Steinberg J, Goodwin P J
Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.
Breast Cancer Res Treat. 1991 Nov;19(3):221-31. doi: 10.1007/BF01961159.
The potential association of alcohol intake with breast cancer risk is currently being debated in the literature and a clear consensus of opinion has not emerged. Clarification of the issues surrounding this controversy would be helpful in developing recommendations for the general public regarding alcohol use. A review of the available evidence regarding the association of alcohol with breast cancer is presented followed by an application of the Bradford Hill criteria for causal inference to this data to examine the existence and nature of the association of alcohol with breast cancer risk. Results of published studies demonstrated a weak association of alcohol with breast cancer risk that was consistent only for relatively high levels of intake (more than 1 or 2 drinks daily). Increasing daily intake was associated with increased risk, but the association was not linear. Criteria relating to temporality and analogy to other causal associations were satisfied while inconsistent evidence was available for those relating to epidemiologic and biologic sense. The criterion for specificity was not satisfied and no experimental evidence was available. It is concluded that insufficient evidence exists to support a causal association of alcohol consumption with breast cancer risk. Further research is recommended to resolve conflicting evidence and to provide additional evidence where needed. In the meantime, recommendations that women should reduce their consumption of alcohol beyond existing guidelines to modify breast cancer risk are probably premature.
饮酒与乳腺癌风险之间的潜在关联目前在文献中存在争议，尚未形成明确的共识。澄清围绕这一争议的问题，将有助于为公众制定关于饮酒的建议。本文先对有关酒精与乳腺癌关联的现有证据进行综述，然后应用布拉德福德·希尔因果推断标准来分析这些数据，以研究酒精与乳腺癌风险关联的存在及性质。已发表研究的结果表明，酒精与乳腺癌风险之间存在微弱关联，且仅在相对较高的摄入量（每天超过1或2杯）时才一致。每日摄入量增加与风险增加相关，但这种关联并非线性。与时间顺序以及与其他因果关联的类比相关的标准得到了满足，而与流行病学和生物学意义相关的标准则存在不一致的证据。特异性标准未得到满足，也没有实验证据。结论是，现有证据不足以支持饮酒与乳腺癌风险之间存在因果关联。建议进一步开展研究以解决相互矛盾的证据，并在必要时提供更多证据。与此同时，建议女性在现有指南基础上进一步减少酒精摄入量以改变乳腺癌风险，这可能为时过早。
