Article

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

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Polly A. Newcomb and Michael N. Passarelli, Fred Hutchinson Cancer Research Center, Seattle, WA
(Impact Factor: 18.43). 04/2013; 31(16). DOI: 10.1200/JCO.2012.46.5765
Source: PubMed

ABSTRACT

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.

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• "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). "
##### Article: Pre- and postoperative alcohol consumption in breast cancer patients: Impact on early events
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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 · SpringerPlus
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• ") 10% (Saxe et al., 1999, 0.98 (0.88 1.11) 0% Saxe et al., 1999, Jain et al., 2000, Reding et al., 2008, Flatt et al., 2010, Hellmann et al., 2010, Kwan et al., 2010, Kwan et al., 2010, Breslow et al., 2011, Harris et al., 2012, Vrieling et al., 2012, Kwan et al., 2013) Kwan et al., 2013) >10g/d (Ewertz et al., 1991, Rohan et al., 1993, Fuchs et al., 1995, Thun et al., 1997, Holmes et al., 1999, 1.03 (0.97 1.10) 51% (Kwan et al., 2013) 1.09 (0.94 1.26) Jain et al., 2000, Reding et al., 2008, Franceschi et al., 2009, Flatt et al., 2010, Hellmann et al., 2010, Allemani et al., 2011, Breslow et al., 2011, Harris et al., 2012, Vrieling et al., 2012, Kwan et al., 2013, Newcomb et al., 2013) <15g/d (Ewertz et al., 1991, Rohan et al., 1993, Fuchs et al., 1995, Zhang et al., 1995, Thun et al., 1997, Holmes et al., 1999, 0.95 (0.90 1.01) 9% (Saxe et al., 1999, 1.00 (0.91 1.10) 0% Saxe et al., 1999, Jain et al., 2000, Reding et al., 2008, Franceschi et al., 2009, Flatt et al., 2010, Hellmann et al., 2010, Kwan et al., 2010, Kwan et al., 2010, Allemani et al., 2011, Breslow et al., 2011, Harris et al., 2012, Vrieling et al., 2012, Kwan et al., 2013, Newcomb et al., 2013) Kwan et al., 2013) >15g/d (Ewertz et al., 1991, Fuchs et al., 1995, Thun et al., 1997, Holmes et al., 1999, Jain et al., 2000, 1.08 (0.98 1.18) 36% (Kwan et al., 2013) 1.04 (0.83 1.30) Franceschi et al., 2009, Hellmann et al., 2010, Kwan et al., 2013, Newcomb et al., 2013) <20g/d (Ewertz et al., 1991, Rohan et al., 1993, Fuchs et al., 1995, Zhang et al., 1995, Thun et al., 1997, Holmes et al., 1999, 0.96 (0.92 1.01) 14% (Saxe et al., 1999, 1.00 (0.91 1.10) 0% Saxe et al., 1999, Jain et al., 2000, Reding et al., 2008, Franceschi et al., 2009, Flatt et al., 2010, Hellmann et al., 2010, Kwan et al., 2010, Kwan et al., 2010, Allemani et al., 2011, Breslow et al., 2011, Harris et al., 2012, Vrieling et al., 2012, Kwan et al., 2013, Newcomb et al., 2013) Kwan et al., 2013) >20g/d (Fuchs et al., 1995, Thun et al., 1997, Jain et al., 2000, Franceschi et al., 2009, Hellmann et al., 2010, Kwan et al., 2013) "
##### Article: Alcohol Consumption and Breast Cancer Survival: A Meta-analysis of Cohort Studies
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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.
Full-text · Article · Aug 2013 · Asian Pacific journal of cancer prevention: APJCP
• ##### Article: McDonald JA, Goyal A, Terry MBAlcohol intake and breast cancer risk: weighing the overall evidence. Curr Breast Cancer Rep 5: 208-221
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ABSTRACT: Moderate alcohol consumption has been linked to an approximate 30 %–50 % increased risk in breast cancer. Case-control and cohort studies have consistently observed this modest increase. We highlight recent evidence from molecular epidemiologic studies and studies of intermediate markers like mammographic density that provide additional evidence that this association is real and not solely explained by factors/correlates of the exposure and outcome present in nonrandomized studies. We also review evidence from studies of higher risk women including BRCA1 and BRCA2 mutation carriers. Given the incidence of heart disease is higher than breast cancer and modest alcohol consumption is associated with reduced risk of heart disease, we examine the latest evidence to evaluate if alcohol reduction should be targeted to women at high risk for breast cancer. We also review the most recent evidence on the effect of alcohol use on tumor recurrence and survival for those diagnosed with breast cancer.
No preview · Article · Sep 2013 · Current Breast Cancer Reports