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Alcohol and Breast Cancer in Women A Pooled Analysis of Cohort Studies

Stephanie A. Smith-Warner, PhD; Donna Spiegelman, ScD; Shiaw-Shyuan Yaun, MPH; Piet A. van den Brandt, PhD; Aaron R. Folsom, MD; R. Alexandra Goldbohm, PhD; Saxon Graham, PhD; Lars Holmberg, MD, PhD; Geoffrey R. Howe, PhD; James R. Marshall, PhD; Anthony B. Miller, MB, BCh; John D. Potter, MB, BS, PhD; Frank E. Speizer, MD; Walter C. Willett, MD; Alicja Wolk, DMSc; David J. Hunter, MB, BS
JAMA. 1998;279(7):535-540. doi:10.1001/jama.279.7.535.
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Objective.— To assess the risk of invasive breast cancer associated with total and beverage-specific alcohol consumption and to evaluate whether dietary and nondietary factors modify the association.

Data Sources.— We included in these analyses 6 prospective studies that had at least 200 incident breast cancer cases, assessed long-term intake of food and nutrients, and used a validated diet assessment instrument. The studies were conducted in Canada, the Netherlands, Sweden, and the United States. Alcohol intake was estimated by food frequency questionnaires in each study. The studies included a total of 322647 women evaluated for up to 11 years, including 4335 participants with a diagnosis of incident invasive breast cancer.

Data Extraction.— Pooled analysis of primary data using analyses consistent with each study's original design and the random-effects model for the overall pooled analyses.

Data Synthesis.— For alcohol intakes less than 60 g/d (reported by >99% of participants), risk increased linearly with increasing intake; the pooled multivariate relative risk for an increment of 10 g/d of alcohol (about 0.75-1 drink) was 1.09 (95% confidence interval [CI], 1.04-1.13; P for heterogeneity among studies, .71). The multivariate-adjusted relative risk for total alcohol intakes of 30 to less than 60 g/d (about 2-5 drinks) vs nondrinkers was 1.41 (95% CI, 1.18-1.69). Limited data suggested that alcohol intakes of at least 60 g/d were not associated with further increased risk. The specific type of alcoholic beverage did not strongly influence risk estimates. The association between alcohol intake and breast cancer was not modified by other factors.

Conclusions.— Alcohol consumption is associated with a linear increase in breast cancer incidence in women over the range of consumption reported by most women. Among women who consume alcohol regularly, reducing alcohol consumption is a potential means to reduce breast cancer risk.

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Nonparametric regression curve for the relationship between total alcohol intake and breast cancer.

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