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Meta-Analysis
. 2002 Nov 18;87(11):1234-45.
doi: 10.1038/sj.bjc.6600596.

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

N Hamajima  1 K HiroseK TajimaT RohanE E CalleC W Heath JrR J CoatesJ M LiffR TalaminiN ChantarakulS KoetsawangD RachawatA MorabiaL SchumanW StewartM SzkloC BainF SchofieldV SiskindP BandA J ColdmanR P GallagherT G HislopP YangL M KolonelA M Y NomuraJ HuK C JohnsonY MaoS De SanjoséN LeeP MarchbanksH W OryH B PetersonH G WilsonP A WingoK EbelingD KundeP NishanJ L HopperG ColditzV GajalanskiN MartinT PardthaisongS SilpisornkosolC TheetranontB BoosiriS ChutivongseP JimakornP VirutamasenC WongsrichanalaiM EwertzH O AdamiL BergkvistC MagnussonI PerssonJ Chang-ClaudeC PaulD C G SkeggG F S SpearsP BoyleT EvstifeevaJ R DalingW B HutchinsonK MaloneE A NoonanJ L StanfordD B ThomasN S WeissE WhiteN AndrieuA BrêmondF ClavelB GairardJ LansacL PianaR RenaudA IzquierdoP ViladiuH R CuevasP OntiverosA PaletS B SalazarN AristizabelA CuadrosL TryggvadottirH TuliniusA BachelotM G LêJ PetoS FranceschiF LubinB ModanE RonY WaxG D FriedmanR A HiattF LeviT BishopK KosmeljM Primic-ZakeljB RavniharJ StareW L BeesonG FraserR D BullbrookJ CuzickS W DuffyI S FentimanJ L HaywardD Y WangA J McMichaelK McPhersonR L HansonM C LeskeM C MahoneyP C NascaA O VarmaA L WeinsteinT R MollerH OlssonJ RanstamR A GoldbohmP A van den BrandtR A ApeloJ BaensJ R de la CruzB JavierL B LacayaC A NgelangelC La VecchiaE NegriE MarubiniM FerraroniM GerberS RichardsonC SegalaD GateiP KenyaA KunguJ G MatiL A BrintonR HooverC SchairerR SpirtasH P LeeM A RookusF E van LeeuwenJ A SchoenbergM McCredieM D GammonE A ClarkeL JonesA NeilM VesseyD YeatesP ApplebyE BanksV BeralD BullB CrossleyA GoodillJ GreenC HermonT KeyN LangstonC LewisG ReevesR CollinsR DollR PetoK MabuchiD PrestonP HannafordC KayL Rosero-BixbyY T GaoF JinJ-M YuanH Y WeiT YunC ZhihengG BerryJ Cooper BoothT JelihovskyR MacLennanR ShearmanQ-S WangC-J BainesA B MillerC WallE LundH StalsbergX O ShuW ZhengK KatsouyanniA TrichopoulouD TrichopoulosA DabancensL MartinezR MolinaO SalasF E AlexanderK AndersonA R FolsomB S HulkaL BernsteinS EngerR W HaileA Paganini-HillM C PikeR K RossG UrsinM C YuM P LongneckerP NewcombL BergkvistA KalacheT M M FarleyS HolckO MeirikCollaborative Group on Hormonal Factors in Breast Cancer
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Free PMC article
Meta-Analysis

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

N Hamajima et al. Br J Cancer. .
Free PMC article

Abstract

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.

Figures

Figure 1
Figure 1
Relative risk of breast cancer in relation to reported intake of alcohol. Relative risks are calculated as floating absolute risk (FAR) and stratified by study, age, parity, age at first birth and smoking.
Figure 2
Figure 2
Details of and results from studies on the relation between alcohol consumption and breast cancer. Relative risks are stratified by age, parity, age at first birth and smoking history.
Figure 3
Figure 3
Details of and results on the relation between tobacco consumption and breast cancer in women who reported drinking no alcohol. Relative risks are stratified by age, parity and age at first birth.
Figure 4
Figure 4
Relative risk of breast cancer in relation to alcohol and tobacco consumption in various subgroups of women.
Figure 5
Figure 5
Estimated cumulative incidence of breast cancer per 100 women in developed countries, according to the number of alcoholic drinks consumed each day (see Methods).

Comment in

  • Smoking and breast cancer.
    Terry P, Johnson KC. Terry P, et al. Br J Cancer. 2003 May 6;88(9):1500. doi: 10.1038/sj.bjc.6600933. Br J Cancer. 2003. PMID: 12778083 Free PMC article. No abstract available.
  • Breast cancer and tobacco smoke.
    Wells AJ. Wells AJ. Br J Cancer. 2003 Sep 1;89(5):955. doi: 10.1038/sj.bjc.6601182. Br J Cancer. 2003. PMID: 12942134 Free PMC article. No abstract available.

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