Hamajima N, Hirose K, Tajima K, Rohan T, Calle E E, Heath C W, Coates R J, Liff J M, Talamini R, Chantarakul N, Koetsawang S, Rachawat D, Morabia A, Schuman L, Stewart W, Szklo M, Bain C, Schofield F, Siskind V, Band P, Coldman A J, Gallagher R P, Hislop T G, Yang P, Kolonel L M, Nomura A M Y, Hu J, Johnson K C, Mao Y, De Sanjosé S, Lee N, Marchbanks P, Ory H W, Peterson H B, Wilson H G, Wingo P A, Ebeling K, Kunde D, Nishan P, Hopper J L, Colditz G, Gajalanski V, Martin N, Pardthaisong T, Silpisornkosol S, Theetranont C, Boosiri B, Chutivongse S, Jimakorn P, Virutamasen P, Wongsrichanalai C, Ewertz M, Adami H O, Bergkvist L, Magnusson C, Persson I, Chang-Claude J, Paul C, Skegg D C G, Spears G F S, Boyle P, Evstifeeva T, Daling J R, Hutchinson W B, Malone K, Noonan E A, Stanford J L, Thomas D B, Weiss N S, White E, Andrieu N, Brêmond A, Clavel F, Gairard B, Lansac J, Piana L, Renaud R, Izquierdo A, Viladiu P, Cuevas H R, Ontiveros P, Palet A, Salazar S B, Aristizabel N, Cuadros A, Tryggvadottir L, Tulinius H, Bachelot A, Lê M G, Peto J, Franceschi S, Lubin F, Modan B, Ron E, Wax Y, Friedman G D, Hiatt R A, Levi F, Bishop T, Kosmelj K, Primic-Zakelj M, Ravnihar B, Stare J, Beeson W L, Fraser G, Bullbrook R D, Cuzick J, Duffy S W, Fentiman I S, Hayward J L, Wang D Y, McMichael A J, McPherson K, Hanson R L, Leske M C, Mahoney M C, Nasca P C, Varma A O, Weinstein A L, Moller T R, Olsson H, Ranstam J, Goldbohm R A, van den Brandt P A, Apelo R A, Baens J, de la Cruz J R, Javier B, Lacaya L B, Ngelangel C A, La Vecchia C, Negri E, Marubini E, Ferraroni M, Gerber M, Richardson S, Segala C, Gatei D, Kenya P, Kungu A, Mati J G, Brinton L A, Hoover R, Schairer C, Spirtas R, Lee H P, Rookus M A, van Leeuwen F E, Schoenberg J A, McCredie M, Gammon M D, Clarke E A, Jones L, Neil A, Vessey M, Yeates D, Appleby P, Banks E, Beral V, Bull D, Crossley B, Goodill A, Green J, Hermon C, Key T, Langston N, Lewis C, Reeves G, Collins R, Doll R, Peto R, Mabuchi K, Preston D, Hannaford P, Kay C, Rosero-Bixby L, Gao Y T, Jin F, Yuan J-M, Wei H Y, Yun T, Zhiheng C, Berry G, Cooper Booth J, Jelihovsky T, MacLennan R, Shearman R, Wang Q-S, Baines C-J, Miller A B, Wall C, Lund E, Stalsberg H, Shu X O, Zheng W, Katsouyanni K, Trichopoulou A, Trichopoulos D, Dabancens A, Martinez L, Molina R, Salas O, Alexander F E, Anderson K, Folsom A R, Hulka B S, Bernstein L, Enger S, Haile R W, Paganini-Hill A, Pike M C, Ross R K, Ursin G, Yu M C, Longnecker M P, Newcomb P, Bergkvist L, Kalache A, Farley T M M, Holck S, Meirik O
Cancer Research UK Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK.
Br J Cancer. 2002 Nov 18;87(11):1234-45. doi: 10.1038/sj.bjc.6600596.
Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.
酒精消费与烟草消费密切相关，已发表的关于它们与乳腺癌关联的研究结果，并未总是充分考虑到这些暴露因素之间的混杂作用。全球超过80%的关于酒精和烟草消费以及乳腺癌的相关信息，都在中心层面进行了整理、核查和分析。分析纳入了来自53项研究的58515例浸润性乳腺癌女性和95067例对照。在按研究、年龄、产次进行分层后，以及在适当时按女性生育第一个孩子时的年龄、酒精和烟草消费情况进行分层后，估计了乳腺癌的相对风险。发达国家对照人群报告的酒精平均消费量为每天6.0克，即每天约半单位/杯酒精，且曾经吸烟者的酒精消费量高于从不吸烟者（分别为每天8.4克和每天5.0克）。与报告不饮酒的女性相比，每天酒精摄入量为35 - 44克时，乳腺癌的相对风险为1.32（1.19 - 1.45，P<0.00001），每天酒精摄入量≥45克时，相对风险为1.46（1.33 - 1.61，P<0.00001）。每天每额外摄入10克酒精，即每天每多喝一单位或一杯酒精，乳腺癌的相对风险增加7.1%（95%置信区间5.5 - 8.7%；P<0.00001）。在曾经吸烟者和从不吸烟者中，这种增加幅度相同（每组每天每10克酒精增加7.1%，P<0.00001）。相比之下，吸烟与乳腺癌之间的关系因酒精的影响而存在显著混杂。当分析仅限于22255例乳腺癌女性和40832例报告不饮酒的对照时，吸烟与乳腺癌无关联（与从不吸烟者相比，曾经吸烟者的相对风险 = 1.03，95%置信区间0.98 - 1.07，当前吸烟者的相对风险 = 0.99，0.92 - 1.05）。酒精和烟草的研究结果在不同研究、研究设计之间，或根据女性的15项个人特征，均未表现出显著差异；这些因素也未对研究结果造成实质性混杂。如果观察到的酒精与乳腺癌之间的关系是因果关系，这些结果表明，发达国家约4%的乳腺癌可归因于酒精。在发展中国家，对照人群的酒精平均消费量仅为每天0.4克，酒精对乳腺癌发病率的影响可忽略不计。总之，吸烟对患乳腺癌风险几乎没有或没有独立影响；酒精对乳腺癌的影响需要在其对心血管疾病的适度有益作用以及对肝硬化和口腔、喉、食管及肝癌的有害作用的背景下进行解读。
