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Alcohol Exposure and Breast Cancer: Results of the Women's Contraceptive and Reproductive Experiences Study

¹ Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; ² Medical Biostatistics, College of Medicine, University of Vermont, Burlington, Vermont; ³ Fred Hutchinson Cancer Research Center, Seattle, Washington; ⁴ Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; ⁵ Institute for Nutrition Research, University of Oslo, Oslo, Norway; ⁶ Division of Hematology and Oncology and ⁷ Division of Epidemiology, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; ⁸ Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; ⁹ Department of Obstetrics and Gynecology, Bay State Medical Center, Springfield, Massachusetts; and ¹⁰ Contraception and Reproductive Health Branch, Center for Population Research, National Institute of Child Health and Human Development, Bethesda, Maryland

Requests for reprints: Jill A. McDonald, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, 4770 Buford Highway Northeast, MS-K22, Atlanta, GA 30341-3724. Phone: 770-488-6373; Fax: 770-488-6291. E-mail: ezm5{at}cdc.gov

Objectives: To explore associated biological outcomes and clarify the role of timing of exposure in the alcohol-breast cancer relationship.

Methods: In a population-based study of 4,575 women ages 35 to 64 years diagnosed with invasive breast cancer between 1994 and 1998 and 4,682 controls, we collected details of lifetime alcohol use and factors that could confound or modify the alcohol-breast cancer relationship. We used conditional logistic regression to compute the odds of breast cancer among drinkers relative to nondrinkers at all ages and at ages 35 to 49 and 50 to 64 years separately.

Results: Recent consumption (at reference age minus two) of 7 drinks per week was associated with increased risk [odds ratio (OR), 1.2; 95% CI, 1.01-1.3] and evidence of dose response was observed. Most of the excess was observed among women ages 50-64 years (OR 1.3; 95% CI, 1.1-1.6), although the test for age interaction was not statistically significant. Exposure later in life seemed more important than early exposure. Excess breast cancer associated with recent consumption was restricted to localized disease. When outcome was examined according to tumor hormone receptor status, highest risks were observed for estrogen receptor–positive/progesterone receptor–negative tumors (OR 1.6; 95% CI, 1.2-2.3).

Conclusions: The effect of timing of alcohol exposure on breast cancer risk is complicated and will require additional study focused on this one issue. Further work is needed to explain how alcohol exposure, sex hormones, and tumor receptor status interact.

Key Words: alcohol consumption • breast cancer • epidemiology • etiology • Breast cancer • Epidemiology

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