The development of breast cancer spans decades. Wellings set forth a model of cellular changes in his seminal papers describing cell changes in normal breast tissue and the progression to advanced benign lesions, ductal carcinoma in situ, and invasive breast cancer 1. Our previous work on adolescent and early adult alcohol intake and breast cancer risk had focused largely on self-reported biopsy confirming benign disease 2 or actual diagnosis of breast cancer 3.
In our new paper 4 we draw on the rich resource of benign breast lesions that have been reviewed by world leaders in breast pathology. This review assures us of consistent classification of these premalignant lesions. With these confirmed premalignant lesions conclusions on the action of alcohol on breast cancer risk can be more directly related to documented changes at the cellular level.
We prospectively assessed alcohol intake at ages 18 to 22 and followed participants in the nurses Health Study II to identify those women who developed benign breast disease and those who remained free from disease. After pathology review we had over 650 cases of premalignant breast lesions. The diagnosis of these lesions carries a twofold increase in development of breast cancer 5,6. Alcohol intake showed a strong positive relation between intake and increased risk of benign lesions. Compared to women who did not drink alcohol during adolescent- those who consumed more than one drink per day, on average, had a relative risk of 1.35 – a 35% increase over the risk of never drinkers.
Since these lesions carry a substantial increase in risk of subsequent breast cancer – this study points directly to the withholding of alcohol leading to lower risk of progression down the pathway to invasive breast cancer.
1. Wellings SR, Jensen HM, Marcum RG. An atlas of subgross pathology of the human breast with special reference to possible precancerous lesions. Journal of the National Cancer Institute. Aug 1975;55(2):231-273.
2. Berkey CS, Willett WC, Frazier AL, et al. Prospective study of adolescent alcohol consumption and risk of benign breast disease in young women. Pediatrics. May 2010;125(5):e1081-1087.
3. Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA : the journal of the American Medical Association. Nov 2 2011;306(17):1884-1890.
4. Liu Y, Tamimi RM, Berkey CS, et al. Intakes of Alcohol and Folate During Adolescence and Risk of Proliferative Benign Breast Disease. Pediatrics. Apr 9 2012.
5. London SJ, Connolly JL, Schnitt SJ, Colditz GA. A prospective study of benign breast disease and the risk of breast cancer. JAMA : the journal of the American Medical Association. Feb 19 1992;267(7):941-944.
6. Collins LC, Baer HJ, Tamimi RM, Connolly JL, Colditz GA, Schnitt SJ. The influence of family history on breast cancer risk in women with biopsy-confirmed benign breast disease: results from the Nurses’ Health Study. Cancer. Sep 15 2006;107(6):1240-1247.