Breast Cancer Research and Treatment

, Volume 136, Issue 1, pp 195–207 | Cite as

Pre-diagnostic alcohol consumption and postmenopausal breast cancer survival: a prospective patient cohort study

  • Alina Vrieling
  • Katharina Buck
  • Judith Heinz
  • Nadia Obi
  • Axel Benner
  • Dieter Flesch-Janys
  • Jenny Chang-Claude


Study results on the association of alcohol consumption with breast cancer survival are inconsistent, partly due to the use of different survival outcomes. We assessed the association of pre-diagnostic alcohol consumption with survival and recurrence in a prospective cohort study in Germany including 2,522 postmenopausal breast cancer patients aged 50–74 years. Patients were diagnosed between 2001 and 2005 and vital status, causes of death, and recurrences were verified through the end of 2009. Cox proportional hazards models were stratified by age at diagnosis and study center and adjusted for relevant prognostic factors. Alcohol consumption was non-linearly associated with increased breast cancer-specific mortality [e.g., ≥12 vs. <0.5 g/day: hazard ratio (HR) = 1.74, 95 % confidence interval (CI): 1.13, 2.67]. Results were independent of estrogen receptor status. A non-significantly decreased risk of mortality due to other causes was found (≥12 vs. <0.5 g/day: HR = 0.67, 95 % CI: 0.35, 1.29). Alcohol consumption was not associated with overall mortality (≥12 vs. <0.5 g/day: HR = 1.28, 95 % CI: 0.90, 1.81) and breast cancer recurrence (≥12 vs. <0.5 g/day: HR = 1.08, 95 % CI: 0.73, 1.58). In conclusion, our findings show that consumption of alcohol before diagnosis is non-linearly associated with increased breast cancer-specific mortality but may be associated with decreased risk of mortality due to other causes.


Breast cancer Alcohol Mortality Recurrence 



This work was supported by the Deutsche Krebshilfe, Project numbers 108253/108419 and the Deutsche Forschungsgemeinschaft, Graduiertenkolleg 793. We thank Ursula Eilber, Christina Krieg, Renate Birr, and Dorothee Zoller for valuable technical assistance.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Key J, Hodgson S, Omar RZ, Jensen TK, Thompson SG, Boobis AR, Davies DS, Elliott P (2006) Meta-analysis of studies of alcohol and breast cancer with consideration of the methodological issues. Cancer Causes Control 17:759–770PubMedCrossRefGoogle Scholar
  2. 2.
    Holmes MD (2010) Challenge of balancing alcohol intake. J Clin Oncol 28:4403–4404PubMedCrossRefGoogle Scholar
  3. 3.
    Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA (2011) Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 342:d671PubMedCrossRefGoogle Scholar
  4. 4.
    Key TJ, Appleby PN, Reeves GK, Roddam AW, Helzlsouer KJ, Alberg AJ, Rollison DE, Dorgan JF, Brinton LA, Overvad K, Kaaks R, Trichopoulou A, Clavel-Chapelon F, Panico S, Duell EJ, Peeters PH, Rinaldi S, Fentiman IS, Dowsett M, Manjer J, Lenner P, Hallmans G, Baglietto L, English DR, Giles GG, Hopper JL, Severi G, Morris HA, Hankinson SE, Tworoger SS, Koenig K, Zeleniuch-Jacquotte A, Arslan AA, Toniolo P, Shore RE, Krogh V, Micheli A, Berrino F, Barrett-Connor E, Laughlin GA, Kabuto M, Akiba S, Stevens RG, Neriishi K, Land CE, Cauley JA, Lui LY, Cummings SR, Gunter MJ, Rohan TE, Strickler HD (2011) Circulating sex hormones and breast cancer risk factors in postmenopausal women: reanalysis of 13 studies. Br J Cancer 105:709–722PubMedCrossRefGoogle Scholar
  5. 5.
    Fuchs CS, Stampfer MJ, Colditz GA, Giovannucci EL, Manson JE, Kawachi I, Hunter DJ, Hankinson SE, Hennekens CH, Rosner B (1995) Alcohol consumption and mortality among women. N Engl J Med 332:1245–1250PubMedCrossRefGoogle Scholar
  6. 6.
    Ewertz M, Gillanders S, Meyer L, Zedeler K (1991) Survival of breast cancer patients in relation to factors which affect the risk of developing breast cancer. Int J Cancer 49:526–530PubMedCrossRefGoogle Scholar
  7. 7.
    Zhang S, Folsom AR, Sellers TA, Kushi LH, Potter JD (1995) Better breast cancer survival for postmenopausal women who are less overweight and eat less fat. The Iowa Women’s Health Study. Cancer 76:275–283PubMedCrossRefGoogle Scholar
  8. 8.
    Holmes MD, Hunter DJ, Colditz GA, Stampfer MJ, Hankinson SE, Speizer FE, Rosner B, Willett WC (1999) Association of dietary intake of fat and fatty acids with risk of breast cancer. JAMA 281:914–920PubMedCrossRefGoogle Scholar
  9. 9.
    Saxe GA, Rock CL, Wicha MS, Schottenfeld D (1999) Diet and risk for breast cancer recurrence and survival. Breast Cancer Res Treat 53:241–253PubMedCrossRefGoogle Scholar
  10. 10.
    Pierce JP, Stefanick ML, Flatt SW, Natarajan L, Sternfeld B, Madlensky L, Al-Delaimy WK, Thomson CA, Kealey S, Hajek R, Parker BA, Newman VA, Caan B, Rock CL (2007) Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol 25:2345–2351PubMedCrossRefGoogle Scholar
  11. 11.
    Barnett GC, Shah M, Redman K, Easton DF, Ponder BA, Pharoah PD (2008) Risk factors for the incidence of breast cancer: do they affect survival from the disease? J Clin Oncol 26:3310–3316PubMedCrossRefGoogle Scholar
  12. 12.
    Hebert JR, Hurley TG, Ma Y (1998) The effect of dietary exposures on recurrence and mortality in early stage breast cancer. Breast Cancer Res Treat 51:17–28PubMedCrossRefGoogle Scholar
  13. 13.
    McDonald PA, Williams R, Dawkins F, Adams-Campbell LL (2002) Breast cancer survival in African American women: is alcohol consumption a prognostic indicator? Cancer Causes Control 13:543–549PubMedCrossRefGoogle Scholar
  14. 14.
    Dal Maso L, Zucchetto A, Talamini R, Serraino D, Stocco CF, Vercelli M, Falcini F, Franceschi S (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123:2188–2194PubMedCrossRefGoogle Scholar
  15. 15.
    Franceschi S, Dal Maso L, Zucchetto A, Talamini R (2009) Alcohol consumption and survival after breast cancer. Cancer Epidemiol Biomarkers Prev 18:1011–1012 author reply 1012–1013PubMedCrossRefGoogle Scholar
  16. 16.
    Hellmann SS, Thygesen LC, Tolstrup JS, Gronbaek M (2010) Modifiable risk factors and survival in women diagnosed with primary breast cancer: results from a prospective cohort study. Eur J Cancer Prev 19:366–373PubMedCrossRefGoogle Scholar
  17. 17.
    Kwan ML, Kushi LH, Weltzien E, Tam EK, Castillo A, Sweeney C, Caan BJ (2010) Alcohol consumption and breast cancer recurrence and survival among women with early-stage breast cancer: the life after cancer epidemiology study. J Clin Oncol 28:4410–4416PubMedCrossRefGoogle Scholar
  18. 18.
    Allemani C, Berrino F, Krogh V, Sieri S, Pupa SM, Tagliabue E, Tagliabue G, Sant M (2011) Do pre-diagnostic drinking habits influence breast cancer survival? Tumori 97:142–148PubMedGoogle Scholar
  19. 19.
    Beasley JM, Newcomb PA, Trentham-Dietz A, Hampton JM, Bersch AJ, Passarelli MN, Holick CN, Titus-Ernstoff L, Egan KM, Holmes MD, Willett WC (2011) Post-diagnosis dietary factors and survival after invasive breast cancer. Breast Cancer Res Treat 128:229–236PubMedCrossRefGoogle Scholar
  20. 20.
    Harris HR, Bergkvist L, Wolk A (2012) Alcohol intake and mortality among women with invasive breast cancer. Br J Cancer 106:592–595PubMedCrossRefGoogle Scholar
  21. 21.
    Holm M, Olsen A, Christensen J, Kroman NT, Bidstrup PE, Johansen C, Overvad K, Tjonneland A (2012) Pre-diagnostic alcohol consumption and breast cancer recurrence and mortality: results from a prospective cohort with a wide range of variation in alcohol intake. Int J Cancer. doi: 10.1002/ijc.27652 Google Scholar
  22. 22.
    Reding KW, Daling JR, Doody DR, O’Brien CA, Porter PL, Malone KE (2008) Effect of prediagnostic alcohol consumption on survival after breast cancer in young women. Cancer Epidemiol Biomarkers Prev 17:1988–1996PubMedCrossRefGoogle Scholar
  23. 23.
    Flatt SW, Thomson CA, Gold EB, Natarajan L, Rock CL, Al-Delaimy WK, Patterson RE, Saquib N, Caan BJ, Pierce JP (2010) Low to moderate alcohol intake is not associated with increased mortality after breast cancer. Cancer Epidemiol Biomarkers Prev 19:681–688PubMedCrossRefGoogle Scholar
  24. 24.
    Rohan TE, Hiller JE, McMichael AJ (1993) Dietary factors and survival from breast cancer. Nutr Cancer 20:167–177PubMedCrossRefGoogle Scholar
  25. 25.
    Borugian MJ, Sheps SB, Kim-Sing C, Van Patten C, Potter JD, Dunn B, Gallagher RP, Hislop TG (2004) Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer? Cancer Epidemiol Biomarkers Prev 13:1163–1172PubMedGoogle Scholar
  26. 26.
    Goodwin PJ, Ennis M, Pritchard KI, Koo J, Trudeau ME, Hood N (2003) Diet and breast cancer: evidence that extremes in diet are associated with poor survival. J Clin Oncol 21:2500–2507PubMedCrossRefGoogle Scholar
  27. 27.
    Holm LE, Nordevang E, Hjalmar ML, Lidbrink E, Callmer E, Nilsson B (1993) Treatment failure and dietary habits in women with breast cancer. J Natl Cancer Inst 85:32–36PubMedCrossRefGoogle Scholar
  28. 28.
    Flesch-Janys D, Slanger T, Mutschelknauss E, Kropp S, Obi N, Vettorazzi E, Braendle W, Bastert G, Hentschel S, Berger J, Chang-Claude J (2008) Risk of different histological types of postmenopausal breast cancer by type and regimen of menopausal hormone therapy. Int J Cancer 123:933–941PubMedCrossRefGoogle Scholar
  29. 29.
    Bohlscheid-Thomas S, Hoting I, Boeing H, Wahrendorf J (1997) Reproducibility and relative validity of energy and macronutrient intake of a food frequency questionnaire developed for the German part of the EPIC project. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26(Suppl 1):S71–S81PubMedCrossRefGoogle Scholar
  30. 30.
    Bohlscheid-Thomas S, Hoting I, Boeing H, Wahrendorf J (1997) Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the German part of the EPIC project. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26(Suppl 1):S59–S70PubMedCrossRefGoogle Scholar
  31. 31.
    Slimani N, Ferrari P, Ocke M, Welch A, Boeing H, Liere M, Pala V, Amiano P, Lagiou A, Mattisson I, Stripp C, Engeset D, Charrondiere R, Buzzard M, Staveren W, Riboli E (2000) Standardization of the 24-hour diet recall calibration method used in the european prospective investigation into cancer and nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54:900–917PubMedCrossRefGoogle Scholar
  32. 32.
    Sieri S, Agudo A, Kesse E, Klipstein-Grobusch K, San-Jose B, Welch AA, Krogh V, Luben R, Allen N, Overvad K, Tjonneland A, Clavel-Chapelon F, Thiebaut A, Miller AB, Boeing H, Kolyva M, Saieva C, Celentano E, Ocke MC, Peeters PH, Brustad M, Kumle M, Dorronsoro M, Fernandez Feito A, Mattisson I, Weinehall L, Riboli E, Slimani N (2002) Patterns of alcohol consumption in 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutr 5:1287–1296PubMedCrossRefGoogle Scholar
  33. 33.
    Therneau TM, Grambsch PM (2000) Modeling survival data. Extending the Cox model. Statistics for biology and health. Springer, New YorkGoogle Scholar
  34. 34.
    Royston P, Ambler G, Sauerbrei W (1999) The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol 28:964–974PubMedCrossRefGoogle Scholar
  35. 35.
    Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387PubMedCrossRefGoogle Scholar
  36. 36.
    Stare J, Perme MP, Henderson R (2011) A measure of explained variation for event history data. Biometrics 67:750–759PubMedCrossRefGoogle Scholar
  37. 37.
    R Development Core Team (2011) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Alina Vrieling
    • 2
  • Katharina Buck
    • 2
  • Judith Heinz
    • 3
  • Nadia Obi
    • 3
  • Axel Benner
    • 4
  • Dieter Flesch-Janys
    • 3
    • 5
  • Jenny Chang-Claude
    • 1
  1. 1.Division of Cancer Epidemiology, Unit of Genetic EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
  2. 2.Division of Cancer Epidemiology, Unit of Genetic EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
  3. 3.Department of Cancer Epidemiology/Clinical Cancer RegistryUniversity Cancer Center Hamburg (UCCH)HamburgGermany
  4. 4.Division of BiostatisticsGerman Cancer Research Center (DKFZ)HeidelbergGermany
  5. 5.Department of Medical Biometrics and EpidemiologyUniversity Medical Center Hamburg-EppendorfHamburgGermany

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