06 May 2014 In Cancer

 

 

 

BACKGROUND: It is uncertain whether evidence supports routinely estimating a postmenopausal woman's risk of breast cancer and intervening to reduce risk.

METHODS: We systematically reviewed prospective studies about models and sex hormone levels to assess breast cancer risk and used meta-analysis with random effects models to summarize the predictive accuracy of breast density. We also reviewed prospective studies of the effects of exercise, weight management, healthy diet, moderate alcohol consumption, and fruit and vegetable intake on breast cancer risk, and used random effects models for a meta-analyses of tamoxifen and raloxifene for primary prevention of breast cancer. All studies reviewed were published before June 2008, and all statistical tests were two-sided.

RESULTS: Risk models that are based on demographic characteristics and medical history had modest discriminatory accuracy for estimating breast cancer risk (c-statistics range = 0.58-0.63). Breast density was strongly associated with breast cancer (relative risk [RR] = 4.03, 95% confidence interval [CI] = 3.10 to 5.26, for Breast Imaging Reporting and Data System category IV vs category I; RR = 4.20, 95% CI = 3.61 to 4.89, for >75% vs <5% of dense area), and adding breast density to models improved discriminatory accuracy (c-statistics range = 0.63-0.66). Estradiol was also associated with breast cancer (RR range = 2.0-2.9, comparing the highest vs lowest quintile of estradiol, P < .01). Most studies found that exercise, weight reduction, low-fat diet, and reduced alcohol intake were associated with a decreased risk of breast cancer. Tamoxifen and raloxifene reduced the risk of estrogen receptor-positive invasive breast cancer and invasive breast cancer overall.

CONCLUSIONS: Evidence from this study supports screening for breast cancer risk in all postmenopausal women by use of risk factors and breast density and considering chemoprevention for those found to be at high risk. Several lifestyle changes with the potential to prevent breast cancer should be recommended regardless of risk.

 

 

 

06 May 2014 In Cancer

 

 

 

Epidemiologic studies addressing the association of alcohol consumption with breast cancer consistently suggest a modest association and a dose-response relationship. The epidemiologic evidence does not point to a single mechanism to explain the association, and several mechanisms have been proposed. Alcohol consumption is shown to increase levels of endogenous estrogens, known risk factors for breast cancer. This hypothesis is further supported by data showing that the alcohol-breast cancer association is limited to women with estrogen-receptor positive tumors. Products of alcohol metabolism are known to be toxic and are hypothesized to cause DNA modifications that lead to cancer. Recent research has focused on genes that influence the rate of alcohol metabolism, with genes that raise blood concentrations of acetaldehyde hypothesized to heighten breast cancer risk. Mounting evidence suggests that antioxidant intake(e.g.folate)mayreducealcohol-associatedbreast cancer risk, because it neutralizes reactive oxygen species, a second-stage product of alcohol metabolism. Diets lacking sufficient antioxidant intake, as a result, may further elevate the risk of breast cancer among alcohol consumers. Given that alcohol consumption is increasing worldwide and especially among women in countries of rapid economic growth, a greater understanding of the mechanisms underlying the known alcohol-breast cancer association is warranted. Avoiding overconsumption of alcohol is recommended, especially for women with known risk factors for breast cancer.

 

 

 

06 May 2014 In Cancer

 

 

 

CONTEXT: Multiple studies have linked alcohol consumption to breast cancer risk, but the risk of lower levels of consumption has not been well quantified. In addition, the role of drinking patterns (ie, frequency of drinking and "binge" drinking) and consumption at different times of adult life are not well understood.

OBJECTIVE: To evaluate the association of breast cancer with alcohol consumption during adult life, including quantity, frequency, and age at consumption.

DESIGN, SETTING, AND PARTICIPANTS: Prospective observational study of 105,986 women enrolled in the Nurses' Health Study followed up from 1980 until 2008 with an early adult alcohol assessment and 8 updated alcohol assessments.

MAIN OUTCOME MEASURES: Relative risks of developing invasive breast cancer.

RESULTS: During 2.4 million person-years of follow-up, 7690 cases of invasive breast cancer were diagnosed. Increasing alcohol consumption was associated with increased breast cancer risk that was statistically significant at levels as low as 5.0 to 9.9 g per day, equivalent to 3 to 6 drinks per week (relative risk, 1.15; 95% CI, 1.06-1.24; 333 cases/100,000 person-years). Binge drinking, but not frequency of drinking, was associated with breast cancer risk after controlling for cumulative alcohol intake. Alcohol intake both earlier and later in adult life was independently associated with risk.

CONCLUSIONS: Low levels of alcohol consumption were associated with a small increase in breast cancer risk, with the most consistent measure being cumulative alcohol intake throughout adult life. Alcohol intake both earlier and later in adult life was independently associated with risk.

 

 

 

06 May 2014 In Cancer

 

 

 

We investigated the effect of alcoholic beverage consumption on the risk of lung cancer using the California Men's Health Study.

METHODS: The California Men's Health Study is a multiethnic cohort of 84,170 men ages 45 to 69 years who are members of the Kaiser Permanente California health plans. Demographics and detailed lifestyle characteristics were collected from surveys mailed between 2000 and 2003. Incident lung cancer cases were identified by health plan cancer registries through December 2006 (n=210). Multivariable Cox's regression was used to examine the effects of beer, red wine, white wine (including rose), and liquor consumption on risk of lung cancer adjusting for age, race/ethnicity, education, income, body mass index, history of chronic obstructive pulmonary disease/emphysema, and smoking history.

RESULTS: There was a significant linear decrease in risk of lung cancer associated with consumption of red wine among ever-smokers: hazard ratio (HR), 0.98; 95% confidence interval (95% CI), 0.96-1.00 for increase of 1 drink per month. This relationship was slightly stronger among heavy smokers (>or=20 pack-years): HR, 0.96; 95% CI, 0.93-1.00. When alcoholic beverage consumption was examined by frequency of intake, consumption of >or=1 drink of red wine per day was associated with an approximately 60% reduced lung cancer risk in ever-smokers: HR, 0.39; 95% CI, 0.14-1.08. No clear associations with lung cancer were seen for intake of white wine, beer, or liquor.

CONCLUSION: Moderate red wine consumption was inversely associated with lung cancer risk after adjusting for confounders. Our results should not be extrapolated to heavy alcohol consumption.

 

 

 

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