按雌激素受体状态划分的饮酒与乳腺癌风险：20项研究的汇总分析
Alcohol consumption and breast cancer risk by estrogen receptor status: in a pooled analysis of 20 studies.
作者信息
Jung Seungyoun, Wang Molin, Anderson Kristin, Baglietto Laura, Bergkvist Leif, Bernstein Leslie, van den Brandt Piet A, Brinton Louise, Buring Julie E, Eliassen A Heather, Falk Roni, Gapstur Susan M, Giles Graham G, Goodman Gary, Hoffman-Bolton Judith, Horn-Ross Pamela L, Inoue Manami, Kolonel Laurence N, Krogh Vittorio, Lof Marie, Maas Paige, Miller Anthony B, Neuhouser Marian L, Park Yikyung, Robien Kim, Rohan Thomas E, Scarmo Stephanie, Schouten Leo J, Sieri Sabina, Stevens Victoria L, Tsugane Schoichiro, Visvanathan Kala, Wilkens Lynne R, Wolk Alicja, Weiderpass Elisabete, Willett Walter C, Zeleniuch-Jacquotte Anne, Zhang Shumin M, Zhang Xuehong, Ziegler Regina G, Smith-Warner Stephanie A
机构信息
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,
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.
出版信息
Int J Epidemiol. 2016 Jun;45(3):916-28. doi: 10.1093/ije/dyv156. Epub 2015 Aug 28.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
背景
乳腺癌的病因可能因雌激素受体（ER）状态而异。在对20个队列的原始数据进行汇总分析中，研究了酒精和叶酸摄入量与按ER状态定义的乳腺癌风险之间的关联。
方法
在对1089273名女性进行的最长6至18年的随访期间，共识别出21624例ER阳性和5113例ER阴性乳腺癌。使用Cox比例风险回归模型计算各研究的多变量相对风险（RRs），然后使用随机效应模型进行合并。
结果
饮酒与ER阳性和ER阴性乳腺癌风险呈正相关。将每日饮酒量≥30克与0克/天进行比较，ER阳性乳腺癌的汇总多变量RRs（95%置信区间）为1.35（1.23 - 1.48），ER阴性乳腺癌为1.28（1.10 - 1.49）（Ptrend≤0.001；按ER状态的共同效应P：0.57）。啤酒、葡萄酒和烈酒的酒精摄入量与乳腺癌的关联相似。酒精摄入量与总（来自食物和补充剂）叶酸摄入量之间的关联无显著差异（P交互作用≥0.26）。膳食（仅来自食物）和总叶酸摄入量与总体、ER阳性和ER阴性乳腺癌风险均无关联；比较极端五分位数时，汇总多变量RRs范围为0.98至1.02。仅在强制叶酸强化之前的时期对美国研究进行随访，结果未改变。酒精和叶酸的关联在按孕激素受体状态定义的肿瘤亚型中无差异。
结论
饮酒与ER阳性和ER阴性乳腺癌风险均呈正相关，即使在叶酸摄入量高的女性中也是如此。叶酸摄入量与乳腺癌风险无关。
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