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, 21 (1), 128

Alcohol Consumption, Cigarette Smoking, and Familial Breast Cancer Risk: Findings From the Prospective Family Study Cohort (ProF-SC)

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Alcohol Consumption, Cigarette Smoking, and Familial Breast Cancer Risk: Findings From the Prospective Family Study Cohort (ProF-SC)

Nur Zeinomar et al. Breast Cancer Res.

Abstract

Background: Alcohol consumption and cigarette smoking are associated with an increased risk of breast cancer (BC), but it is unclear whether these associations vary by a woman's familial BC risk.

Methods: Using the Prospective Family Study Cohort, we evaluated associations between alcohol consumption, cigarette smoking, and BC risk. We used multivariable Cox proportional hazard models to estimate hazard ratios (HR) and 95% confidence intervals (CI). We examined whether associations were modified by familial risk profile (FRP), defined as the 1-year incidence of BC predicted by Breast Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA), a pedigree-based algorithm.

Results: We observed 1009 incident BC cases in 17,435 women during a median follow-up of 10.4 years. We found no overall association of smoking or alcohol consumption with BC risk (current smokers compared with never smokers HR 1.02, 95% CI 0.85-1.23; consuming ≥ 7 drinks/week compared with non-regular drinkers HR 1.10, 95% CI 0.92-1.32), but we did observe differences in associations based on FRP and by estrogen receptor (ER) status. Women with lower FRP had an increased risk of ER-positive BC associated with consuming ≥ 7 drinks/week (compared to non-regular drinkers), whereas there was no association for women with higher FRP. For example, women at the 10th percentile of FRP (5-year BOADICEA = 0.15%) had an estimated HR of 1.46 (95% CI 1.07-1.99), whereas there was no association for women at the 90th percentile (5-year BOADICEA = 4.2%) (HR 1.07, 95% CI 0.80-1.44). While the associations with smoking were not modified by FRP, we observed a positive multiplicative interaction by FRP (pinteraction = 0.01) for smoking status in women who also consumed alcohol, but not in women who were non-regular drinkers.

Conclusions: Moderate alcohol intake was associated with increased BC risk, particularly for women with ER-positive BC, but only for those at lower predicted familial BC risk (5-year BOADICEA < 1.25). For women with a high FRP (5-year BOADICEA ≥ 6.5%) who also consumed alcohol, being a current smoker was associated with increased BC risk.

Keywords: Alcohol consumption; BOADICEA; Breast cancer; Cigarette smoking; Familial risk.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Associations of current smoking compared to never smoking and breast cancer (BC) risk by percentiles of absolute predicted 1-year BC risk for overall BC, estrogen receptor-positive BC, and estrogen receptor-negative BC. Hazard ratios (HR) reflect associations for current smokers compared to never smokers and breast cancer risk by percentiles of absolute predicted 1-year breast cancer risk, as estimated by BOADICEA  for overall breast cancer (panel a), estrogen-receptor positive breast cancer (panel b), and estrogen-receptor negative breast cancer (panel c). HRs are stratified by birth cohort and are adjusted for race/ethnicity, study center, education, oral contraceptive use, and body mass index
Fig. 2
Fig. 2
Associations of consuming ≥ 7 alcoholic drinks per week (compared to non-regular drinkers) and breast cancer risk by percentiles of absolute predicted 1-year breast cancer risk for overall breast cancer, estrogen receptor-positive breast cancer, and estrogen receptor-negative breast cancer. Hazard ratios (HR) reflect associations for consuming ≥ 7 alcoholic drinks per week compared to non-drinkers and breast cancer risk by percentiles of absolute predicted 1-year breast cancer risk, as estimated by BOADICEA for overall breast cancer (panel a), estrogen-receptor positive breast cancer (panel b), and estrogen-receptor negative breast cancer (panel c). HRs are stratified by birth cohort and are adjusted for race/ethnicity, study center, education, oral contraceptive use, body mass index, and cigarette smoking
Fig. 3
Fig. 3
Associations of current smoking compared to never smoking and breast cancer risk by percentiles of absolute predicted 1-year breast cancer risk stratified by alcohol consumption at baseline. Hazard ratios (HR) reflect associations for current smokers compared to never smokers and breast cancer risk by percentiles of absolute predicted 1-year breast cancer risk, as estimated by BOADICEA, stratified by alcohol consumption status at baseline; regular drinkers are presented in panel a and non-regular drinkers in panel b. HRs are stratified by birth cohort and are adjusted for race/ethnicity, study center, education, oral contraceptive use, and body mass index

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