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Moderate Alcohol Consumption During Adult Life, Drinking Patterns, and Breast Cancer Risk
Open accessAbstract
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.
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“The main biological pathway seems to be through overall tissue exposure to acetaldehyde, which may not be affected by drinking patterns; however, through modifications of insulin‐like growth factor (IGF) serum levels, drinking patterns may have an effect on the risk of developing breast cancer (as well as other cancers, where modifications to IGF serum levels play a role 180).”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [180]
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“through modifications of insulin‐like growth factor (IGF) serum levels, drinking patterns may have an effect on the risk of developing breast cancer (as well as other cancers, where modifications to IGF serum levels play a role 180).”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [180]
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Kapoor, M., Wang, J., Wetherill, L. F., Le, N., Bertelsen, S. E., Hinrichs, A. L., Budde, J., Arpana Agrawal, A., Bucholz, K. K., Dick, D. M., et al. (2013) · Human Genetics · doi:10.1007/s00439-013-1318-z · Cited by 97
“Epidemiological studies indicate that moderate alcohol consumption by younger women could increase the risk of breast cancer later in life (Allen et al. 2009; Brooks and Zakhari 2013; Chen et al. 2011).”
BackgroundAlcohol�s Effects on Breast Cancer in Women
Freudenheim, J. L. (2020) · Alcohol research · doi:10.35946/arcr.v40.2.11 · Cited by 97
Barbhaiya, M., Lü, B., Sparks, J. A., Malspeis, S., Chang, S., Karlson, E. W., & Costenbader, K. H. (2016) · Arthritis Care & Research · doi:10.1002/acr.22945 · Cited by 94
“Response rates to followup questionnaires are >90% in each cycle, and only 5% of person-time has been lost to follow-up (10).”
Breast cancers, mammary stem cells, and cancer stem cells, characteristics, and hypotheses
Taurin, S., & Alkhalifa, H. (2020) · Neoplasia · doi:10.1016/j.neo.2020.09.009 · Cited by 96
Romieu, I., Scoccianti, C., Chajès, V., de Batlle, J., Biessy, C., Dossus, L., Baglietto, L., Clavel‐Chapelon, F., Overvad, K., Olsen, A., et al. (2015) · International Journal of Cancer · doi:10.1002/ijc.29469 · Cited by 95
Shapira, N. (2013) · The EPMA Journal · doi:10.1186/1878-5085-4-1 · Cited by 90
“b The American Cancer Society's recommendation for alcohol intake was recently reduced to no more than one drink per day for women and two for men [121], in response to findings of alcohol-cancer links [74] even with intake previously considered ‘low’ [61,70,71,74,75].”
BackgroundObesity and the risk of systemic lupus erythematosus among women in the Nurses’ Health Studies
Tedeschi, S. K., Barbhaiya, M., Malspeis, S., Lü, B., Sparks, J. A., Karlson, E. W., Willett, W. C., & Costenbader, K. H. (2017) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2017.05.011 · Cited by 85
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Brooks, P. J., & Zakhari, S. (2012) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2012.01888.x · Cited by 78
“We focus primarily on 3 large epidemiologic studies (Allen et al., 2009; Chen et al., 2011; Li et al., 2010) in part because they raised several important issues that impact the interpretation of other epidemiologic studies.”
InfluentialMukherjee, S., Mukherjee, A., Bytešníková, Z., Ashrafi, A. M., Richtera, L., & Adam, V. (2024) · Biosensors and Bioelectronics · doi:10.1016/j.bios.2024.116050 · Cited by 77
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What Should We Recommend to Our Patients with NAFLD Regarding Alcohol Use?
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“Despite these potential benefits of light to moderate alcohol consumption, one must be aware of possible risks associated with light to moderate drinking, such as risks of breast and colon cancer (26,27).”
BackgroundNomura, S. J. O., Inoue‐Choi, M., Lazovich, D., & Robien, K. (2016) · International Journal of Cancer · doi:10.1002/ijc.29994 · Cited by 73
Kwan, M. L., Chen, W. Y., Flatt, S. W., Weltzien, E. K., Nechuta, S., Poole, E. M., Holmes, M. D., Patterson, R. E., Shu, X. O., Pierce, J. P., et al. (2012) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-12-1022 · Cited by 72
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Moderate alcohol intake lowers biochemical markers of bone turnover in postmenopausal women
Marrone, J. A., Maddalozzo, G. F., Branscum, A. J., Hardin, K., Cialdella-Kam, L. A., Philbrick, K. A., Breggia, A., Rosen, C. J., Turner, R. T., & Iwaniec, U. T. (2012) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e31824ac071 · Cited by 69
“Moderate alcohol consumption, although associated with a lower risk of cardiovascular disease, cardiovascular diseaseY related mortality, and all-cause mortality, may increase the risk for breast cancer.(33,34) An increase in aromatase activity has been suggested as a mechanism for the effects of alcohol on estrogen t…”
BackgroundAlcohol Increases Impulsivity and Abuse Liability in Heavy Drinking Women
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“In addition, we had no information on drinking patterns such as heavy episodic or binge drinking, which may also affect the risk of breast cancer.(6,25) In conclusion, our findings support the hypothesis that moderate alcohol consumption increases risk of postmenopausal breast cancer.”
BackgroundResultBreast cancer prevention in premenopausal women: role of the Mediterranean diet and its components
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Dietary Factors and Female Breast Cancer Risk: A Prospective Cohort Study
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“Similar to prior analyses, alcohol consumption was modeled using updated cumulative intake to best estimate long-term exposure, and was grouped into the following categories: 0, 1–4, 5–14, 15– 29, and (cid:21) 30g/day [26–28].”
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“Females who consume four to nine drinks weekly are 15% more likely to develop breast cancer than non-drinkers [101].”
BackgroundAlcohol Consumption and Breast Cancer Risk among Women in Three Sub-Saharan African Countries
Qian, F., Ogundiran, T. O., Hou, N., Ndom, P., Gakwaya, A., Jombwe, J., Morhason-Bello, I. O., Adebamowo, C., Ademola, A. F., Ojengbede, O. A., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0106908 · Cited by 60
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“Recent epidemiological studies have provided convincing evidence that ethanol (EtOH) consumption is associated with an increased risk of breast cancer in women (Chen et al., 2011).”
BackgroundWine: An Aspiring Agent in Promoting Longevity and Preventing Chronic Diseases
Pavlidou, E., Mantzorou, M., Fasoulas, A., Tryfonos, C., Petridis, D., & Giaginis, C. (2018) · Diseases · doi:10.3390/diseases6030073 · Cited by 56
Ethanol exposure induces the cancer-associated fibroblast phenotype and lethal tumor metabolism
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“Over the years, numerous epidemiological studies have shown that increased alcohol consumption and binge-drinking are dose-dependently associated with the development of human breast cancers.(3-9) These findings have also been recapitulated using mouse animal models, where ethanol-fed mice showed increased rates of br…”
BackgroundAlcohol Intake and Risk of Incident Psoriatic Arthritis in Women
Wu, S., Cho, E., Li, W., Han, J., & Qureshi, A. A. (2015) · The Journal of Rheumatology · doi:10.3899/jrheum.140808 · Cited by 52
Daily Drinking Is Associated with Increased Mortality
Hartz, S. M., Oehlert, M. E., Horton, A. C., Grucza, R. A., Fisher, S. L., Culverhouse, R., Nelson, K. G., Sumerall, S. W., Neal, P. C., Regnier, P., et al. (2018) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.13886 · Cited by 53
“In contrast to the inconsistent findings regarding alcohol use and cardiovascular health, there is a consensus that alcohol use is associated with increased cancer incidence (Cao et al., 2015; Chen et al., 2011; Trichopoulou et al., 2010; World Cancer Research Fund and American Institute for Cancer Research 2018).”
Komorowski, A. S., & Pezo, R. C. (2019) · Breast Cancer Research and Treatment · doi:10.1007/s10549-019-05472-w · Cited by 55
Metadata
- Authors
- Chen, W. Y., Rosner, B., Hankinson, S. E., Colditz, G. A., & Willett, W. C.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Corresponding author
- Chen, Wendy Y.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2011-11-02
- Volume
- 306
- Issue
- 17
- Pages
- 1884
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3292347
- OpenAlex
- W2062112003
- Cited by
- 509
- References
- 43
- Citations by year
- 2026: 23 · 2025: 20 · 2024: 29 · 2023: 32 · 2022: 28 · 2021: 43 · 2020: 34 · 2019: 45 · 2018: 21 · 2017: 30 · 2016: 46 · 2015: 46 · 2014: 32 · 2013: 32 · 2012: 41
- FWCI
- 24.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (P01CA087969, [P01 CA87969)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- breast cancer risk, alcohol consumption, binge drinking, drinking frequency, moderate drinking, women, Nurses' Health Study
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Alcohol Drinking, Ethanol, Central Nervous System Stimulants, Breast Neoplasms, Dose-Response Relationship, Drug, Estrogens, Female, Humans, Middle Aged, Prospective Studies, Receptors, Estrogen, Risk Assessment, Young Adult
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