Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studiesBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4238 (Published 18 August 2015) Cite this as: BMJ 2015;351:h4238
- Yin Cao, postdoctoral research fellow1,
- Walter C Willett, professor123,
- Eric B Rimm, professor123,
- Meir J Stampfer, professor123,
- Edward L Giovannucci, professor123
- 1Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA 02115, USA
- 2Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
- 3Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Correspondence to: E L Giovannucci
- Accepted 28 July 2015
Objectives To quantify risk of overall cancer across all levels of alcohol consumption among women and men separately, with a focus on light to moderate drinking and never smokers; and assess the influence of drinking patterns on overall cancer risk.
Design Two prospective cohort studies.
Setting Health professionals in the United States.
Participants 88 084 women and 47 881 men participating in the Nurses’ Health Study (from 1980) and Health Professionals Follow-up Study (from 1986), followed until 2010.
Main outcomes and measures Relative risks of cancer.
Results 19 269 and 7571 (excluding non-advanced prostate cancers) incident cancers were documented among women and men, respectively, over 3 144 853 person years. Compared with non-drinkers, light to moderate drinkers had relative risks of total cancer of 1.02 (95% confidence interval 0.98 to 1.06) and 1.04 (1.00 to 1.09; Ptrend=0.12) for alcohol intake of 0.1-4.9 and 5-14.9 g/day among women, respectively. Corresponding values for men were 1.03 (0.96 to 1.11), 1.05 (0.97 to 1.12), and 1.06 (0.98 to 1.15; Ptrend=0.31) for alcohol intake of 0.1-4.9, 5-14.9, and 15-29.9 g/day, respectively. Associations for light to moderate drinking and total cancer were similar among ever or never smokers, although alcohol consumption above moderate levels (in particular ≥30 g/day) was more strongly associated with risk of total cancer among ever smokers than never smokers. For a priori defined alcohol related cancers in men, risk was not appreciably increased for light and moderate drinkers who never smoked (Ptrend=0.18). However, for women, even an alcohol consumption of 5-14.9 g/day was associated with increased risk of alcohol related cancer (relative risk 1.13 (95% confidence interval 1.06 to 1.20)), driven by breast cancer. More frequent and heavy episodic drinking was not further associated with risk of total cancer after adjusting for total alcohol intake.
Conclusion Light to moderate drinking is associated with minimally increased risk of overall cancer. For men who have never smoked, risk of alcohol related cancers is not appreciably increased for light and moderate drinking (up to two drinks per day). However, for women who have never smoked, risk of alcohol related cancers (mainly breast cancer) increases even within the range of up to one alcoholic drink a day.
We thank the participants and staff of the Health Professionals Follow-up Study and the Nurses’ Health Study for their valuable contributions, as well as the following US state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, and WY.
Contributors: YC and ELG had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. YC and ELG conceived and designed the study. WCW, EBR, MJS, and ELG acquired the data. YC and ELG drafted the manuscript. All the authors critically revised the manuscript for important intellectual content. YC carried out the statistical analysis. WCW, EBR, MJS, and ELG obtained funding. YC and ELG were responsible for administrative, technical, or material support. ELG was responsible for study supervision. YC is guarantor. The authors assume full responsibility for analyses and interpretation of these data.
Funding: This work was supported by grants from the US National Institutes of Health (UM1 CA186107, P01 CA87969, P01 CA55075, and UM1 CA167552). The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The study protocol was approved by the institutional review boards of the Harvard T H Chan School of Public Health and Brigham and Women’s Hospital. The completion of the self-administered questionnaire was considered to imply informed consent.
Data sharing: No additional data available.
The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
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