Journal of the National Cancer Institute Advance Access originally published online on February 24, 2009
JNCI Journal of the National Cancer Institute 2009 101(5):296-305; doi:10.1093/jnci/djn514
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© The Author 2009. Published by Oxford University Press.
ARTICLES |
Moderate Alcohol Intake and Cancer Incidence in Women
on behalf of the Million Women Study Collaborators
Affiliation of authors: Cancer Epidemiology Unit, University of Oxford, Oxford, UK
Correspondence to: Dr Naomi E. Allen, Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford OX3 7LF, UK (e-mail: naomi.allen{at}ceu.ox.ac.uk).
Background: With the exception of breast cancer, little is known about the effect of moderate intakes of alcohol, or of particular types of alcohol, on cancer risk in women.
Methods: A total of 1 280 296 middle-aged women in the United Kingdom enrolled in the Million Women Study were routinely followed for incident cancer. Cox regression models were used to calculate adjusted relative risks and 95% confidence intervals (CIs) for 21 site-specific cancers according to amount and type of alcoholic beverage consumed. All statistical tests were two-sided.
Results: A quarter of the cohort reported drinking no alcohol; 98% of drinkers consumed fewer than 21 drinks per week, with drinkers consuming an average of 10 g alcohol (1 drink) per day. During an average 7.2 years of follow-up per woman 68 775 invasive cancers occurred. Increasing alcohol consumption was associated with increased risks of cancers of the oral cavity and pharynx (increase per 10 g/d = 29%, 95% CI = 14% to 45%, Ptrend < .001), esophagus (22%, 95% CI = 8% to 38%, Ptrend = .002), larynx (44%, 95% CI = 10% to 88%, Ptrend = .008), rectum (10%, 95% CI = 2% to 18%, Ptrend = .02), liver (24%, 95% CI = 2% to 51%, Ptrend = .03), breast (12%, 95% CI = 9% to 14%, Ptrend < .001), and total cancer (6%, 95% CI = 4% to 7%, Ptrend < .001). The trends were similar in women who drank wine exclusively and other consumers of alcohol. For cancers of the upper aerodigestive tract, the alcohol-associated risk was confined to current smokers, with little or no effect of alcohol among never and past smokers (Pheterogeneity < .001). Increasing levels of alcohol consumption were associated with a decreased risk of thyroid cancer (Ptrend = .005), non–Hodgkin lymphoma (Ptrend = .001), and renal cell carcinoma (Ptrend = .03).
Conclusions: Low to moderate alcohol consumption in women increases the risk of certain cancers. For every additional drink regularly consumed per day, the increase in incidence up to age 75 years per 1000 for women in developed countries is estimated to be about 11 for breast cancer, 1 for cancers of the oral cavity and pharynx, 1 for cancer of the rectum, and 0.7 each for cancers of the esophagus, larynx and liver, giving a total excess of about 15 cancers per 1000 women up to age 75.
| Context and Caveats Prior knowledge With the exception of breast cancer, there was little information on the cancer risks conferred by alcohol consumption in women. Study design Prospective cohort study with alcohol consumption determined on the basis of a questionnaire and information on incidence of specific cancers obtained from a national registry. Cox regression models were used to estimate cancer risks associated with alcohol consumption after adjustment for other risk factors. Contribution Increasing but moderate alcohol consumption in women was determined to be associated with an increased risk of cancers of the oral cavity and pharynx, esophagus, larynx, rectum, breast, and liver, and with a decreased risk for thyroid cancer, non–Hodgkin lymphoma, and renal cell carcinoma. No differences in cancer risks were observed between drinkers of wine only and other consumers of alcohol. Implications In middle-aged women, moderate alcohol consumption increases the risk of cancer overall; each additional drink regularly consumed per day may account for approximately 15 excess cancers per 1000 women up to age 75 in this age group in developed countries. Limitations The study could not address the risk conferred by heavy sustained drinking due to the composition of the cohort. From the Editors
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Manuscript received April 7, 2008; revised October 20, 2008; accepted December 18, 2008.
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J Natl Cancer Inst 2009 101: 281.
J Natl Cancer Inst 2009 101: 281.
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