Alcohol and postmenopausal breast cancer risk defined by estrogen and progesterone receptor status: a prospective cohort study.

BACKGROUND Alcohol intake has been reported to be positively associated with an increased risk of postmenopausal breast cancer; however, the association with the estrogen receptor (ER) and progesterone receptor (PR) status of the breast tumors remains unclear. METHODS Self-reported data on alcohol consumption were collected in 1987 and 1997 from 51,847 postmenopausal women in the population-based Swedish Mammography Cohort. Through June 30, 2004, 1188 invasive breast cancer case patients with known ER and PR status were identified during an average 8.3-year follow-up. We used Cox proportional hazards models to estimate multivariable relative risks (RRs) of breast cancer, adjusting for age; family history of breast cancer; body mass index; height; parity; age at menarche, first birth, and menopause; education level; use of postmenopausal hormones; and diet. Heterogeneity among groups was evaluated using the Wald test. All statistical tests were two-sided. RESULTS Alcohol consumption was associated with an increased risk for the development of ER-positive (+) tumors, irrespective of PR status (highest intake [> or = 10 g of alcohol per day] versus nondrinkers, multivariable RR = 1.35, 95% confidence interval [CI] = 1.02 to 1.80; Ptrend < .049 for ER+PR+ tumors; and RR = 2.36, 95% CI = 1.56 to 3.56; Ptrend < .001 for ER+PR-tumors). The absolute rate of ER+ breast cancer (standardized to the age distribution of person-years experienced by all study participants using 5-year age categories) was 232 per 100,000 person-years among women in the highest category of alcohol intake, and 158 per 100,000 person-years among nondrinkers. No association was observed between alcohol intake and the risk of developing ER-tumors. Furthermore, we observed a statistically significant interaction between alcohol intake and the use of postmenopausal hormones on the risk for ER+PR+ tumors (Pinteraction = .039). CONCLUSION The observed association between risk of developing postmenopausal ER+ breast cancer and alcohol drinking, especially among those women who use postmenopausal hormones, may be important, because the majority of breast tumors among postmenopausal women overexpress ER.

[1]  Graham A Colditz,et al.  Risk factors for breast cancer according to estrogen and progesterone receptor status. , 2004, Journal of the National Cancer Institute.

[2]  S. Thorpe.  Estrogen and progesterone receptor determinations in breast cancer. Technology, biology and clinical significance. , 1988, Acta oncologica.

[3]  Å. Borg,et al.  Tumour biological features of BRCA1-induced breast and ovarian cancer. , 1997, European journal of cancer.

[4]  B Mattsson,et al.  Completeness of the Swedish Cancer Register. Non-notified cancer cases recorded on death certificates in 1978. , 1984, Acta radiologica. Oncology.

[5]  E D Brown,et al.  Serum hormones and the alcohol-breast cancer association in postmenopausal women. , 2001, Journal of the National Cancer Institute.

[6]  M N Pollak,et al.  Influence of BRCA1 mutations on nuclear grade and estrogen receptor status of breast carcinoma in Ashkenazi Jewish women , 1997, Cancer.

[7]  John D. Potter,et al.  Food, nutrition and the prevention of cancer : a global perspective , 2001 .

[8]  P. Nasca,et al.  Alcohol consumption and breast cancer: estrogen receptor status and histology. , 1994, American journal of epidemiology.

[9]  M. C. Leske,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 , 2002, British Journal of Cancer.

[10]  P. Porter,et al.  The relationship between alcohol use and risk of breast cancer by histology and hormone receptor status among women 65-79 years of age. , 2003, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[11]  E. Rosen,et al.  Alcohol stimulates estrogen receptor signaling in human breast cancer cell lines. , 2000, Cancer research.

[12]  W. McGuire,et al.  Estrogen control of progesterone receptor in human breast cancer. Correlation with nuclear processing of estrogen receptor. , 1978, The Journal of biological chemistry.

[13]  Daniel Birnbaum,et al.  Steroid receptors in hereditary breast carcinomas associated with BRCA1 or BRCA2 mutations or unknown susceptibility genes , 1999, Cancer.

[14]  J. Cerhan,et al.  Progesterone and estrogen receptors and mammary neoplasia in the Iowa Women's Health Study: how many kinds of breast cancer are there? , 1995, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[15]  J. Klijn,et al.  Survival and tumour characteristics of breast-cancer patients with germline mutations of BRCA1 , 1998, The Lancet.

[16]  J. Gavaler,et al.  Exposure-dependent effects of ethanol on serum estradiol and uterus mass in sexually mature oophorectomized rats: a model for bilaterally ovariectomized-postmenopausal women. , 1987, Journal of studies on alcohol.

[17]  M. Erdos,et al.  BRCA1 inhibition of estrogen receptor signaling in transfected cells. , 1999, Science.

[18]  J. Potter,et al.  Synergistic effect between alcohol and estrogen replacement therapy on risk of breast cancer differs by estrogen/progesterone receptor status in the Iowa Women's Health Study. , 1995, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[19]  V. Feron,et al.  Aldehydes: occurrence, carcinogenic potential, mechanism of action and risk assessment. , 1991, Mutation research.

[20]  E L Korn,et al.  Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. , 1997, American journal of epidemiology.

[21]  S. Gapstur,et al.  Alcohol and breast cancer: review of epidemiologic and experimental evidence and potential mechanisms. , 2001, JAMA.

[22]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[23]  J. Gustafsson,et al.  Quantitation of estrogen receptor in seventy-five specimens of breast cancer: comparison between an immunoassay (Abbott ER-EIA monoclonal) and a [3H]estradiol binding assay based on isoelectric focusing in polyacrylamide gel. , 1986, Cancer research.

[24]  K. Yoo,et al.  Breast cancer risk factors according to combined estrogen and progesterone receptor status: a case-control analysis. , 1997, American journal of epidemiology.

[25]  W. D. Ray.  4. Modelling Survival Data in Medical Research , 1995 .

[26]  M. Cotterchio,et al.  Hormonal factors and the risk of breast cancer according to estrogen- and progesterone-receptor subgroup. , 2003, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[27]  Julian Peto,et al.  Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52 705 women with breast cancer and 108 411 women without breast cancer , 1997, The Lancet.

[28]  R. Frey,et al.  Effect of ethanol on proliferation and estrogen receptor-alpha expression in human breast cancer cells. , 2001, Cancer letters.

[29]  L. Holmberg,et al.  A prospective study of association of monounsaturated fat and other types of fat with risk of breast cancer. , 1998, Archives of internal medicine.

[30]  R C Millikan,et al.  Hormone-related factors and risk of breast cancer in relation to estrogen receptor and progesterone receptor status. , 2000, American journal of epidemiology.

[31]  M. Longnecker,et al.  Alcohol consumption and breast cancer oestrogen and progesterone receptor status , 1999, British Journal of Cancer.

[32]  R. Clarke,et al.  Hormonal aspects of breast cancer. Growth factors, drugs and stromal interactions. , 1992, Critical reviews in oncology/hematology.

[33]  R. Barbieri,et al.  The effects of ethanol on the clearance of estradiol in postmenopausal women. , 1995, Fertility and sterility.

[34]  J. Manson,et al.  Use of Postmenopausal Hormones, Alcohol, and Risk for Invasive Breast Cancer , 2002, Annals of Internal Medicine.

[35]  E. Dougherty,et al.  Gene-expression profiles in hereditary breast cancer. , 2001, The New England journal of medicine.

[36]  Matthew P. Longnecker,et al.  Alcoholic beverage consumption in relation to risk of breast cancer: meta-analysis and review , 2005, Cancer Causes & Control.

[37]  Tim Futing Liao,et al.  Comparing Social Groups: Wald Statistics for Testing Equality Among Multiple Logit Models , 2004 .

[38]  D. Horsfall,et al.  Risk factors for breast cancer by oestrogen receptor status: a population-based case-control study. , 1989, British Journal of Cancer.

[39]  F. Speizer,et al.  Alcohol and breast cancer in women: a pooled analysis of cohort studies. , 1998, JAMA.

[40]  P. J. Brooks.  DNA damage, DNA repair, and alcohol toxicity--a review. , 1997, Alcoholism, clinical and experimental research.