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Review of Epidemiologic and Experimental Evidence and Potential Mechanisms

Keith W. Singletary, PhD; Susan M. Gapstur, PhD

JAMA. 2001;286:2143-2151.

The association of alcohol consumption with increased risk for breast cancer has been a consistent finding in a majority of epidemiologic studies during the past 2 decades. Herein, we summarize information on this association from human and animal investigations, with particular reference to epidemiologic data published since 1995. Increased estrogen and androgen levels in women consuming alcohol appear to be important mechanisms underlying the association. Other plausible mechanisms include enhanced mammary gland susceptibility to carcinogenesis, increased mammary carcinogen DNA damage, and greater metastatic potential of breast cancer cells, processes for which the magnitude likely depends on the amount of alcohol consumed. Susceptibility to the breast cancer–enhancing effect of alcohol may also be affected by other dietary factors (such as low folate intake), lifestyle habits (such as use of hormone replacement therapy), or biological characteristics (such as tumor hormone receptor status). Additional progress in understanding alcohol's enhancing effect on breast cancer will depend on a better understanding of the interactions between alcohol and other risk factors and on additional insights into the multiple biological mechanisms involved.

Author Affiliations: Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign (Dr Singletary); and Department of Preventive Medicine, Northwestern University Medical School, Chicago, Ill (Dr Gapstur).

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