Smoking and alcohol consumption in relation to risk of triple-negative breast cancer in a cohort of postmenopausal women
Little is known about the risk factors for triple-negative breast cancer (TNBC), which has a worse prognosis compared to hormone receptor-positive breast cancer. We examined the association of smoking and alcohol intake with TNBC and estrogen receptor-positive (ER+) breast cancer.
Among 148,030 women enrolled in the Women’s Health Initiative, 300 TNBC cases and 2,479 ER+ cases were identified over a median of 8.0 years of follow-up. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI).
Cigarette smoking was not associated with TNBC, whereas drinkers had reduced risk compared to never drinkers. In contrast, both exposures showed slight positive associations with ER+ breast cancer: for women with ≥40 pack-years of smoking, the HR was 1.24, 95% CI 1.06–1.44; for women consuming ≥7 servings of alcohol per week, the HR was 1.26, 95% CI 1.06–1.50. Intakes of wine and hard liquor were also significantly positively associated with ER+ breast cancer.
These findings from a large cohort of postmenopausal women suggest that smoking and alcohol consumption are not associated with increased risk of TNBC, but may be modestly associated with increased risk of ER+ breast cancer.
KeywordsBreast neoplasms Triple-negative Estrogen receptor-positive Cigarette smoking Alcohol consumption Postmenopausal women
Conflicts of interest
- 4.Carey LA, Winer E, Viale G, Cameron D, Gianni L (2010) Triple-negative breast cancer: disease entity or title of convenience. Nat Rev Clin Oncol. doi: 10.1038/nrclinonc.2010.154
- 5.Parise CA, Bauer KR, Brown MM, Caggiano V (2009) Breast cancer subtypes as defined by the estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2) among women with invasive breast cancer in California, 1999–2004. Breast J 15:593–602PubMedCrossRefGoogle Scholar
- 7.Kreike B, van Kouwenhove M, Horlings H, et al. (2007) Gene expression profiling and histopathological characterization of triple-negative/basal-like breast carcinomas. Breast Cancer Res 9:R65 doi: 10.1186/bcr1771
- 10.Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V (2007) Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor(PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer registry. Cancer 109:1721–1728PubMedCrossRefGoogle Scholar
- 21.Collaborative Group on Hormonal Factors in Breast Cancer (2002) Alcohol, tobacco and breast cancer–collaborative reanalysis of individual data from 53 epidemiological studies, including 58, 515 women with breast cancer and 95, 067 women with the disease. Br J Cancer 87:1234–1245CrossRefGoogle Scholar
- 28.Curb JD, McTiernan A, Heckbert SR, et al. (2003) Outcomes ascertainment and adjudication methods in the women’s health initiative. Ann Epidemiol (9 Suppl): S122–S128Google Scholar
- 30.Kabat GC, Kim M, Kakani C, et al. (2010) Cigarette smoking in relation to risk of ductal carcinoma in situ of the breast in a cohort of postmenopausal women. Am J Epidemiol doi: 10.1093/aje/kwq159