1.63). Analysis by cancer site showed that for ever-smokers/irradiated the risk for hematological, gastrointestinal, gynecological urological and lung/pulmonary cancer was significantly increased by two to five-fold. Mortality was significantly higher for ever-smokers/irradiated (HR = 1.25; 95%CI, 1.06-1.47), but was lower for never-smokers/irradiated (HR = 0.85; 95%CI, 0.73-0.99). Alcohol consumption did not alter the association between radiotherapy and SPC risk, but was associated with lower mortality risk. CONCLUSION Patients who received radiotherapy and smoked before or at time of BC diagnosis have an increased risk for specific SPCs; drinking alcohol did not alter the effect of radiotherapy. Smoking significantly increased mortality risk reducing the protective effect of radiotherapy treatment.
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Affiliation(s)
- Paola DiMarzio
- Department of Population Health, Northwell Health, Great Neck, NY, USA.
| | - Rita Peila
- Department of Occupational Medicine, Epidemiology and Prevention, Feinstein Institute for Medical Research, Northwell Health, Great Neck, NY, USA.
| | - Oonagh Dowling
- Department of Anesthesiology, Long Island Jewish Medical Center, Northwell Health, Glen Oaks, NY, USA.
| | | | - Amrita Balgobind
- Hofstra School of Medicine, Northwell Health, Hempstead, NY, USA.
| | - Lucille N Lee
- Radiation Medicine, Center for Advanced Medicine, Hofstra School of Medicine, Northwell Health, New Hyde Park, NY, USA.
| | - Karen M Kostroff
- Department of Surgical Oncology, Hofstra School of Medicine, Northwell Health, New Hyde Park, NY, USA.
| | - Gloria Y F Ho
- Department of Occupational Medicine, Epidemiology and Prevention, Feinstein Institute for Medical Research, Northwell Health, Great Neck, NY, USA; Hofstra School of Medicine, Northwell Health, Hempstead, NY, USA.
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Zeinomar N, Thai A, Cloud AJ, McDonald JA, Liao Y, Terry MB. Alcohol consumption and breast cancer-specific and all-cause mortality in women diagnosed with breast cancer at the New York site of the Breast Cancer Family Registry. PLoS One 2017; 12:e0189118. [PMID: 29244822 PMCID: PMC5731703 DOI: 10.1371/journal.pone.0189118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Alcohol consumption is an established and important risk factor for breast cancer incidence in the general population. However, the relationship between alcohol and mortality among women with breast cancer is less clear. This study examines the effect of alcohol consumption on mortality in women affected with breast cancer at baseline from a high-risk family breast and ovarian cancer registry. Methods We studied 1116 women affected with breast cancer at baseline from the Metropolitan New York Registry. The examined reported alcohol consumption (total of beer, wine, liquor) was defined as the average number of drinks per week reported from age 12 to age at baseline. We assessed vital status of each participant using participant or family reported data and we used the National Death Index to supplement deaths reported through family updates. We used Cox proportional hazards models to estimate the association between alcohol intake and overall mortality (HRO), breast cancer-specific mortality (HRBC), and non-breast cancer mortality (HRNBC), adjusted for confounders. Results After a mean follow-up of 9.1 years, we observed 211 total deaths and 58 breast cancer deaths. Compared to non-drinkers, we found that both low and moderate to heavy levels of alcohol intake were not associated with greater overall mortality (≤3 drinks/week: HRO: 0.66, 95% CI: 0.38–1.14); > 3 drinks/week: HRO: 1.16, 95% CI: 0.85–1.58), breast cancer–specific mortality (≤ 3 drinks/week: HRBC:0.62, 95% CI: 0.19–2.03; >3 drinks/week: HR BC: 0.96, 95% CI: 0.49–1.89), or non-breast cancer-specific mortality (≤3 drinks/week: HR NBC: 0.73, 95% CI: 0.32–1.6; >3 drinks/week: HRNBC: 1.18, 95% CI: 0.75–1.86). Conclusions Alcohol intake reported from age 12 to age at baseline was not associated with overall or breast cancer-specific mortality in this cohort of affected women with a family history of breast cancer.
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Affiliation(s)
- Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Ashley Thai
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Ann J. Cloud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Jasmine A. McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States of America
- * E-mail:
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8
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Pourmasoumi M, Karimbeiki R, Vosoughi N, Feizi A, Ghiasvand R, Barak F, Miraghajani M. Healthy Eating Index/Alternative Healthy Eating Index and Breast Cancer Mortality and Survival: A Systematic Review and Meta-analysis. Asia Pac J Oncol Nurs 2016; 3:297-305. [PMID: 27981174 PMCID: PMC5123523 DOI: 10.4103/2347-5625.189819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Breast cancer is the most common cancer in women worldwide. The effects of overall diet quality instead of single nutrients after breast cancer diagnosis on mortality have been a growing area of research interest. The aim of this systematic review was to investigate the relationship between the Healthy Eating Index (HEI)/the Alternative Healthy Eating Index (AHEI) and risk of breast cancer mortality or survival rates as a primary outcome, and some related inflammatory factors, as secondary outcomes among postdiagnosed women. METHODS This study methodology was performed based on the Preferred Reporting Item for Systematic Review and Meta-analysis statement recommendation and had been registered at PROSPERO (registration number: CRD42015015605). The systematic search was conducted in the electronic databases including PubMed, ISI, Scopus, Cochrane, and Google before July 2016. Researches that had not reported risk of breast cancer mortality or survival rates separately were excluded from the study. Similarly, this review excluded studies which only had examined the HEI or AHEI without reporting their association with the risk of mortality or survival rates. RESULTS After primary search, of 643 studies identified, 4 studies including eligible criteria were selected for the final assessment. All selected studies had been conducted in the USA and used self-report food-frequency questionnaire for diet quality assessment. In two studies HEI-2005, in one study AHEI, and in another study AHEI-2010 were applied. Meta-analysis result showed no significant association between these indexes and risk of breast cancer mortality/survival among women with this malignancy [relative risk: (RR) 1.04; 95% confidence interval (CI): 0.69-1.56; P = 0.87]. CONCLUSIONS Regarding the adherence HEI/AHEI, we found no association between mentioned indexes and risk of mortality or survival from breast cancer in women with breast cancer. However, evidence in this field is limited and inconsistence and further studies are needed.
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Affiliation(s)
- Makan Pourmasoumi
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Karimbeiki
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nooshin Vosoughi
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health and Cardiac Rehabilitation Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Ghiasvand
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzane Barak
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Miraghajani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Alcohol consumption and rates of cancer screening: Is cancer risk overestimated? Cancer Causes Control 2015; 27:281-9. [PMID: 26590914 DOI: 10.1007/s10552-015-0692-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/31/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Alcohol consumption in moderation has been associated with incident breast and colorectal cancer. Whether these associations may be overestimated by more intensive screening among moderate consumers is unknown. This study examines the associations of alcohol consumption with cancer screening. METHODS In six iterations (2002-2012) of the Behavioral Risk Factor Surveillance System, a telephone survey of US adults conducted by the Centers for Disease Control and Prevention, participants reported their alcohol use and recent screening for several cancers. We assessed whether alcohol use was associated with breast, cervical, and colorectal cancer screening after sample-weighted adjustment for sociodemographic and healthcare utilization factors. RESULTS Among 2,191,483 survey respondents, 80.5 % (weighted prevalence) of eligible individuals reported having an up-to-date mammogram, 87.7 % having a Pap test, and 56.8 % having a colonoscopy/sigmoidoscopy. For all breast, cervical, and colorectal cancers, moderate consumers were more likely to report screening (84.7, 91.2, 61.1 %) than non-consumers, even after multivariate adjustment (adjusted prevalence ratios 1.04, 1.04, 1.07; p < 0.001 for all). Among binge consumers, the weighted prevalence was lower than that in non-binge consumers (binge vs non-binge moderate consumers 80.5 vs 85.5 %, 89.9 vs 91.8 %, 52.8 vs 63.3 %) but still higher than non-consumers for breast and cervical cancer screening. CONCLUSIONS In the USA, moderate consumers consistently report a greater likelihood of breast, cervical, and colorectal cancer screening than do non-consumers. Given the likelihood of overdiagnosis, further study of alcohol consumption and cancer should include cancer-specific mortality, which is less sensitive to differences in screening and detection.
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10
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Catsburg C, Miller AB, Rohan TE. Active cigarette smoking and risk of breast cancer. Int J Cancer 2014; 136:2204-9. [PMID: 25307527 DOI: 10.1002/ijc.29266] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/12/2014] [Accepted: 09/30/2014] [Indexed: 01/18/2023]
Abstract
Although epidemiological evidence on the role of active cigarette smoking in breast cancer risk has been inconsistent, recent literature supports a modest association between smoking and breast cancer. This association is particularly observed in women who smoke for a long duration, or who smoke for a long time prior to their first pregnancy. Here, we provide updated results on cigarette smoking and breast cancer risk in the Canadian National Breast Screening Study (NBSS). The NBSS is a large cohort of 89,835 women, aged 40-59, who were followed for a mean of 22.1 years, resulting in the ascertainment of 6,549 incident cases of breast cancer. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of cigarette smoking variables with breast cancer risk. We found breast cancer to be associated with duration (40 years vs. 0: HR = 1.57; 95%CI = 1.29-1.92), intensity (40 cigarettes per day vs. 0: HR = 1.21; 95%CI = 1.04-1.40), cumulative exposure (40 pack-years vs. 0: HR = 1.19; 95%CI = 1.06-1.13) and latency (40 years since initiation vs. 0: HR = 1.19; 95%CI = 1.10-1.53) of cigarette smoking. Number of years smoked prior to first full-term pregnancy was associated with higher risk of breast cancer than comparative years smoked post-pregnancy (among parous women, 5 years pre pregnancy vs. 0: HR = 1.18; 95%CI = 1.10-1.26). These results strongly support a role for cigarette smoking in breast cancer etiology and emphasize the importance of timing of this exposure.
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Affiliation(s)
- Chelsea Catsburg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY
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11
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Gou YJ, Xie DX, Yang KH, Liu YL, Zhang JH, Li B, He XD. Alcohol Consumption and Breast Cancer Survival: A Meta- analysis of Cohort Studies. Asian Pac J Cancer Prev 2014; 14:4785-90. [PMID: 24083744 DOI: 10.7314/apjcp.2013.14.8.4785] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence for associations between alcohol consumption with breast cancer survival are conflicting, so we conducted the present meta-analysis. METHODS Comprehensive searches were conducted to find cohort studies that evaluated the relationship between alcohol consumption with breast cancer survival. Data were analyzed with meta-analysis software. RESULTS We included 25 cohort studies. The meta-analysis results showed that alcohol consumption was not associated with increased breast cancer mortality and recurrence after pooling all data from highest versus lowest comparisons. Subgroup analyses showed that pre-diagnostic or post-diagnostic consumpotion, and ER status did not affect the relationship with breast cancer mortality and recurrence. Although the relationships of different alcohol consumption with breast cancer mortality and recurrence were not significant, there seemed to be a dose-response relationship of alcohol consumption with breast cancer mortality and recurrence. Only alcohol consumption of >20 g/d was associated with increased breast cancer mortality, but not with increased breast cancer recurrence. CONCLUSION Although our meta-analysis showed alcohol drinking was not associated with increased breast cancer mortality and recurrence, there seemed to be a dose-response relationship of alcohol consumption with breast cancer mortality and recurrence and alcohol consumption of >20 g/d was associated with increased breast cancer mortality.
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Affiliation(s)
- Yun-Jiu Gou
- Department of Thoracic Surgery, Lanzhou University, Second Hospital, Lanzhou, Gansu Province, China E-mail :
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12
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Weaver AM, McCann SE, Nie J, Edge SB, Nochajski TH, Russell M, Trevisan M, Freudenheim JL. Alcohol intake over the life course and breast cancer survival in Western New York exposures and breast cancer (WEB) study: quantity and intensity of intake. Breast Cancer Res Treat 2013; 139:245-53. [PMID: 23605086 DOI: 10.1007/s10549-013-2533-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/10/2013] [Indexed: 11/26/2022]
Abstract
Alcohol intake is a risk factor for breast cancer, but the association between alcohol and mortality among breast cancer survivors is poorly understood. We examined the association between alcohol intake from all sources, assessed by cognitive lifetime drinking history, and all-cause and breast cancer mortality among women with breast cancer (N = 1,097) who participated in a population-based case-control study. Vital status was ascertained through 2006 using the National Death Index. Using Cox proportional hazards models, we computed hazard ratios for all-cause and breast cancer mortality in association with alcohol intake. We examined lifetime volume and intensity (drinks per drinking day) of alcohol consumption as well as drinking status during various life periods. Analyses were stratified by menopausal status. After adjustment for total intake, postmenopausal women with consumption of four or more drinks per drinking day over their lifetimes were nearly three times more likely to die from any cause compared to abstainers (HR 2.94, 95 % CI 1.31, 6.62). There was a similar but non-significant association with breast cancer mortality (HR 2.68, 95 % CI 0.94, 7.67). Postmenopausal women who drank one drink or fewer per drinking day between menarche and first birth had a significantly decreased hazard of all-cause (HR 0.54, 95 % CI 0.31, 0.95) and breast cancer mortality (HR 0.27, 95 % CI 0.09, 0.77). Premenopausal breast cancer survival was not associated with drinking intensity. We observed no associations between drinking status or total volume of alcohol intake and breast cancer or all-cause mortality. High-intensity alcohol consumption may be associated with decreased survival in postmenopausal women with breast cancer. Low-intensity alcohol consumption between menarche and first birth may be inversely associated with all-cause and breast cancer mortality; this period may be critical for development of and survival from breast cancer. Intensity of alcohol intake may be a more important factor than absolute volume of intake on survival in women with breast cancer.
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Affiliation(s)
- Anne M Weaver
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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13
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Newcomb PA, Kampman E, Trentham-Dietz A, Egan KM, Titus LJ, Baron JA, Hampton JM, Passarelli MN, Willett WC. Alcohol consumption before and after breast cancer diagnosis: associations with survival from breast cancer, cardiovascular disease, and other causes. J Clin Oncol 2013; 31:1939-46. [PMID: 23569314 DOI: 10.1200/jco.2012.46.5765] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Alcohol intake is associated with increased risk of breast cancer. In contrast, the relation between alcohol consumption and breast cancer survival is less clear. PATIENTS AND METHODS We assessed pre- and postdiagnostic alcohol intake in a cohort of 22,890 women with incident invasive breast cancer who were residents of Wisconsin, Massachusetts, or New Hampshire and diagnosed from 198 to 200 at ages 20 to 79 years. All women reported on prediagnostic intake; a subsample of 4,881 reported on postdiagnostic intake. RESULTS During a median follow-up of 11.3 years from diagnosis, 7,780 deaths occurred, including 3,484 resulting from breast cancer. Hazard ratios (HR) and 95% CIs were estimated. Based on a quadratic analysis, moderate alcohol consumption before diagnosis was modestly associated with disease-specific survival (compared with nondrinkers, HR = 0.93 [95% CI, 0.85 to 1.02], 0.85 [95% CI, 0.75 to 0.95], 0.88 [95% CI, 0.75 to 1.02], and 0.89 [95% CI, 0.77 to 1.04] for two or more, three to six, seven to nine, and ≥ 10 drinks/wk, respectively). Alcohol consumption after diagnosis was not associated with disease-specific survival (compared with nondrinkers, HR = 0.88 [95% CI, 0.61 to 1.27], 0.80 [95% CI, 0.49 to 1.32], 1.01 [95% CI, 0.55 to 1.87], and 0.83 [95% CI, 0.45 to 1.54] for two or more, three to six, seven to nine, and ≥ 10 drinks/wk, respectively). Results did not vary by beverage type. Women consuming moderate levels of alcohol, either before or after diagnosis, experienced better cardiovascular and overall survival than nondrinkers. CONCLUSION Overall alcohol consumption before diagnosis was not associated with disease-specific survival, but we found a suggestion favoring moderate consumption. There was no evidence for an association with postdiagnosis alcohol intake and breast cancer survival. This study, however, does provide support for a benefit of limited alcohol intake for cardiovascular and overall survival in women with breast cancer.
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Affiliation(s)
- Polly A Newcomb
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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14
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Kwan ML, Chen WY, Flatt SW, Weltzien EK, Nechuta SJ, Poole EM, Holmes MD, Patterson RE, Shu XO, Pierce JP, Caan BJ. Postdiagnosis alcohol consumption and breast cancer prognosis in the after breast cancer pooling project. Cancer Epidemiol Biomarkers Prev 2012; 22:32-41. [PMID: 23150063 DOI: 10.1158/1055-9965.epi-12-1022] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Alcohol consumption is an established risk factor for incident breast cancer. However, its role in breast cancer prognosis remains unclear. METHODS We conducted an investigation of postdiagnosis alcohol consumption with recurrence and mortality among 9,329 breast cancer patients in the After Breast Cancer Pooling Project. Women were diagnosed from 1990 to 2006 with AJCC Stage I-III breast tumors from three prospective US cohorts. Alcohol intake was assessed at cohort entry (mean 2.1 years postdiagnosis) using a food frequency questionnaire. HR and 95% confidence intervals (CI) were estimated using delayed entry Cox proportional hazards models with adjustment for known prognostic factors. RESULTS After a mean follow-up of 10.3 years, 1,646 recurrences and 1,543 deaths were ascertained. 5,422 women (58%) were considered drinkers (≥0.36 g/day of alcohol, ≥0.25 drinks/week) with a median of 5.3 g/day. Overall, compared with nondrinking, regular alcohol intake (≥6.0 g/day) was not associated with risk of recurrence (HR for 6 to less than 12 g/day, 1.03; 95% CI, 0.86-1.24; HR for 12 to less than 24 g/day, 1.12; 95% CI, 0.93-1.34; HR for ≥24 g/day, 1.04; 95% CI, 0.84-1.31). However, risk varied significantly by menopausal status (P for interaction < 0.05). Postmenopausal women who regularly consumed alcohol (≥6.0 g/day) had increased risk of recurrence (HR, 1.19; 95% CI, 1.01-1.40). Alcohol intake was not associated with mortality. CONCLUSIONS Regular alcohol consumption was not associated with breast cancer recurrence and total mortality overall, yet recurrence risk was only elevated in postmenopausal women. IMPACT The association between alcohol intake and recurrence may depend on menopausal status at breast cancer diagnosis.
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Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
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15
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Taghipour S, Banjevic D, Fernandes J, Miller AB, Montgomery N, Harvey BJ, Jardine AKS. Incidence of invasive breast cancer in the presence of competing mortality: the Canadian National Breast Screening Study. Breast Cancer Res Treat 2012; 134:839-51. [PMID: 22689090 DOI: 10.1007/s10549-012-2113-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/23/2012] [Indexed: 12/29/2022]
Abstract
Mortality due to causes other than breast cancer is a potential competing risk which may alter the incidence probability of breast cancer and as such should be taken into account in predictive modelling. We used data from the Canadian National Breast Screening Study (CNBSS), which consist of two randomized controlled trials designed to evaluate the efficacy of mammography among women aged 40-59. The participants in the CNBSS were followed up for incidence of breast cancer and mortality due to breast cancer and other causes; this allowed us to construct a breast cancer risk prediction model while taking into account mortality for the same study population. In this study, we use 1980-1989 as the study period. We exclude the prevalent cancers from the CNBSS to estimate the probability of developing breast cancer, given the fact that women were cancer-free at the beginning of the follow-up. By the end of 1989, from 89,434 women, 944 (1.1 %) were diagnosed with invasive breast cancer, 922 (1.0 %) died from causes other than breast cancer, and 87,568 (97.9 %) were alive and not diagnosed with invasive breast cancer. We constructed a risk prediction model for invasive breast cancer based on 39 risk factors collected at the time of enrolment or the initial physical examination of the breasts. Age at entry (HR 1.07, 95 % CI 1.05-1.10), lumps ever found in left or right breast (HR 1.92, 95 % CI 1.19-3.10), abnormality in the left breast (HR 1.26, 95 % CI 1.07-1.48), history of other breast disease, family history of breast cancer score (HR 1.01, 95 % CI 1.00-1.01), years menstruating (HR 1.02, 95 % CI 1.01-1.03) and nulliparity (HR 1.70, 95 % CI 1.23-2.36) are the model's predictors. We investigated the effects of time-dependent factors. The model is well calibrated with a moderate discriminatory power (c-index 0.61, 95 % CI 0.59-0.63); we use it to predict the 9-year risk of developing breast cancer for women of different age groups. As an example, we estimated the probability of invasive cancer at 5 years after enrolment to be 0.00448, 0.00556, 0.00691, 0.00863, and 0.01034, respectively, for women aged 40, 45, 50, 55, and 59, all of whom had never noted lumps in their breasts, had 32 years of menstruating, 1-2 live births, no other types of breast disease and no abnormality found in their left breasts. The results of this study can be used by clinicians to identify women at high risk of breast cancer for screening intervention and to recommend a personalized intervention plan. The model can be also utilized by a woman as a breast cancer risk prediction tool.
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Modifiable risk factors and survival in women diagnosed with primary breast cancer: results from a prospective cohort study. Eur J Cancer Prev 2010; 19:366-73. [PMID: 20502344 DOI: 10.1097/cej.0b013e32833b4828] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examines the impact of smoking, body mass index, alcohol consumption, hormone replacement therapy, and physical activity on all-cause mortality among 528 Danish women diagnosed with primary breast cancer. Participants were women enrolled in the Copenhagen City Heart Study. Prospective self-reported exposure information was collected from four points of follow-up in 1976-1978, 1981-1983, 1991-1994, and 2001-2003. Kaplan-Meier survival curves and multivariate Cox regression analyses were performed adjusting for age, disease stage, adjuvant treatment, menopausal status, parity, alcohol intake, smoking, physical activity, body mass index, and hormone replacement therapy. The study shows that smoking for total mortality [hazard ratio, 1.16; 95% confidence interval, 1.05-1.29] and obesity for both total mortality (1.61; 1.12-2.33) and breast cancer-specific mortality (1.82; 1.11-2.99) were significantly associated with decreased survival after breast cancer diagnosis. A moderate alcohol intake of 1-6 units/week (0.85; 0.64-1.12), 7-14 units/week (0.77; 0.56-1.08), and treatment with hormone replacement therapy (0.79; 0.59-1.05) were less than 1, but not statistically significantly associated with prolonged survival. A moderate physical activity of 2-4 h/week (1.07; 0.77-1.49) and a high physical activity of more than 4 h/week (1.00; 0.69-1.45) showed no association with survival after breast cancer diagnosis.
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Kwan ML, Kushi LH, Weltzien E, Tam EK, Castillo A, Sweeney C, Caan BJ. Alcohol consumption and breast cancer recurrence and survival among women with early-stage breast cancer: the life after cancer epidemiology study. J Clin Oncol 2010; 28:4410-6. [PMID: 20805458 DOI: 10.1200/jco.2010.29.2730] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To examine the association of alcohol consumption after breast cancer diagnosis with recurrence and mortality among early-stage breast cancer survivors. PATIENTS AND METHODS Patients included 1,897 LACE study participants diagnosed with early-stage breast cancer between 1997 and 2000 and recruited on average 2 years postdiagnosis, primarily from the Kaiser Permanente Northern California Cancer Registry. Alcohol consumption (ie, wine, beer, and liquor) was assessed at cohort entry using a food frequency questionnaire. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% CI with adjustment for known prognostic factors. RESULTS Two hundred ninety-three breast cancer recurrences and 273 overall deaths were ascertained after an average follow-up of 7.4 years. Nine hundred fifty-eight women (51%) were considered drinkers (> 0.5 g/d of alcohol), and the majority drank wine (89%). Drinking ≥ 6 g/d of alcohol compared with no drinking was associated with an increased risk of breast cancer recurrence (HR, 1.35; 95% CI, 1.00 to 1.83) and death due to breast cancer (HR, 1.51; 95% CI, 1.00 to 2.29). The increased risk of recurrence appeared to be greater among postmenopausal (HR, 1.51; 95% CI, 1.05 to 2.19) and overweight and obese women (HR, 1.60; 95% CI, 1.08 to 2.38). Alcohol intake was not associated with all-cause death and possibly associated with decreased risk of non-breast cancer death. CONCLUSION Consuming three to four alcoholic drinks or more per week after a breast cancer diagnosis may increase risk of breast cancer recurrence, particularly among postmenopausal and overweight/obese women, yet the cardioprotective effects of alcohol on non-breast cancer death were suggested.
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Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente, 2000 Oakland, CA 94612, USA.
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18
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Hernández-Valero MA, Thomson CA, Hernández M, Tran T, Detry MA, Theriault RL, Hajek RA, Pierce JP, Flatt SW, Caan BJ, Jones LA. Comparison of baseline dietary intake of Hispanic and matched non-Hispanic white breast cancer survivors enrolled in the Women's Healthy Eating and Living study. ACTA ACUST UNITED AC 2008; 108:1323-9. [PMID: 18656572 DOI: 10.1016/j.jada.2008.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 02/21/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the reported baseline dietary intake of Hispanic and non-Hispanic white breast cancer survivors in the Women's Healthy Eating and Living study, a randomized plant-based dietary intervention clinical trial. DESIGN Dietary data from 4 days repeated 24-hour recalls within 3 weeks included daily total intake of energy, protein, carbohydrates, cholesterol, total fat, monounsaturated fat, saturated fat, polyunsaturated fat, fruit/vegetable servings, carotenoids, alcohol, caffeine, and percentage of energy from protein, carbohydrates, alcohol, and fats. SUBJECTS One hundred sixty-five Hispanic breast cancer survivors age-matched to 165 non-Hispanic white breast cancer survivors diagnosed with Stage I, II, or IIIA primary operable breast cancer. STATISTICAL ANALYSES Two-sample t tests and Wilcoxon rank sum tests to compare dietary intake, and logistic and ordinal logistic regression analyses to examine the association between ethnicity, alcohol, and lycopene consumption, while controlling for place of birth, education, body mass index, and time since diagnosis. RESULTS Hispanics were more likely to be foreign-born (P<0.001), less educated (P<0.0001) and to consume higher amounts of lycopene (P=0.029), while non-Hispanic whites were more likely to consume alcohol (P=0.001). However, no differences were observed in the average amounts of alcohol consumed or total percents of energy from alcohol. Both groups consumed more than five servings of fruits and vegetables daily. Being Hispanic remained a significant predictor of lower alcohol use (P=0.004) and higher lycopene consumption (P=0.005) after controlling for place of birth, education, body mass index, and time since diagnosis. CONCLUSIONS There are more similarities than differences in the dietary intake of Hispanic and non-Hispanic white breast cancer survivors in the Women's Healthy Eating and Living study. Further analysis is needed to determine if higher lycopene consumption shown among the Hispanic participants will translate to greater protection against breast cancer recurrence or increased survival.
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Affiliation(s)
- María A Hernández-Valero
- Center for Research on Minority Health, Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Hanf V, Gonder U. Nutrition and primary prevention of breast cancer: foods, nutrients and breast cancer risk. Eur J Obstet Gynecol Reprod Biol 2005; 123:139-49. [PMID: 16316809 DOI: 10.1016/j.ejogrb.2005.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Revised: 05/02/2005] [Accepted: 05/10/2005] [Indexed: 10/25/2022]
Abstract
Worldwide, each year approximately one million women are newly diagnosed with breast cancer (BC), in Germany 65 new cases per 100,000 inhabitants are registered, yearly. The fact that incidence has been rising in parallel with economic development indicates that environmental factors might play a role in the causation of BC. Migrational data have pointed to nutrition as one of the more relevant external factors involved. Preventive dietary advice often includes a reduction of alcohol, red meat and animal fat and increasing the intake of vegetables, fruit and fibre and lately, phyto-estrogens from various sources. Clearly, the scientific basis for these recommendations appears sparse. The available prospective data from epidemiological studies and interventional trials do not support the overall hypothesis that higher fat-intakes are a relevant risk factor for BC development, more important seems the relative distribution of various fatty acids. A non-vegetarian eating habit (consumption of animal products) per se does not elevate BC risk, while consumption of broiled or deep fried meats cannot be ruled out as a risk factor in genetically susceptible individuals. It appears prudent to abstain from regular and increased alcohol consumption. This should be particularly true for pubescent girls, in whom glandular breast tissue is particularly vulnerable. In general, if alcohol is consumed on a regular basis, a sufficient supply of fresh vegetables and fruit is essential. While there is no overall protective effect of a high fruit and vegetable consumption speculation remains over possible beneficial effects of certain subcategories, especially brassica vegetables like broccoli, cauliflower and cabbage. In essence, regional differences in BC incidence are probably partially attributable to life long dietary habits. There is no need to adopt a foreign dietary plan in order to protect oneself against BC. Traditional western diets also have their beneficial ingredients that should be regular constituents in our meals. Lignans from traditionally made sourdough rye bread, linseed/flaxseed and berries are local sources of potentially canceroprotective phyto-estrogens. Furthermore, indole-3-carbinol rich cabbage species might contribute to BC protection by diet. Nevertheless, clear cut recommendations for or against single nutrients or secondary plant metabolites are not yet possible, lacking sufficient data on individual bioavailability, safety and long term outcome. BC prevention by dietary means therefore relies on an individually tailored mixed diet, rich in basic foods and traditional manufacturing and cooking methods.
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Affiliation(s)
- Volker Hanf
- Department of Obstetrics and Gynecology, University of Göttingen, Robert-Koch-Street 40, 37099 Göttingen, Germany.
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Zhang B, Ferrence R, Cohen J, Bondy S, Ashley MJ, Rehm J, Jain M, Rohan T, Miller A. Smoking cessation and lung cancer mortality in a cohort of middle-aged Canadian women. Ann Epidemiol 2005; 15:302-9. [PMID: 15780778 DOI: 10.1016/j.annepidem.2004.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Accepted: 08/05/2004] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the impact of smoking cessation on lung cancer mortality among women. METHODS Survival analysis is used to assess the effect of smoking cessation on lung cancer death in the dietary cohort of 49,165 women aged 40 to 59 years enrolled in the Canadian National Breast Screening Study. RESULTS During an average of 10.3 years of follow-up, 106 women died of lung cancer. The risk of lung cancer mortality among women who quit before age 50 (HR=0.26; 95% CI, 0.13-0.55 among women who quit at ages 40-49) or quit in the previous 10 years (HR=0.39; 95% CI, 0.22-0.69) is substantially lower than the risk among current smokers. Women who quit after age 40 or have quit for less than 20 years are at substantially higher risk of lung cancer mortality compared with never smokers. Both duration of smoking cessation and age at quitting have independent effects on lung cancer mortality, after controlling for number of cigarettes smoked per day and number of years smoked, as well as other potential confounding variables. CONCLUSION These findings suggest that programs and policies to promote early cessation of smoking and prevention of relapse should be a public health priority.
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Affiliation(s)
- Bo Zhang
- Ontario Tobacco Research Unit, University of Toronto, Toronto, Canada.
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Ebbert JO, Janney CA, Sellers TA, Folsom AR, Cerhan JR. The association of alcohol consumption with coronary heart disease mortality and cancer incidence varies by smoking history. J Gen Intern Med 2005; 20:14-20. [PMID: 15693922 PMCID: PMC1490037 DOI: 10.1111/j.1525-1497.2005.40129.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effect of alcohol on coronary heart disease (CHD), cancer incidence, and cancer mortality by smoking history. DESIGN/SETTING A prospective, general community cohort was established with a baseline mailed questionnaire completed in 1986. PARTICIPANTS A population-based sample of 41,836 Iowa women aged 55-69 years. MEASUREMENTS Mortality (total, cancer, and CHD) and cancer incidence outcomes were collected through 1999. Relative hazard rates (HR) were calculated using Cox regression analyses. MAIN RESULTS Among never smokers, alcohol consumption (> or =14 g/day vs none) was inversely associated with age-adjusted CHD mortality (HR, 0.40; 95% confidence interval [CI], 0.19 to 0.84) and total mortality (HR, 0.71; 95% CI, 0.55 to 0.92). Among former smokers, alcohol consumption was also inversely associated with CHD mortality (HR, 0.45; 95% CI, 0.23 to 0.88) and total mortality (HR, 0.78; 95% CI, 0.62 to 0.97), but was positively associated with cancer incidence (HR, 1.25; 95% CI, 1.03 to 1.51). Among current smokers, alcohol consumption was not associated with CHD mortality (HR, 1.05; 95% CI, 0.73 to 1.50) or total mortality (HR, 1.07; 95% CI, 0.92 to 1.25), but was positively associated with cancer incidence (HR, 1.30; 95% CI, 1.10 to 1.54). CONCLUSIONS Health behavior counseling regarding alcohol consumption for cardioprotection should include a discussion of the lack of a decreased risk of CHD mortality for current smokers and the increased cancer risk among former and current smokers.
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Affiliation(s)
- Jon O Ebbert
- Nicotine Research Center, Division of Community Internal Medicine, Rochester, MN 55905, USA.
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McDonald JA, Mandel MG, Marchbanks PA, Folger SG, Daling JR, Ursin G, Simon MS, Bernstein L, Strom BL, Norman SA, Malone KE, Weiss LK, Burkman RT, Weber AL, Spirtas R. Alcohol Exposure and Breast Cancer: Results of the Women's Contraceptive and Reproductive Experiences Study. Cancer Epidemiol Biomarkers Prev 2004. [DOI: 10.1158/1055-9965.2106.13.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Objectives: To explore associated biological outcomes and clarify the role of timing of exposure in the alcohol-breast cancer relationship.
Methods: In a population-based study of 4,575 women ages 35 to 64 years diagnosed with invasive breast cancer between 1994 and 1998 and 4,682 controls, we collected details of lifetime alcohol use and factors that could confound or modify the alcohol-breast cancer relationship. We used conditional logistic regression to compute the odds of breast cancer among drinkers relative to nondrinkers at all ages and at ages 35 to 49 and 50 to 64 years separately.
Results: Recent consumption (at reference age minus two) of ≥7 drinks per week was associated with increased risk [odds ratio (OR), 1.2; 95% CI, 1.01-1.3] and evidence of dose response was observed. Most of the excess was observed among women ages 50-64 years (OR 1.3; 95% CI, 1.1-1.6), although the test for age interaction was not statistically significant. Exposure later in life seemed more important than early exposure. Excess breast cancer associated with recent consumption was restricted to localized disease. When outcome was examined according to tumor hormone receptor status, highest risks were observed for estrogen receptor–positive/progesterone receptor–negative tumors (OR 1.6; 95% CI, 1.2-2.3).
Conclusions: The effect of timing of alcohol exposure on breast cancer risk is complicated and will require additional study focused on this one issue. Further work is needed to explain how alcohol exposure, sex hormones, and tumor receptor status interact.
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Affiliation(s)
- Jill A. McDonald
- 1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- 2Medical Biostatistics, College of Medicine, University of Vermont, Burlington, Vermont
| | - Michele G. Mandel
- 1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Polly A. Marchbanks
- 1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suzanne G. Folger
- 1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet R. Daling
- 3Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Giske Ursin
- 4Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
- 5Institute for Nutrition Research, University of Oslo, Oslo, Norway
| | | | - Leslie Bernstein
- 4Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Brian L. Strom
- 8Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sandra A. Norman
- 8Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Linda K. Weiss
- 7Division of Epidemiology, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan
| | - Ronald T. Burkman
- 9Department of Obstetrics and Gynecology, Bay State Medical Center, Springfield, Massachusetts; and
| | - Anita L. Weber
- 8Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Spirtas
- 10Contraception and Reproductive Health Branch, Center for Population Research, National Institute of Child Health and Human Development, Bethesda, Maryland
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Abstract
Low alcohol consumption seems to decrease total mortality and to have beneficial properties on cardiovascular disease; data for cancer are still inconclusive. There is evidence that wine consumption decreases the risk of cancer at several sites, including cancer of upper digestive tract, lung, colon, basal cell carcinoma, and non-Hodgkin lymphoma. The presence of resveratrol, a polyphenol specifically present in red wine, may contribute to these cancer preventive effects. Resveratrol in fact inhibits the metabolic activation of carcinogens, has antioxidant and anti-inflammatory properties, decreases cell proliferation and induces apoptosis. Data on the availability of resveratrol in vivo are however still lacking. Although regular consumption of one or two glasses of wine seems reasonably safe from the health point of view, a recommendation to the general population for low wine consumption is not justified.
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Affiliation(s)
- F Bianchini
- International Agency for Research on Cancer, Unit of Chemoprevention, Lyon Cedex, France.
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25
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Thomson CA, Flatt SW, Rock CL, Ritenbaugh C, Newman V, Pierce JP. Increased fruit, vegetable and fiber intake and lower fat intake reported among women previously treated for invasive breast cancer. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:801-8. [PMID: 12067045 DOI: 10.1016/s0002-8223(02)90180-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To describe the dietary intake patterns of women before and after breast cancer diagnosis. SUBJECTS AND SETTING 3,084 women (age range 27 to 70 years) who had been treated for early-stage breast cancer, who were free of recurrent disease, and who were willing to complete study questionnaires. DESIGN A descriptive analysis of baseline demographic and lifestyle questionnaire data, including reported dietary intake data from women who have had breast cancer participating in a randomized, controlled dietary intervention trial. Outcomes include dietary intakes of high- and low-fat foods, fruits and vegetables, and whole grains. STATISTICAL ANALYSIS PERFORMED Analyses included frequency of intake of selected food items, chi2 analysis to determine associations between reported intakes and demographic and personal characteristics, and logistic regression to assess odds of making more healthful changes. RESULTS Women who have had breast cancer reported higher fruit, vegetable, and fiber-rich food intakes (58%, 60%, 38% more, respectively) and lower intakes of high-fat foods, including fast foods, after diagnosis. Those older than age 60 years were more likely to report no change in intake, including red meat (41%), vegetables (51%), and whole grains (62%). Odds ratios (OR) for more healthful diet choices varied by age and time since diagnosis. The longer the time since diagnosis the more likely women selected low-fat (vs high-fat) foods (OR 1.56, 95% confidence interval [CI] 1.16-2.09 for 3 to 4 years vs <1 year after diagnosis) and reduced added fats (OR 1.47, 95% CI 1.17-1.84 for 3 to 4 years vs <1 year after diagnosis). APPLICATIONS Women who have had breast cancer report more healthful diet habits after diagnosis. Through nutrition education and counseling, dietetics professionals may be able to promote healthful and evidence-based eating habits among women previously treated for breast cancer.
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Affiliation(s)
- Cynthia A Thomson
- Department of Nutritional Sciences, University of Arizona, Arizona Cancer Center, Tucson 85724, USA
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