title: Alcohol consumption and rates of cancer screening: Is cancer risk overestimated?
abstract: OBJECTIVE
  Alcohol consumption in moderation has been associated with incident breast and colorectal cancer. Whether these associations may be overestimated by more intensive screening among moderate consumers is unknown. This study examines the associations of alcohol consumption with cancer screening.
  
  
  METHODS
  In six iterations (2002-2012) of the Behavioral Risk Factor Surveillance System, a telephone survey of US adults conducted by the Centers for Disease Control and Prevention, participants reported their alcohol use and recent screening for several cancers. We assessed whether alcohol use was associated with breast, cervical, and colorectal cancer screening after sample-weighted adjustment for sociodemographic and healthcare utilization factors.
  
  
  RESULTS
  Among 2,191,483 survey respondents, 80.5 % (weighted prevalence) of eligible individuals reported having an up-to-date mammogram, 87.7 % having a Pap test, and 56.8 % having a colonoscopy/sigmoidoscopy. For all breast, cervical, and colorectal cancers, moderate consumers were more likely to report screening (84.7, 91.2, 61.1 %) than non-consumers, even after multivariate adjustment (adjusted prevalence ratios 1.04, 1.04, 1.07; p < 0.001 for all). Among binge consumers, the weighted prevalence was lower than that in non-binge consumers (binge vs non-binge moderate consumers 80.5 vs 85.5 %, 89.9 vs 91.8 %, 52.8 vs 63.3 %) but still higher than non-consumers for breast and cervical cancer screening.
  
  
  CONCLUSIONS
  In the USA, moderate consumers consistently report a greater likelihood of breast, cervical, and colorectal cancer screening than do non-consumers. Given the likelihood of overdiagnosis, further study of alcohol consumption and cancer should include cancer-specific mortality, which is less sensitive to differences in screening and detection.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 1309 Beacon Street, 2nd Floor, Brookline, MA, 02446, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Mu
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 1309 Beacon Street, 2nd Floor, Brookline, MA, 02446, USA. kmukamal@bidmc.harvard.edu.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D040343:Behavioral Risk Factor Surveillance System; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D012306:Risk; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears / Q000706:statistics & numerical data
keywords: Alcohol; Ascertainment bias; Colonoscopy; Mammography; Overdiagnosis; Screening