15 June 2015 In Cancer

BACKGROUND: Alcohol consumption has been suggested to increase risk of breast cancer through a mechanism that also increases mammographic density. Whether the association between alcohol consumption and mammographic density is modified by background breast cancer risk has, however, not been studied.

METHODS: We conducted a population-based cross-sectional study of 53 060 Swedish women aged 40-74 years. Alcohol consumption was assessed using a web-based self-administered questionnaire. Mammographic density was measured using the fully-automated volumetric Volpara method. The Tyrer-Cuzick prediction model was used to estimate risk of developing breast cancer in the next 10 years. Linear regression models were used to evaluate the association between alcohol consumption and volumetric mammographic density and the potential influence of Tyrer-Cuzick breast cancer risk.

RESULTS: Overall, increasing alcohol consumption was associated with higher absolute dense volume (cm3) and per cent dense volume (%). The association between alcohol consumption and absolute dense volume was most pronounced among women with the highest (5%) Tyrer-Cuzick 10-year risk. Among high-risk women, women consuming 5.0-9.9, 10.0-19.9, 20.0-29.9, and 30.0-40.0 g of alcohol per day had 2.6 cm3 (95% confidence interval (CI), 0.2-4.9), 2.9 cm3 (95% CI, -0.6 to 6.3), 4.6 cm3 (95% CI, 1.5-7.7), and 10.8 cm3 (95% CI, 4.8-17.0) higher absolute dense volume, respectively, as compared with women abstaining from alcohol. A trend of increasing alcohol consumption and higher absolute dense volume was seen in women at low (3%) risk, but not in women at moderate (3.0-4.9%) risk.

CONCLUSION: Alcohol consumption may increase breast cancer risk through increasing mammographic density, particularly in women at high background risk of breast cancer.

British Journal of Cancer advance online publication, 2 June 2015; doi:10.1038/bjc.2015.185 www.bjcancer.com

15 June 2015 In Cancer

BACKGROUND: Alcohol intake is associated with increased circulating concentrations of sex hormones, which in turn may increase hormone-dependent cancer risk. This association may be modulated by dietary fiber intake, which has been shown to decrease steroid hormone bioavailability (decreased blood concentration and increased sex hormone-binding globulin concentration). However, this potential modulation has not been investigated in any prospective cohort.

OBJECTIVES: Our objectives were to study the relation between alcohol intake and the risk of hormone-dependent cancers (breast, prostate, ovarian, endometrial, and testicular) and to investigate whether dietary fiber intake modulated these associations.

DESIGN: This prospective observational analysis included 3771 women and 2771 men who participated in the Supplementation en Vitamines et Mineraux Antioxydants study (1994-2007) and completed at least 6 valid 24-h dietary records during the first 2 y of follow-up. After a median follow-up of 12.1 y, 297 incident hormone-dependent cancer cases, including 158 breast and 123 prostate cancers, were diagnosed. Associations were tested via multivariate Cox proportional hazards models.

RESULTS: Overall, alcohol intake was directly associated with the risk of hormone-dependent cancers (tertile 3 vs. tertile 1: HR: 1.36; 95% CI: 1.00, 1.84; P-trend = 0.02) and breast cancer (HR: 1.70; 95% CI: 1.11, 2.61; P-trend = 0.04) but not prostate cancer (P-trend = 0.3). In stratified analyses (by sex-specific median of dietary fiber intake), alcohol intake was directly associated with hormone-dependent cancer (tertile 3 vs. tertile 1: HR: 1.76; 95% CI: 1.10, 2.82; P-trend = 0.002), breast cancer (HR: 2.53; 95% CI: 1.30, 4.95; P-trend = 0.02), and prostate cancer (HR: 1.37; 95% CI: 0.65, 2.89; P-trend = 0.02) risk among individuals with low dietary fiber intake but not among their counterparts with higher dietary fiber intake (P-trend = 0.9, 0.8, and 0.6, respectively). The P-interaction between alcohol and dietary fiber intake was statistically significant for prostate cancer (P = 0.01) but not for overall hormone-dependent (P = 0.2) or breast (P = 0.9) cancer.

CONCLUSION: In line with mechanistic hypotheses and experimental data, this prospective study suggested that dietary fiber intake might modulate the association between alcohol intake and risk of hormone-dependent cancer.

This trial was registered at clinicaltrials.gov as NCT00272428

11 May 2015 In General Health

BACKGROUND: Studies show that alcohol consumption appears to have a disproportionate impact on people of low socioeconomic status. Further exploration of the relationship between alcohol consumption, socioeconomic status and the development of chronic alcohol-attributable diseases is therefore important to inform the development of effective public health programmes.

METHODS: We used systematic review methodology to identify published studies of the association between socioeconomic factors and mortality and morbidity for alcohol-attributable conditions. To attempt to quantify differences in the impact of alcohol consumption for each condition, stratified by SES, we (i) investigated the relationship between SES and risk of mortality or morbidity for each alcohol-attributable condition, and (ii) where, feasible explored alcohol consumption as a mediating or interacting variable in this relationship.

RESULTS: We identified differing relationships between a range of alcohol-attributable conditions and socioeconomic indicators. Pooled analyses showed that low, relative to high socioeconomic status, was associated with an increased risk of head and neck cancer and stroke, and in individual studies, with hypertension and liver disease. Conversely, risk of female breast cancer tended to be associated with higher socioeconomic status. These findings were attenuated but held when adjusted for a number of known risk factors and other potential confounding factors. A key finding was the lack of studies that have explored the interaction between alcohol-attributable disease, socioeconomic status and alcohol use.

CONCLUSIONS: Despite some limitations to our review, we have described relationships between socioeconomic status and a range of alcohol-attributable conditions, and explored the mediating and interacting effects of alcohol consumption where feasible. However, further research is needed to better characterise the relationship between socioeconomic status alcohol consumption and alcohol-attributable disease risk so as to gain a greater understanding of the mechanisms and pathways that influence the differential risk in harm between people of low and high socioeconomic status.

11 May 2015 In Cancer

The aim of this study was to obtain an overview of the associations between alcohol consumption and breast cancer risk at adulthood, by type of alcohol and subtype of breast cancer. Between 1993 and 2008, 66 481 women from the French E3N-EPIC cohort were followed up and asked to report their alcohol consumption, by type of alcohol, through a 208-item diet-history questionnaire. A total of 2812 breast cancer cases were validated during the follow-up session. No association was found between high alcohol consumption, whatever its type, and increase in breast cancer risk in the premenopausal period. During the postmenopausal period, a linear association between total alcohol consumption and breast cancer risk was found (P<0.0001), mainly driven by the associations with wine and beer [hazard ratio=1.33 (1.11-1.58) and 1.85 (1.19-2.89)] for more than two glasses per day of wine and beer, respectively, compared with nondrinkers] and with ER+/PR+ breast cancer subtypes. In the postmenopausal period, we observed interactions between total alcohol and folate intake levels (P=0.1192) and BMI (P=0.0367), with higher increased risks observed for high alcohol intake among women with low folate intake or who were overweight or obese. Our results make precise the current body of knowledge on the relationship between alcohol and breast cancer subtypes. Interactions between alcohol and other factors should further be taken into account in public health nutrition programs.

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