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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;279:535-540.

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.

From the Departments of Nutrition (Drs Smith-Warner and Willett), Epidemiology (Drs Spiegelman, Willett, and Hunter), Biostatistics (Dr Spiegelman), and Environmental Health (Dr Speizer), Harvard School of Public Health, Boston, Mass; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (Ms Yaun and Drs Speizer, Willett, and Hunter); Department of Epidemiology, University of Maastricht, the Netherlands (Dr van den Brandt); Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (Dr Folsom); Department of Epidemiology, TNO Nutrition and Food Research Institute, Zeist, the Netherlands (Dr Goldbohm); Department of Social and Preventive Medicine, State University of New York at Buffalo (Dr Graham); Department of Surgery, University Hospital, Uppsala, Sweden (Dr Holmberg); National Cancer Institute of Canada Epidemiology Unit, Department of Preventive Medicine and Biostatistics, Faculty of Medicine, University of Toronto, Ontario (Drs Howe and Miller); Arizona Cancer Center, University of Arizona, Tucson (Dr Marshall); Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Wash (Dr Potter); Harvard Center for Cancer Prevention, Boston (Drs Willett and Hunter); and Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden (Dr Wolk).

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References
Circulation 2002;106:3373-3421.
FULL TEXT  

Use of Postmenopausal Hormones, Alcohol, and Risk for Invasive Breast Cancer
Chen et al.
ANN INTERN MED 2002;137:798-804.
ABSTRACT | FULL TEXT  

Alcohol Consumption and Incidence of Benign Breast Disease
Byrne et al.
Cancer Epidemiol. Biomarkers Prev. 2002;11:1369-1374.
ABSTRACT | FULL TEXT  

Can Lifestyle Modification Increase Survival in Women Diagnosed with Breast Cancer?
Rock and Demark-Wahnefried
J. Nutr. 2002;132:3504S-3509.
ABSTRACT | FULL TEXT  

Interaction of Dietary Folate Intake, Alcohol, and Risk of Hormone Receptor-defined Breast Cancer in a Prospective Study of Postmenopausal Women
Sellers et al.
Cancer Epidemiol. Biomarkers Prev. 2002;11:1104-1107.
ABSTRACT | FULL TEXT  

Intake of Alcohol and Alcoholic Beverages and the Risk of Basal Cell Carcinoma of the Skin
Fung et al.
Cancer Epidemiol. Biomarkers Prev. 2002;11:1119-1122.
ABSTRACT | FULL TEXT  

Environmental Toxins and Breast Cancer on Long Island. I. Polycyclic Aromatic Hydrocarbon DNA Adducts
Gammon et al.
Cancer Epidemiol. Biomarkers Prev. 2002;11:677-685.
ABSTRACT | FULL TEXT  

Obesity and colorectal cancer risk in women
Terry et al.
Gut 2002;51:191-194.
ABSTRACT | FULL TEXT  

Nutrition and Survival After the Diagnosis of Breast Cancer: A Review of the Evidence
Rock and Demark-Wahnefried
JCO 2002;20:3302-3316.
ABSTRACT | FULL TEXT  

Improving standards of medical and public health research
Colditz
J. Epidemiol. Community Health 2002;56:333-334.
FULL TEXT  

Alcoholic Cardiomyopathy* : Incidence, Clinical Characteristics, and Pathophysiology
Piano
Chest 2002;121:1638-1650.
ABSTRACT | FULL TEXT  

Identifying and Counseling Women at Increased Risk for Breast Cancer
Rhodes
Mayo Clin Proc. 2002;77:355-361.
ABSTRACT  

Meat and dairy food consumption and breast cancer: a pooled analysis of cohort studies
Missmer et al.
Int J Epidemiol 2002;31:78-85.
ABSTRACT | FULL TEXT  

Commentary: Improving pooled analyses in epidemiology
Friedenreich
Int J Epidemiol 2002;31:86-87.
FULL TEXT  

Breast Carcinoma In Situ: Risk Factors and Screening Patterns
Claus et al.
JNCI J Natl Cancer Inst 2001;93:1811-1817.
ABSTRACT | FULL TEXT  

Alcohol and Breast Cancer: Review of Epidemiologic and Experimental Evidence and Potential Mechanisms
Singletary and Gapstur
JAMA 2001;286:2143-2151.
ABSTRACT | FULL TEXT  

Exploring the Relation of Alcohol Consumption to Risk of Breast Cancer
Ellison et al.
Am J Epidemiol 2001;154:740-747.
ABSTRACT | FULL TEXT  

Low-to-Moderate Alcohol Consumption and Breast Cancer Risk by Age 50 Years among Women in Germany
Kropp et al.
Am J Epidemiol 2001;154:624-634.
ABSTRACT | FULL TEXT  

Commentary: Alcohol, coronary heart disease and public health: which evidence-based policy
Bovet and Paccaud
Int J Epidemiol 2001;30:734-737.
FULL TEXT  

Alcohol consumption and risk of prostate cancer: The Harvard Alumni Health Study
Sesso et al.
Int J Epidemiol 2001;30:749-755.
ABSTRACT | FULL TEXT  

Systematic reviews in health care: Systematic reviews of evaluations of prognostic variables
Altman
BMJ 2001;323:224-228.
FULL TEXT  

Serum Hormones and the Alcohol-Breast Cancer Association in Postmenopausal Women
Dorgan et al.
JNCI J Natl Cancer Inst 2001;93:710-715.
ABSTRACT | FULL TEXT  

Intake of Fruits and Vegetables and Risk of Breast Cancer: A Pooled Analysis of Cohort Studies
Smith-Warner et al.
JAMA 2001;285:769-776.
ABSTRACT | FULL TEXT  

'Women and Alcohol: The Facts': A pilot evaluation of a self-help resource
Bagnall et al.
Health Education Journal 2001;60:35-44.
ABSTRACT