title: Alcohol consumption and breast cancer risk by estrogen receptor status: in a pooled analysis of 20 studies.
abstract: Breast cancer aetiology may differ by estrogen receptor (ER) status. Associations of alcohol and folate intakes with risk of breast cancer defined by ER status were examined in pooled analyses of the primary data from 20 cohorts.
  
  
  
  During a maximum of 6-18 years of follow-up of 1 089 273 women, 21 624 ER+ and 5113 ER- breast cancers were identified. Study-specific multivariable relative risks (RRs) were calculated using Cox proportional hazards regression models and then combined using a random-effects model.
  
  
  
  Alcohol consumption was positively associated with risk of ER+ and ER- breast cancer. The pooled multivariable RRs (95% confidence intervals) comparing ≥ 30 g/d with 0 g/day of alcohol consumption were 1.35 (1.23-1.48) for ER+ and 1.28 (1.10-1.49) for ER- breast cancer (Ptrend ≤ 0.001; Pcommon-effects by ER status: 0.57). Associations were similar for alcohol intake from beer, wine and liquor. The associations with alcohol intake did not vary significantly by total (from foods and supplements) folate intake (Pinteraction ≥ 0.26). Dietary (from foods only) and total folate intakes were not associated with risk of overall, ER+ and ER- breast cancer; pooled multivariable RRs ranged from 0.98 to 1.02 comparing extreme quintiles. Following-up US studies through only the period before mandatory folic acid fortification did not change the results. The alcohol and folate associations did not vary by tumour subtypes defined by progesterone receptor status.
  
  
  
  Alcohol consumption was positively associated with risk of both ER+ and ER- breast cancer, even among women with high folate intake. Folate intake was not associated with breast cancer risk.
authors: Department of Nutrition, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA, sjung@epi.umaryland.edu.
authors: Seungyoun
authors: S
authors: Jung
authors: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors: Molin
authors: M
authors: Wang
authors: Division of Epidemiology and Community Health, School of Public Health, and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
authors: Kristin
authors: K
authors: Anderson
authors: Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, VIC, Australia, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, VIC, Australia.
authors: Laura
authors: L
authors: Baglietto
authors: Department of Surgery and Centre for Clinical Research, Central Hospital, Västerås, Sweden.
authors: Leif
authors: L
authors: Bergkvist
authors: Division of Cancer Etiology, Department of Population Science, Beckman Research Institute and City of Hope National Medical Center, Duarte, CA, USA.
authors: Leslie
authors: L
authors: Bernstein
authors: Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
authors: Piet A
authors: PA
authors: van den Brandt
authors: Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, Bethesda, MD, USA.
authors: Louise
authors: L
authors: Brinton
authors: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Julie E
authors: JE
authors: Buring
authors: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors: A Heather
authors: AH
authors: Eliassen
authors: Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, Bethesda, MD, USA.
authors: Roni
authors: R
authors: Falk
authors: Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA.
authors: Susan M
authors: SM
authors: Gapstur
authors: Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, VIC, Australia, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, VIC, Australia.
authors: Graham G
authors: GG
authors: Giles
authors: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors: Gary
authors: G
authors: Goodman
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Judith
authors: J
authors: Hoffman-Bolton
authors: Cancer Prevention Institute of California, Fremont, CA, USA.
authors: Pamela L
authors: PL
authors: Horn-Ross
authors: Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan, AXA Department of Health and Human Security, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors: Manami
authors: M
authors: Inoue
authors: Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA.
authors: Laurence N
authors: LN
authors: Kolonel
authors: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors: Vittorio
authors: V
authors: Krogh
authors: Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden.
authors: Marie
authors: M
authors: Lof
authors: Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, Bethesda, MD, USA.
authors: Paige
authors: P
authors: Maas
authors: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors: Anthony B
authors: AB
authors: Miller
authors: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors: Marian L
authors: ML
authors: Neuhouser
authors: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO, USA.
authors: Yikyung
authors: Y
authors: Park
authors: Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
authors: Kim
authors: K
authors: Robien
authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Thomas E
authors: TE
authors: Rohan
authors: Division of Epidemiology, Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.
authors: Stephanie
authors: S
authors: Scarmo
authors: Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
authors: Leo J
authors: LJ
authors: Schouten
authors: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors: Sabina
authors: S
authors: Sieri
authors: Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA.
authors: Victoria L
authors: VL
authors: Stevens
authors: Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.
authors: Schoichiro
authors: S
authors: Tsugane
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Kala
authors: K
authors: Visvanathan
authors: Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA.
authors: Lynne R
authors: LR
authors: Wilkens
authors: Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
authors: Alicja
authors: A
authors: Wolk
authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway, Department of Research, Cancer Registry of Norway, Oslo, Norway and Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
authors: Elisabete
authors: E
authors: Weiderpass
authors: Department of Nutrition, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors: Walter C
authors: WC
authors: Willett
authors: Division of Epidemiology, Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.
authors: Anne
authors: A
authors: Zeleniuch-Jacquotte
authors: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Shumin M
authors: SM
authors: Zhang
authors: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors: Xuehong
authors: X
authors: Zhang
authors: Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, Bethesda, MD, USA.
authors: Regina G
authors: RG
authors: Ziegler
authors: Department of Nutrition, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors: Stephanie A
authors: SA
authors: Smith-Warner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000235:genetics; D019587:Dietary Supplements; D000431:Ethanol / Q000378:metabolism; D005260:Female; D005492:Folic Acid / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011960:Receptors, Estrogen / Q000235:genetics*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D011960:Receptors, Estrogen; D000431:Ethanol; D005492:Folic Acid
keywords: Alcohol; breast cancer; cohort study; epidemiology; estrogen receptor; folate; pooled analyses; progesterone receptor