title: Folate intake, alcohol use, and postmenopausal breast cancer risk in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.
abstract: BACKGROUND
  Several epidemiologic studies suggest that higher folate intakes are associated with lower breast cancer risk, particularly in women with moderate alcohol consumption.
  
  
  OBJECTIVE
  We investigated the association between dietary folate, alcohol consumption, and postmenopausal breast cancer in women from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial cohort.
  
  
  METHODS
  Dietary data were collected at study enrollment between 1993 and 2001. Folate content was assigned on the basis of prefortification (ie, pre-1998) databases. Of the 25 400 women participants with a baseline age of 55-74 y and with complete dietary and multivitamin information, 691 developed breast cancer between September 1993 and May 2003. We used Cox proportional hazard models with age as the underlying time metric to generate hazard ratios (HRs) and 95% CIs.
  
  
  RESULTS
  The adjusted HRs were 1.19 (95% CI: 1.01, 1.41; P for trend = 0.04) for women reporting supplemental folic acid intake >/=400 mug/d compared with subjects reporting no supplemental intake. Comparison of the highest with the lowest quintile gave adjusted HRs of 1.04 (95% CI: 0.83, 1.31; P for trend = 0.56) and 1.32 (95% CI: 1.04, 1.68; P for trend = 0.03) for food and total folate intake, respectively. Alcohol consumption was positively associated with breast cancer risk (highest compared with lowest quintile: HR = 1.37; 95% CI: 1.08, 1.76; P for trend = 0.02); the risk was greatest in women with lower total folate intake.
  
  
  CONCLUSIONS
  Our results do not support the hypothesis that high folate intake reduces breast cancer risk; instead, they suggest that a high intake, generally attributable to supplemental folic acid, may increase the risk in postmenopausal women. However, our results confirm previous studies showing positive associations between moderate alcohol consumption and breast cancer.
authors.affiliation: Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Boulevard, Suite 320, Rockville, MD 20852, USA. rs221z@nih.gov
authors.forename: Rachael Z
authors.initials: RZ
authors.lastname: Stolzenberg-Solomon
authors.forename: Shih-Chen
authors.initials: SC
authors.lastname: Chang
authors.forename: Michael F
authors.initials: MF
authors.lastname: Leitzmann
authors.forename: Karen A
authors.initials: KA
authors.lastname: Johnson
authors.forename: Christine
authors.initials: C
authors.lastname: Johnson
authors.forename: Saundra S
authors.initials: SS
authors.lastname: Buys
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hoover
authors.forename: Regina G
authors.initials: RG
authors.lastname: Ziegler
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D016001:Confidence Intervals; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D005492:Folic Acid