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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Alcohol, Postmenopausal Hormone Therapy, and Breast Cancer
19 November 2002 | Volume 137 Issue 10 | Page I-43
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Use of Postmenopausal Hormones, Alcohol, and Risk for Invasive Breast Cancer." It is in the 19 November 2002 issue of Annals of Internal Medicine (volume 137, pages 798-804). The authors are WY Chen, GA Colditz, B Rosner, SE Hankinson, DJ Hunter, JE Manson, MJ Stampfer, WC Willett, and FE Speizer.
What is the problem and what is known about it so far?
Women who drink alcohol have a higher risk for breast cancer than women who do not drink alcohol. Some scientists think that this is because alcohol affects female hormones, such as estrogen, that are related to breast cancer risk. Women who take estrogen after menopause (postmenopausal hormone therapy) have a higher risk for breast cancer than women who do not use postmenopausal estrogen. However, the combined effect of drinking alcohol and taking postmenopausal hormones is poorly understood. Since both drinking alcohol and taking hormones are risk factors that women can control, it is important to know about the relationships between these factors and breast cancer risk.
Why did the researchers do this particular study?
To find out whether the combined use of alcohol and postmenopausal hormones puts women at higher risk for breast cancer than either of these risk factors alone.
Who was studied?
44,187 postmenopausal nurses who were participating in the Nurses' Health Study, a large study of health issues affecting women.
How was the study done?
The Nurses' Health Study mailed questionnaires to participating nurses every 2 years to collect information related to their health. In this analysis, the researchers used 1980–1994 survey information on alcohol use, postmenopausal hormone use, and breast cancer diagnoses. The researchers compared the frequency of breast cancer in women who drank alcohol, women who used postmenopausal hormones, and women who used both.
What did the researchers find?
Of the 44,187 nurses, 1722 developed breast cancer during the study years. Women who used postmenopausal hormones for 5 years or longer and drank no alcohol had about a 30% higher risk for breast cancer than women who used neither. Women who drank at least 20 grams of alcohol per day but used no hormones also had about a 30% higher risk for breast cancer than women who used neither. Women who both drank more than 20 grams of alcohol per day and used postmenopausal hormones for at least 5 years had almost twice the risk for breast cancer as women who used neither. The researchers calculated grams of alcohol from women's reported intake of beverages as 12.8 grams of alcohol per 12-ounce serving of beer, 11 grams per 4-ounce serving of wine, and 14 grams per standard serving of spirits.
What were the limitations of the study?
This study was based on women's reports of hormone use and alcohol intake and on breast cancer diagnosis. The accuracy of their reports of alcohol and postmenopausal hormone use is not known. In addition, this study did not separate the various types of hormone regimens (for example, estrogen alone or with progesterone).
What are the implications of the study?
Women who are making decisions about alcohol and postmenopausal hormone use should consider the associated risks for breast cancer. Of course, they will also need to factor the potential protective effects of small amounts of alcohol on cardiovascular disease into their decisions.
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  W. Y. Chen, J. E. Manson, S. E. Hankinson, B. Rosner, M. D. Holmes, W. C. Willett, and G. A. Colditz Unopposed estrogen therapy and the risk of invasive breast cancer. Arch Intern Med, May 8, 2006; 166(9): 1027 - 1032. [Abstract] [Full Text] [PDF]
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 R. Suzuki, W. Ye, T. Rylander-Rudqvist, S. Saji, G. A. Colditz, and A. Wolk Alcohol and Postmenopausal Breast Cancer Risk Defined by Estrogen and Progesterone Receptor Status: A Prospective Cohort Study J Natl Cancer Inst, November 2, 2005; 97(21): 1601 - 1608. [Abstract] [Full Text] [PDF]
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V. Dumeaux, E. Lund, and A. Hjartaker Use of Oral Contraceptives, Alcohol, and Risk for Invasive Breast Cancer Cancer Epidemiol. Biomarkers Prev., August 1, 2004; 13(8): 1302 - 1307. [Abstract] [Full Text] [PDF]
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 M. D. Holmes, S. Liu, S. E. Hankinson, G. A. Colditz, D. J. Hunter, and W. C. Willett Dietary Carbohydrates, Fiber, and Breast Cancer Risk Am. J. Epidemiol., April 15, 2004; 159(8): 732 - 739. [Abstract] [Full Text] [PDF]
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P. L. Horn-Ross, A. J. Canchola, D. W. West, S. L. Stewart, L. Bernstein, D. Deapen, R. Pinder, R. K. Ross, H. Anton-Culver, D. Peel, et al. Patterns of Alcohol Consumption and Breast Cancer Risk in the California Teachers Study Cohort Cancer Epidemiol. Biomarkers Prev., March 1, 2004; 13(3): 405 - 411. [Abstract] [Full Text]
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C. C. Benz, C. A. Clarke, and D. H. Moore II Geographic Excess of Estrogen Receptor-Positive Breast Cancer Cancer Epidemiol. Biomarkers Prev., December 1, 2003; 12(12): 1523 - 1527. [Abstract] [Full Text] [PDF]
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 S. Gallus, S. Franceschi, and C. La Vecchia Alcohol, Postmenopausal Hormones, and Breast Cancer Ann Intern Med, October 7, 2003; 139(7): 601 - 602. [Full Text] [PDF]
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 K. Aronson Alcohol: a recently identified risk factor for breast cancer Can. Med. Assoc. J., April 29, 2003; 168(9): 1147 - 1148. [Full Text] [PDF]
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 A Dose-Response Risk for Breast Cancer with Alcohol Consumption Journal Watch Women's Health, February 19, 2003; 2003(219): 5 - 5. [Full Text]
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 Synergy Between Moderate Alcohol Use and HRT for Breast Cancer Risk Journal Watch (General), December 27, 2002; 2002(1227): 1 - 1. [Full Text]
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