Alcohol Consumption Before and After Breast Cancer Diagnosis: Associations With Survival From Breast Cancer, Cardiovascular Disease, and Other Causes

Article · April 2013with13 Reads
DOI: 10.1200/JCO.2012.46.5765 · Source: PubMed
PURPOSEAlcohol 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 methodsWe 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 1985 to 2006 at ages 20 to 79 years. All women reported on prediagnostic intake; a subsample of 4,881 reported on postdiagnostic intake.ResultsDuring 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.
    • These findings indicate that health behavior and associated sociodemographic factors with them in gastric cancer survivors are one of the most important issues in cancer survivor management. Although researchers' attention has been devoted to evaluating health behavior patterns of cancer survivors in Western countries[7][8][9], the majority of findings were not focused on gastric cancer which is relatively uncommon in these regions[1]. Thus, this study investigated the prevalence of smoking, alcohol drinking, and physical inactivity in gastric cancer survivors compared to non-cancer controls and the associated sociodemographic factors with aforementioned health-related characteristics, using population based data in Korea where gastric cancer incidence is one of the highest worldwide[5].
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: This study investigated the prevalence of smoking, drinking, and physical inactivity and the associated factors of these behaviors in gastric cancer survivors. Materials and methods: The baseline data from the nationwide cohort study was used. 437 gastric cancer survivors who survived ≥2 years from diagnosis and reported completion of treatment were matched with 4,370 controls according to age, gender, education, and household income. Results: The prevalence rates of current smoking and drinking among gastric cancer survivors were 8.7% and 38.3%, which were significantly lower than those among matched controls (p-value ≤ 0.001), but the prevalence rates of physical inactivity were not significantly different (55.8% vs. 59.9%, P-value=0.248). In gastric cancer survivors, ≥5 years since cancer diagnosis and current drinking contributed to more current smoking; otherwise, age increment and female were associated with lower current smoking. Those with household income ≥2000$ and current smokers were more likely to drink and female showed less drinkin. Female, currently employed state, and self-rated health status were associated with more physical inactivity. Conclusion: Although gastric cancer survivors showed better health behaviors than controls, suggesting that the diagnosis of cancer may motivate individuals towards healthy behaviors, their current prevalence rates of smoking and drinking were still high, and more than 50% of them were physically inactive. Tailored interventions to improve their health behaviors considering associated factors for the gastric cancer survivors are necessary.
    Article · Jul 2017
    • The prevalence of daily drinking among the total sample from the parent study was in line with national estimates (20%)[14][15][16]; however, drinking quantity was lower than that found in other survivor samples. Specifically, 15-18% of breast cancer survivors from large cohort samples reported consuming 1+ drinks per day[15,16], compared with our sample where 11% of participants drank more than 1 standard drink per day and an additional 9% drank about half a drink per day. This difference may be due to our rural sample of overweight or obese women interested in losing weight.
    [Show abstract] [Hide abstract] ABSTRACT: Background Daily alcohol intake in quantities as small as half a drink/day significantly increases the risk of breast cancer recurrence for postmenopausal survivors. Interventions designed to modify alcohol use among survivors have not been studied; however, lifestyle interventions that target change in dietary intake may affect alcohol intake. Objective To evaluate change in alcohol use during a weight loss intervention for obese, rural-dwelling breast cancer survivors. Methods Data were derived from an 18-month trial that included a 6-month weight loss intervention delivered via group conference calls, followed by a 12-month randomized weight loss maintenance phase in which participants received continued group calls or mailed newsletters. Participants who reported regular alcohol use at baseline (N=37) were included in this study. Results Mean daily alcohol intake significantly decreased from baseline to 6 months during the weight loss intervention (19.6-2.3 g; P=.001). Mean alcohol intake did not significantly increase (b=0.99, P=.12) during the weight loss maintenance phase (months 6-18) and did not depend on randomization group (b=0.32, P=.799). Conclusions Findings provide preliminary evidence that a weight loss intervention may address obesity and alcohol use risk factors for cancer recurrence. Minimal mail-based contact post weight loss can maintain alcohol use reductions through 18 months, suggesting durability in these effects. These results highlight a possibility that lifestyle interventions for survivors may modify health behaviors that are not the main foci of an intervention but that coincide with intervention goals. Trial Registration NCT01441011; (Archived by WebCite at
    Full-text · Article · Nov 2016
    • The impact of alcohol on cancer risk remains inconclusive due to seemingly conflicting data in several reports (Allen et al., 2009;Brandon-Warner, Walling, Schrum, & McKillop, 2012;Fowke, Howard, Andriole, & Freedland, 2014;Garcia-Lavandeira, RuanoRavina, & Barros-Dios, 2016;Gong, Kristal, Schenk, Tangen, Goodman, & Thompson, 2009;Newcomb et al., 2013;). These conflicting reports may be partially due to the study of different types of cancer, such as prostate, liver, breast, lung and melanoma, but also are due in large part to direct effects of alcohol on the immune system.
    [Show abstract] [Hide abstract] ABSTRACT: Dendritic cells (DCs) are a critical component of anti-tumor immunity due to their ability to induce a robust immune response to antigen (Ag). Alcohol was previously shown to reduce DC ability to present foreign Ag and promote pro-inflammatory responses in situations of infection and trauma. However the impact of alcohol exposure on generation of an anti-tumor response, especially in the context of generation of an immune vaccine has not been examined. In the clinic, DC vaccines are typically generated from autologous blood, therefore prior exposure to substances such as alcohol may be a critical factor to consider regarding the effectiveness in generating an immune response. In this study we demonstrate for the first time that ethanol differentially affects DC and tumor Ag-specific T cell responses depending on sex. Signaling pathways were found to be differentially regulated in DC in females compared to males and these differences were exacerbated by ethanol treatment. DC from female mice treated with ethanol were unable to activate Ag-specific cytotoxic T cells (CTL) as shown by reduced expression of CD44, CD69, and decreased production of granzyme B and IFNγ. Furthermore, although FOXO3, an immune suppressive mediator of DC function, was found to be upregulated in DC from female mice, ethanol related suppression was independent of FOXO3. These findings demonstrate for the first time differential impacts of alcohol on the immune system of females compared to males and may be a critical consideration for determining the effectiveness of an immune based therapy for cancer in patients that consume alcohol.
    Full-text · Article · Oct 2016
    • Breast cancer survivors enrolled in the Health, Eating, Activity, and Lifestyle (HEAL) study, participating in moderate-intensity recreational physical activity after diagnosis, had 64% lower risk of death versus inactive women (). Consistent with our findings a review of several studies showed that physical activity levels were low among cancer survivors and that most cancer survivors were interested in increasing their activity levels (Newcomb et al., 2013; Szymlek-Gay et al., 2011). In contrast, 50.8% of those who " strongly agree " and 37% of those who " agree " with the statement " engaging in regular physical activity will reduce the risk of breast cancer recurrence " actually engaged in the ACS' recommendations for exercise (Weiner et al., 2010).
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this secondary analysis was to describe the extent to which women with breast cancer, who participated in a randomized control trial on exercise, adopted American Cancer Society (ACS) guidelines for healthy lifestyle behaviors. Women in the study exercised during cancer treatment and for 6 months after completion of treatment. The sample included 106 women, average age 50.7 years (SD = 9.6). Adherence to guidelines for 5 servings of fruits and vegetables ranged from 36% (n = 28) to 39% (n = 36). Adherence with alcohol consumption guidelines was 71% (n = 28) to 83% (n = 30). Adherence with meeting a healthy weight ranged from 52% (n = 33) to 61% (n = 31). Adherence with physical activity guidelines ranged from 13% (n = 30) to 31% (n = 35). Alcohol and healthy weight guidelines were followed by more than half of the participants, but physical activity and dietary guidelines were followed by far fewer women. Further prospective clinical studies are indicated to determine whether interventions are effective in producing a healthy lifestyle in cancer survivors.
    Full-text · Article · Oct 2014
    • Accordingly, experts have stated that the Mediterranean way of drinking alcohol -regular and moderate consumption of polyphenol-rich wine mainly with folate-rich foods -does not appreciably influence the overall risk of cancer [123]. Given that moderate alcohol consumption also reduces the risk of cardiovascular disease [124], it appears that consuming approximately one alcoholic drink per day on average, including after BC diagnosis, is associated with optimal life expectancy without compromising BC-specific survival125126127.
    [Show abstract] [Hide abstract] ABSTRACT: Background Physical exercise and healthy dietary habits are recommended to prevent breast cancer. Discussion Increased intake of omega-3 fatty acids associated with decreased omega-6 - resulting in higher omega-3 to omega-6 ratio compared with Western-type diet - is inversely associated with breast cancer risk. The modernized Mediterranean diet with high omega-3 to omega-6 ratio, high fiber and polyphenol intake, and consumption of low-glycemic index foods reduces overall cancer risk and specifically breast cancer risk. It has been suggested that consuming no more than one alcoholic drink per day, preferably wine, is preferable. Eliminating environmental contaminants, including endocrine disruptors, and favoring organic foods to increase polyphenol intake and the omega-3 to omega-6 ratios were also shown to be beneficial. Cholesterol-lowering statins may decrease antitumor defenses; are toxic for the mitochondria; decrease the omega-3 to omega-6 ratio; increase body mass index, insulin resistance and diabetic risk; and have been associated with an increased breast cancer risk. Summary Therefore, as well as making lifestyle changes to decrease breast cancer risk, we argue that physicians should carefully consider (and often avoid) therapies that may increase breast cancer or diabetes risk in high-risk women and women who wish to decrease their breast cancer risk.
    Article · Jun 2014
    • The majority of studies report no association between alcohol consumption and overall survival (Holmes et al. 1999; Dal Maso et al. 2008; Hellmann et al. 2010; Kwan et al. 2010; Ali et al. 2014) or breast cancer-specific survival (Dal Maso et al. 2008; Harris et al. 2012; Holm et al. 2013). Some studies report a protective effect from alcohol consumption on overall survival (Harris et al. 2012; Reding et al. 2008; Barnett et al. 2008; Flatt et al. 2010) and breast cancer-specific survival (Ali et al. 2014; Reding et al. 2008; Flatt et al. 2010; Newcomb et al. 2013), while other studies report higher breast cancer-specific mortality (Kwan et al. 2010; Allemani et al. 2011; Vrieling et al. 2012). Five studies have investigated the association between alcohol consumption and recurrence of breast cancer (Kwan et al. 2010; Holm et al. 2013; Flatt et al. 2010; Vrieling et al. 2012; Kwan et al. 2013), and two of these report an increased risk of breast cancer recurrence (Kwan et al. 2010; Holm et al. 2013).
    [Show abstract] [Hide abstract] ABSTRACT: Purpose To investigate the association between pre- and postoperative alcohol consumption and risk for early breast cancer events, since the association between alcohol consumption and prognosis in breast cancer patients is unclear. Methods Alcohol consumption was recorded for 934 primary breast cancer patients who underwent breast cancer surgery in Lund, Sweden, between 2002 and 2011 and were followed until December 31st 2012. Clinical data were obtained from medical records and population registries. Pre- and postoperative alcohol consumption was analyzed in relation to risk for early events. Results Median follow-up time was 3.03 years and 100 breast cancer events, 65 distant metastases, and 76 deaths occurred. Compared to no consumption, any preoperative alcohol consumption was weakly associated with lower risk for early events, adjusted HR 0.69 (0.45-1.04), distant metastases, 0.60 (0.36-1.00) and death, 0.62 (0.38-1.01). In the 572 patients without axillary lymph node involvement, any alcohol consumption was not associated with risk for early events. However, in the 360 patients with axillary lymph node involvement, preoperative alcohol consumption was associated with lower risk for early events (adjusted HR 0.43 0.24-0.77; Pinteraction = 0.01). Conclusion Pre- and postoperative alcohol consumption was weakly associated with lower risk for early breast cancer events. The data does not support recommending that all breast cancer patients abstain from low to moderate alcohol consumption.
    Full-text · Article · May 2014
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        Background Daily alcohol intake in quantities as small as half a drink/day significantly increases the risk of breast cancer recurrence for postmenopausal survivors. Interventions designed to modify alcohol use among survivors have not been studied; however, lifestyle interventions that target change in dietary intake may affect alcohol intake. Objective To evaluate change in alcohol use... [Show full abstract]
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