Current Breast Cancer Reports

, Volume 5, Issue 3, pp 208–221

Alcohol Intake and Breast Cancer Risk: Weighing the Overall Evidence

  • Jasmine A. McDonald
  • Abhishek Goyal
  • Mary Beth Terry
Risk, Prevention, and Screening (DL Hershman, Section Editor)

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.

Keywords

Alcohol Alcohol dehydrogenase (ADH) BRCA1 BRCA2 Breast cancer Mammographic density Risk Prevention Screening Review 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Seitz HK, Pelucchi C, Bagnardi V, La Vecchia C. Epidemiology and pathophysiology of alcohol and breast cancer: Update 2012. Alcohol Alcoholism. 2012;47:204–12.Google Scholar
  2. 2.
    Dumitrescu RG, Shields PG. The etiology of alcohol-induced breast cancer. Alcohol. 2005;35:213–25.PubMedCrossRefGoogle Scholar
  3. 3.
    Oyesanmi O, Snyder D, Sullivan N, et al. Alcohol consumption and cancer risk: understanding possible causal mechanisms for breast and colorectal cancers. Evid Rep Technol Assess. 2010;197:1–151.Google Scholar
  4. 4.
    Fernandez SV. Estrogen, alcohol consumption, and breast cancer. Alcohol Clin Exp Res. 2011;35:389–91.PubMedCrossRefGoogle Scholar
  5. 5.
    Singletary KW, Gapstur SM. Alcohol and breast cancer: review of epidemiologic and experimental evidence and potential mechanisms. JAMA. 2001;286:2143–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Terry MB, Zhang FF, Kabat G, et al. Lifetime alcohol intake and breast cancer risk. Ann Epidemiol. 2006;16:230–40.PubMedCrossRefGoogle Scholar
  7. 7.
    • Chen WY, Rosner B, Hankinson SE, et al. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA. 2011;306:1884–90. The prospective Nurses’ Health Study found levels as low as 3–6 drinks/wk were associated with increased breast cancer risk. Stratified analysis found that alcohol consumption at ages 18–40 years and after age 40 was independently associated with increased breast cancer risk. Alcohol consumption was also strongly associated with hormone receptor positive tumor status.PubMedCrossRefGoogle Scholar
  8. 8.
    Smith-Warner SA, Spiegelman D, Yaun SS, et al. Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA. 1998;279:535–40.PubMedCrossRefGoogle Scholar
  9. 9.
    Boffetta P, Hashibe M. Alcohol and cancer. Lancet Oncol. 2006;7:149–56.PubMedCrossRefGoogle Scholar
  10. 10.
    Hamajima N, Hirose K, Tajima K, et al. 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 without the disease. Br J Cancer. 2002;87:1234–45.PubMedCrossRefGoogle Scholar
  11. 11.
    Bosron WF, Li TK. Genetic polymorphism of human liver alcohol and aldehyde dehydrogenases, and their relationship to alcohol metabolism and alcoholism. Hepatology. 1986;6:502–10.PubMedCrossRefGoogle Scholar
  12. 12.
    Seitz HK, Oneta CM. Gastrointestinal alcohol dehydrogenase. Nutr Rev. 1998;56(2 Pt 1):52–60.PubMedGoogle Scholar
  13. 13.
    Wright RM, McManaman JL, Repine JE. Alcohol-induced breast cancer: a proposed mechanism. Free Radic Biol Med. 1999;26:348–54.PubMedCrossRefGoogle Scholar
  14. 14.
    Crabb DW, Matsumoto M, Chang D, You M. Overview of the role of alcohol dehydrogenase and aldehyde dehydrogenase and their variants in the genesis of alcohol-related pathology. Proc Nutr Soc. 2004;63:49–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Druesne-Pecollo N, Tehard B, Mallet Y, et al. Alcohol and genetic polymorphisms: effect on risk of alcohol-related cancer. Lancet Oncol. 2009;10:173–80.PubMedCrossRefGoogle Scholar
  16. 16.
    Fan S, Meng Q, Gao B, et al. Alcohol stimulates estrogen receptor signaling in human breast cancer cell lines. Cancer Res. 2000;60:5635–9.PubMedGoogle Scholar
  17. 17.
    Seitz HK, Stickel F. Acetaldehyde as an underestimated risk factor for cancer development: role of genetics in ethanol metabolism. Genes Nutr. 2010;5:121–8.Google Scholar
  18. 18.
    Hines LM, Hankinson SE, Smith-Warner SA, et al. A prospective study of the effect of alcohol consumption and ADH3 genotype on plasma steroid hormone levels and breast cancer risk. Cancer Epidemiol Biomark Prev. 2000;9:1099–105.Google Scholar
  19. 19.
    Freudenheim JL, Ambrosone CB, Moysich KB, et al. Alcohol dehydrogenase 3 genotype modification of the association of alcohol consumption with breast cancer risk. Cancer Causes Control. 1999;10:369–77.Google Scholar
  20. 20.
    Coutelle C, Hohn B, Benesova M, et al. Risk factors in alcohol associated breast cancer: alcohol dehydrogenase polymorphism and estrogens. Int J Oncol. 2004;25:1127–32.PubMedGoogle Scholar
  21. 21.
    Terry MB, Gammon MD, Zhang FF, et al. ADH3 genotype, alcohol intake and breast cancer risk. Carcinogenesis. 2006;27:840–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Terry MB, Knight JA, Zablotska L, et al. Alcohol metabolism, alcohol intake, and breast cancer risk: a sister-set analysis using the Breast Cancer Family Registry. Breast Cancer Res Treat. 2007;106:281–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Visvanathan K, Crum RM, Strickland PT, et al. Alcohol dehydrogenase genetic polymorphisms, low-to-moderate alcohol consumption, and risk of breast cancer. Alcohol Clin Exp Res. 2007;31:467–76.Google Scholar
  24. 24.
    McCarty CA, Reding DJ, Commins J, et al. Alcohol, genetics, and risk of breast cancer in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Breast Cancer Res Treat. 2012;133:785–92.PubMedCrossRefGoogle Scholar
  25. 25.
    Benzon Larsen S, Vogel U, Christensen J, et al. Interaction between ADH1C Arg(272)Gln and alcohol intake in relation to breast cancer risk suggests that ethanol is the causal factor in alcohol related breast cancer. Cancer Lett. 2010;295:191–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Sturmer T, Wang-Gohrke S, Arndt V, et al. Interaction between alcohol dehydrogenase II gene, alcohol consumption, and risk for breast cancer. Br J Cancer. 2002;87:519–23.PubMedCrossRefGoogle Scholar
  27. 27.
    Lilla C, Koehler T, Kropp S, et al. Alcohol dehydrogenase 1B (ADH1B) genotype, alcohol consumption and breast cancer risk by age 50 years in a German case-control study. Br J Cancer. 2005;92:2039–41.PubMedCrossRefGoogle Scholar
  28. 28.
    Kawase T, Matsuo K, Hiraki A, et al. Interaction of the effects of alcohol drinking and polymorphisms in alcohol-metabolizing enzymes on the risk of female breast cancer in Japan. J Epidemiol. 2009;19:244–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Brennan P, Lewis S, Hashibe M, et al. Pooled analysis of alcohol dehydrogenase genotypes and head and neck cancer: a huge review. Am J Epidemiol. 2004;159:1–16.PubMedCrossRefGoogle Scholar
  30. 30.
    Martin LJ, Boyd NF. Mammographic density. Potential mechanisms of breast cancer risk associated with mammographic density: hypotheses based on epidemiological evidence. Breast Cancer Res. 2008;10:201.PubMedCrossRefGoogle Scholar
  31. 31.
    Boyd NF, Martin LJ, Yaffe MJ, Minkin S. Mammographic density and breast cancer risk: current understanding and future prospects. Breast Cancer Res. 2011;13:223.PubMedCrossRefGoogle Scholar
  32. 32.
    Herrinton LJ, Saftlas AF, Stanford JL, et al. Do alcohol intake and mammographic densities interact in regard to the risk of breast cancer? Cancer. 1993;71:3029–35.PubMedCrossRefGoogle Scholar
  33. 33.
    Byrne C, Schairer C, Wolfe J, et al. Mammographic features and breast cancer risk: effects with time, age, and menopause status. J Natl Cancer Inst. 1995;87:1622–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Conroy SM, Koga K, Woolcott CG, et al. Higher alcohol intake may modify the association between mammographic density and breast cancer: an analysis of 3 case-control studies. Cancer Epidemiol. 2012;36:458–60.PubMedCrossRefGoogle Scholar
  35. 35.
    Wolfe JN. Breast patterns as an index of risk for developing breast cancer. Am J Roentgenol. 1976;126:1130–7.CrossRefGoogle Scholar
  36. 36.
    Wolfe JN. Risk for breast cancer development determined by mammographic parenchymal pattern. Cancer. 1976;37:2486–92.PubMedCrossRefGoogle Scholar
  37. 37.
    American College of Radiology. Breast imaging reporting and data system Atlas (BI-RADS). 4th ed. Reston, VA: American College of Radiology; 2003.Google Scholar
  38. 38.
    Boyd NF, Martin LJ, Yaffe M, Minkin S. Mammographic density. Breast Cancer Res. 2009;11 Suppl 3:S4.PubMedCrossRefGoogle Scholar
  39. 39.
    Yaffe M. Mammographic density. Measurement of mammographic density. Breast Cancer Res. 2008;10:209.PubMedCrossRefGoogle Scholar
  40. 40.
    Funkhouser E, Waterbor JW, Cole P, Rubin E. Mammographic patterns and breast cancer risk factors among women having elective screening. South Med J. 1993;86:177–80.Google Scholar
  41. 41.
    Sala E, Warren R, Duffy S, et al. High risk mammographic parenchymal patterns and diet: a case-control study. Br J Cancer. 2000;83:121–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Brisson J, Verreault R, Morrison AS, et al. Diet, mammographic features of breast tissue, and breast cancer risk. Am J Epidemiol. 1989;130:14–24.PubMedGoogle Scholar
  43. 43.
    Masala G, Ambrogetti D, Assedi M, et al. Dietary and lifestyle determinants of mammographic breast density. A longitudinal study in a Mediterranean population. Int J Cancer. 2006;118:1782–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Tseng M, Byrne C, Evers KA, Daly MB. Dietary intake and breast density in high-risk women: a cross-sectional study. Breast Cancer Res. 2007;9:R72.PubMedCrossRefGoogle Scholar
  45. 45.
    Gapstur SM, Lopez P, Colangelo LA, et al. Associations of breast cancer risk factors with breast density in Hispanic women. Cancer Epidemiol Biomark Prev. 2003;12:1074–80.Google Scholar
  46. 46.
    Qureshi SA, Couto E, Hofvind S, et al. Alcohol intake and mammographic density in postmenopausal Norwegian women. Breast Cancer Res Treat. 2012;131:993–1002.PubMedCrossRefGoogle Scholar
  47. 47.
    • Yaghjyan L, Mahoney MC, Succop P, et al. Relationship between breast cancer risk factors and mammographic breast density in the Fernald Community Cohort. Br J Cancer. 2012;106:996–1003. The longitudinal Fernald Community Cohort study defined low density (BI-RADS I) and high density (BI-RADS IV) as sustained low or high densities throughout the cohort’s follow-up. They found that among both pre- and postmenopausal women, ever users of alcohol were at twice the risk of having high breast density (BIRADS density IV vs I: OR 2.0; 95% CI 1.4–2.8) compared with never users.PubMedCrossRefGoogle Scholar
  48. 48.
    Jeon JH, Kang JH, Kim Y, et al. Reproductive and hormonal factors associated with fatty or dense breast patterns among Korean Women. Cancer Res Treat. 2011;43:42–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Boyd NF, Connelly P, Byng J, et al. Plasma lipids, lipoproteins, and mammographic densities. Cancer Epidemiol Biomark Prev. 1995;4:727–33.Google Scholar
  50. 50.
    Vachon CM, Kuni CC, Anderson K, et al. Association of mammographically defined percent breast density with epidemiologic risk factors for breast cancer (United States). Cancer Causes Control. 2000;11:653–62.PubMedCrossRefGoogle Scholar
  51. 51.
    Vachon CM, Kushi LH, Cerhan JR, et al. Association of diet and mammographic breast density in the Minnesota breast cancer family cohort. Cancer Epidemiol Biomark Prev. 2000;9:151–60.Google Scholar
  52. 52.
    Flom JD, Ferris JS, Tehranifar P, Terry MB. Alcohol intake over the life course and mammographic density. Breast Cancer Res Treat. 2009;117:643–51.PubMedCrossRefGoogle Scholar
  53. 53.
    Cabanes A, Pastor-Barriuso R, Garcia-Lopez M, et al. Alcohol, tobacco, and mammographic density: a population-based study. Breast Cancer Res Treat. 2011;129:135–47.PubMedCrossRefGoogle Scholar
  54. 54.
    Maskarinec G, Takata Y, Pagano I, et al. Alcohol consumption and mammographic density in a multiethnic population. Int J Cancer. 2006;118:2579–83.PubMedCrossRefGoogle Scholar
  55. 55.
    Vachon CM, Sellers TA, Janney CA, et al. Alcohol intake in adolescence and mammographic density. Int J Cancer. 2005;117:837–41.PubMedCrossRefGoogle Scholar
  56. 56.
    Boyd NF, McGuire V, Fishell E, et al. Plasma lipids in premenopausal women with mammographic dysplasia. Br J Cancer. 1989;59:766–71.PubMedCrossRefGoogle Scholar
  57. 57.
    Boyd NF, Melnichouk O, Martin LJ, et al. Mammographic density, response to hormones, and breast cancer risk. J Clin Oncol. 2011;29:2985–92.PubMedCrossRefGoogle Scholar
  58. 58.
    Vanderweele TJ, Adami HO, Tamimi RM. Mammographic density as a mediator for breast cancer risk: analytic approaches. Breast Cancer Res. 2012;14:317.PubMedGoogle Scholar
  59. 59.
    Horn-Ross PL, Canchola AJ, Bernstein L, et al. Alcohol consumption and breast cancer risk among postmenopausal women following the cessation of hormone therapy use: the California Teachers Study. Cancer Epidemiol Biomark Prev. 2012;21:2006–13.CrossRefGoogle Scholar
  60. 60.
    Centers for Disease Control and Prevention: Alcohol and Public Health. Available at: http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm. Accessed March 2013.
  61. 61.
    Ronksley PE, Brien SE, Turner BJ, et al. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011;342:d671.PubMedCrossRefGoogle Scholar
  62. 62.
    American Heart Association: Alcoholic Beverages and Cardiovascular Disease. Available at: http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Alcoholic-Beverages-and-Cardiovascular-Disease_UCM_305864_Article.jsp. Accessed March 2013.
  63. 63.
    National Institute of Alcohol Abuse and Alcoholism: moderate & binge drinking. Available at: http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking. Accessed March 2013.
  64. 64.
    The U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans. 7th ed. Washington, D.C: U.S. Government Printing Office; 2010.Google Scholar
  65. 65.
    Centers for Disease Control and Prevention (CDC)/National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survey Data 1999-2010. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed February 2013.
  66. 66.
    U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion: Healthy People 2020. Available at: http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=40#260956. Accessed March 2013.
  67. 67.
    Chiung M Chen, Hsiao-ye Yi PD, Deborah A Dawson, et al. Alcohol use and alcohol use disorders in the United States, a 3-year follow-up: main findings from the 2004–2005 Wave 2 National Epidemiologic Survey On Alcohol And Related Conditions (NESARC). National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health. September 2010;8.Google Scholar
  68. 68.
    Willett WC, Stampfer MJ, Colditz GA, et al. Moderate alcohol consumption and the risk of breast cancer. N Engl J Med. 1987;316:1174–80.PubMedCrossRefGoogle Scholar
  69. 69.
    Schatzkin A, Jones DY, Hoover RN, et al. Alcohol consumption and breast cancer in the epidemiologic follow-up study of the first National Health and Nutrition Examination Survey. N Engl J Med. 1987;316:1169–73.PubMedCrossRefGoogle Scholar
  70. 70.
    Vachon CM, Cerhan JR, Vierkant RA, Sellers TA. Investigation of an interaction of alcohol intake and family history on breast cancer risk in the Minnesota Breast Cancer Family Study. Cancer. 2001;92:240–8.PubMedCrossRefGoogle Scholar
  71. 71.
    Dennis J, Krewski D, Cote FS, et al. Breast cancer risk in relation to alcohol consumption and BRCA gene mutations—a case-only study of gene-environment interaction. Breast J. 2011;17:477–84.PubMedCrossRefGoogle Scholar
  72. 72.
    McGuire V, John EM, Felberg A, et al. No increased risk of breast cancer associated with alcohol consumption among carriers of BRCA1 and BRCA2 mutations ages <50 years. Cancer Epidemiol Biomark Prev. 2006;15:1565–7.CrossRefGoogle Scholar
  73. 73.
    Nkondjock A, Robidoux A, Paredes Y, et al. Diet, lifestyle and BRCA-related breast cancer risk among French-Canadians. Breast Cancer Res Treat. 2006;98:285–94.PubMedCrossRefGoogle Scholar
  74. 74.
    Moorman PG, Iversen ES, Marcom PK, et al. Evaluation of established breast cancer risk factors as modifiers of BRCA1 or BRCA2: a multi-center case-only analysis. Breast Cancer Res Treat. 2010;124:441–51.PubMedCrossRefGoogle Scholar
  75. 75.
    • Dennis J, Ghadirian P, Little J, et al. Alcohol consumption and the risk of breast cancer among BRCA1 and BRCA2 mutation carriers. Breast. 2010;19:479–83. In a case-control study of 1925 matched pairs in primarily postmenopausal BRCA1 or BRCA2 mutation carriers, alcohol intake was not associated with BRCA-related breast cancer. They also found, compared with non-drinkers, an inverse association between exclusive wine consumers and breast cancer risk in BRCA1 mutation carriers (P trend= 0.01).PubMedCrossRefGoogle Scholar
  76. 76.
    Lecarpentier J, Nogues C, Mouret-Fourme E, et al. Variation in breast cancer risk with mutation position, smoking, alcohol, and chest X-ray history, in the French National BRCA1/2 carrier cohort (GENEPSO). Breast Cancer Res Treat. 2011;130:927–38.PubMedCrossRefGoogle Scholar
  77. 77.
    Patterson RE, Cadmus LA, Emond JA, Pierce JP. Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010;66:5–15.PubMedCrossRefGoogle Scholar
  78. 78.
    Ligibel J. Lifestyle Factors in Cancer Survivorship. J Clin Oncol. 2012;30:3697–704.PubMedCrossRefGoogle Scholar
  79. 79.
    Brooks PJ, Zakhari S. Moderate alcohol consumption and breast cancer in women: from epidemiology to mechanisms and interventions. Alcohol Clin Exp Res. 2013;37:23–30.PubMedCrossRefGoogle Scholar
  80. 80.
    Holmes MD. Challenge of balancing alcohol intake. J Clin Oncol. 2010;28:4403–4.PubMedCrossRefGoogle Scholar
  81. 81.
    Bandera EV, August DA. Alcohol consumption and breast cancer survival. J Clin Oncol. 2009;27:1727.PubMedCrossRefGoogle Scholar
  82. 82.
    • Newcomb PA, Kampman E, Trentham-Dietz A, et al. Alcohol consumption before and after breast cancer diagnosis: associations with survival from breast cancer, cardiovascular disease, and other causes. J Clin Oncol. 2013. The Collaborative Breast Cancer Study found that moderate alcohol intake before breast cancer diagnosis was associated with improved breast cancer survival, but there was no association with alcohol intake after diagnosis. Furthermore, compared with nondrinkers, alcohol intake before or after breast cancer diagnosis was associated with increased cardiovascular disease survival. Google Scholar
  83. 83.
    Holm M, Olsen A, Christensen J, et al. Pre-diagnostic alcohol consumption and breast cancer recurrence and mortality: Results from a prospective cohort with a wide range of variation in alcohol intake. Int J Cancer. 2013;132:686–94.Google Scholar
  84. 84.
    • Kwan ML, Chen WY, Flatt SW, et al. Postdiagnosis alcohol consumption and breast cancer prognosis in the after breast cancer pooling project. Cancer Epidemiol Biomark Prev. 2013;22:32–41. This is one of the largest studies to date to assess the effects of post-diagnostic alcohol use and recurrence. Post-diagnosis alcohol consumption (average 2 years) was not associated with breast cancer recurrence or mortality; however, in women who were postmenopausal and ER + there was a marginal association between higher levels of alcohol use and breast cancer recurrence.Google Scholar
  85. 85.
    Li Y, Baer D, Friedman GD, et al. Wine, liquor, beer and risk of breast cancer in a large population. Eur J Cancer. 2009;45:843–50.PubMedCrossRefGoogle Scholar
  86. 86.
    Suzuki R, Orsini N, Mignone L, et al. Alcohol intake and risk of breast cancer defined by estrogen and progesterone receptor status—a meta-analysis of epidemiological studies. Int J Cancer. 2008;122:1832–41.PubMedCrossRefGoogle Scholar
  87. 87.
    Lew JQ, Freedman ND, Leitzmann MF, et al. Alcohol and risk of breast cancer by histologic type and hormone receptor status in postmenopausal women: the NIH-AARP Diet and Health Study. Am J Epidemiol. 2009;170:308–17.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jasmine A. McDonald
    • 1
  • Abhishek Goyal
    • 1
  • Mary Beth Terry
    • 1
    • 2
  1. 1.Department of EpidemiologyMailman School of Public Health, Columbia UniversityNew YorkUSA
  2. 2.Herbert Irving Comprehensive Cancer CenterColumbia UniversityNew YorkUSA

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