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1. Alcohol consumption after menarche but before a woman’s first pregnancy was associated with increased risk of both breast cancer and proliferative benign breast disease.

2. The risk appeared dose dependent such that increasing alcohol consumption was associated with greater risk of breast disease.

 Evidence Rating Level: 2 (Good)

Study Rundown: This study found a small but significant dose-dependent increase in breast cancer risk associated with alcohol consumption during the period between menarche and first pregnancy. Previous research has demonstrated that adult alcohol consumption is associated with increased adult breast cancer risk and it has been shown that breast tissue is particularly susceptible to carcinogens during development. This is the first study to evaluate the relationship between alcohol consumption in young women with future breast cancer development.

The strengths of this study include its design- a large, prospective cohort study with excellent rates of follow-up. Recall and selection bias are major limitations. Alcohol consumption was self-reported from recall of alcohol consumption over the past year. Future studies might further characterize the relationships between alcohol, benign breast disease, and cancer development.

Click to read the study in JNCI

Relevant Reading: Uptodate: Overview of the risks and benefits of alcohol consumption

Study Author, Dr. Graham A. Colditz, MD, DrPH, talks to 2 Minute Medicine: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine

“Our research suggests that pediatricians and adolescent specialist should focus more attention on exposures in adolescent and early adult years that can increase (e.g. alcohol) or decrease (e.g. exercise and high fiber diet) lifelong breast cancer risk. Future research could be targeted at finding aspects of diet that can counter the adverse effect of alcohol and so protect women who drink from alcohol’s carcinogenic effects.” 

In-Depth [prospective study]: This study analyzed data from 91,005 women ages 25-44 with no history of cancer enrolled in the Nurses’ Health Study II who were followed biennially over a 20-year period. Data on alcohol consumption was obtained across four age groups (15-17, 18-22, 23-30 and 31-40 years of age) with cumulative alcohol intake between menarche and first pregnancy defined as the exposure. 18,555 (20%) women reported no alcohol intake between menarche and first pregnancy, and served as controls. The primary outcomes were self-reported, record-confirmed breast cancer and biopsy-confirmed benign breast disease. Results were controlled for established breast cancer risk factors.

When adjusted for drinking after first pregnancy, alcohol consumption between menarche and first pregnancy was associated with an 11% per 10g/day increased incidence of future breast cancer (95% CI 1.00-1.23) and a 16% per 10g/day increased incidence of benign breast disease (CI 1.02-1.32). Overall, these associations were stronger in women with longer intervals between menarche and first pregnancy compared to women with shorter intervals. Compared with nondrinkers, those who drank were younger, had an older age of first pregnancy, and were more likely to have a first-degree family history of breast cancer.

By Maren Shapiro and Leah Hawkins, MD, MPH

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