Critique 005:Alcohol, benign breast disease, young women

Critique 005: 27 May 2010

Subject:  Alcohol, benign breast disease, young women

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Berkey CS; Willett WC; Lindsay Frazier A; Rosner B; Colditz GA; Rockett RH; Helaine RM.  Prospective study of adolescent alcohol consumption and risk of benign breast disease in young women.  Pediatrics 2010;125:e1081-e1087.

Authors’ Abstract

Objective: To investigate prospectively, using alcoholic beverage consumption data collected in real time, the association between adolescent drinking and risk of biopsy-confirmed benign breast disease (BBD) in young women.

Participants and Methods: The Growing Up Today Study is a prospective cohort study of US girls, aged 9 to 15 years at baseline, with annual questionnaires from 1996 through 2001, followed by questionnaires in 2003, 2005, and 2007.  On the 2003 survey, the participants (then aged 16-23 years) provided information about their alcoholic beverage consumption in the previous year.  On the 2005 and 2007 surveys, a total of 6,899 women (aged 18-27 years) reported whether a health care provider had ever diagnosed them with BBD (n = 147 cases) and whether it was confirmed by biopsy (n = 67 cases);  6,752 women reported never being diagnosed with BBD.

Results:  Adjusted for age and BMI, quantity of alcohol consumed was associated with increased risk of biopsy-confirmed BBD (odds ratio: 1.50 per drink per day [95% confidence interval: 1.19–1.90]).  Girls who typically drank 6 or 7 days/week were at higher risk (odds ratio: 5.50 [95% CI: 1.23–24.53]) compared with those who never drank or who drank less than once per week.

Conclusions: Higher amounts consumed, and more frequent consumption, of alcoholic beverages in adolescence may increase the occurrence of BBD in young women.  Advising teenagers to avoid alcoholic beverages, along with smoking and sun exposure, may reduce cancer incidence in adulthood.

Forum Comments

While no agency encourages any alcohol consumption among children or adolescents, it is realized that younger women are consuming alcohol; especially after entering college, binge drinking is not uncommon among young women.  In the present study, young women who stated that they consumed  alcohol were reported to be at increased risk of developing benign breast disease (BBD); this was estimated as a 50% increase for each drink per day consumed (in comparison with those who never drank or drank less than once per week), with even higher risk for heavier drinkers. 

These analyses are based on rather small numbers (only 67 confirmed cases of BBD) out of more than 6,000 subjects being followed.  Adjustments were made only for age at which alcohol consumption was reported and BMI, with statements that certain other factors (age at menarche, maternal history of BBD or breast cancer, age when first began to drink) did not show “significant effects.”  Further, while the title refers to “adolescent” alcohol consumption, the age when alcohol consumption was reported was 18 years of age or greater for most subjects with BBD.  Hence, data are not available on alcohol intake in the years shortly after menarche, when factors associated with the later development of breast cancer may be especially important. 

It may be important that data of baseline breast examination findings are not presented in this paper, nor is age at menarche, menstrual history information such as patterns of ovulation vs. anovulation or diagnoses of polycystic ovarian findings; use of oral contraceptives and pregnancy data; caffeine consumption patterns and dietary fat intake.  All of these variables have been shown to relate to the diagnosis of benign breast disease.^1-3  There is also a lack of sufficient baseline data in this population prior to the initiation of alcohol consumption.  Fibrocystic breast disorders, substratified into benign proliferative and non-proliferative fibrocystic disease, fibroadenoma, and sclerosing adenosis are not reported and may have a bearing on which portion of the population may be at greater risk of developing breast cancer later in life.  BBD occurs commonly in the general population, with some reports suggesting up to 50% incidence.  Further, the incidence of benign breast disease has been well-studied and reported in predominantly alcohol-abstinent Muslim cultures, as in Nigeria.4  As of now, we know that benign breast disease is a multifaceted, complex condition of the breasts for which all women are at significant risk.

The potentially beneficial effects from moderate drinking relate to the chronic diseases of middle-aged and older adults; there are no data suggesting a benefit in young people, and there is evidence of harm from heavy intake among children.  While key information on the subjects are not included in this paper, and replication will be key, the study does raise the possibility that alcohol consumption in young women may increase their risk of benign breast disease.

References from Forum Critique

1.  Minton JP, Abou-Issa H.   Nonendocrine theories of the etiology of benign breast disease.  World J Surg 1989 13:680-684.        

2.  Ferrini RL, Barrett-Connor E.  Caffeine intake and endogenous sex steroid levels in postmenopausal women. The Rancho Bernardo Study. Am J Epidemiol 1996;144:642–644.  PMID 8823059.

3.  Santen RJ, Mansel R.   Benign breast disorders.  N. Engl J Med 2005;353;275–285.  doi: 10.1056/NEJMrao35692.

4.  African Journal Pediatric Surgery 2010;7:78-80.

Lay Summary

Among more than 6,000 young women being followed in a longitudinal study, 67 confirmed cases of benign breast disease (BBD) were diagnosed.  Alcohol consumption was reported on 57 women who developed BBD when they were 16 – 23 years of age, with all but 8 subjects being 18 or older when they reported alcohol intake, and no data were presented on potential exposures earlier following menarche.  A significant increase in the risk of BBD was associated with alcohol intake, although many key factors that have been shown to relate to BBD were not reported in the paper.  Hence, while the number of cases is small, and a number of potential risk factors are not included, this study suggests that BBD may be increased by alcohol consumption in young women. 

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Contributions to this critique by the International Scientific Forum on Alcohol Research were made by

R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA  

Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA

 Lynn Gretkowski, MD, Obstetrics/Gynecology, Mountainview, CA, Stanford University, Stanford, CA, USA