PROSPECTIVE STUDY OF ADOLESCENT ALCOHOL CONSUMPTION AND RISK OF BENIGN BREAST DISEASE IN YOUNG WOMEN

Dr. R. Curt Ellison, Professor of Medicine and Founder and Director of the Institute on Lifestyle and Health at Boston University School of Medicine asked Dr. Gretkowski to comment on the above study.  Below is the study's abstract and Dr. Gretkowski's commentary.

Pediatrics. 2010 May;125(5):e1081-7. Epub 2010 Apr 12.
Berkey CS, Willett WC, Frazier AL, Rosner B, Tamimi RM, Rockett HR, Colditz GA.
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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 6899 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); 6752 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% confidence interval: 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.
PMID: 20385629 [PubMed - indexed for MEDLINE]

Commentary.

In review of the above  Berkey et al  article in the  Journal of Pediatrics I am impressed by the study design and analysis.  A cohort of slender daughters of nurses (presumably who have very adequate access to health care) are evaluated prospectively through their adolescent years for drinking habits which evolve over the 9 years of evaluation.  Types of drinks are combined not allowing inferences regarding types of alcohol consumed. 

Data of baseline breast examination findings are not included, 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 are omitted from the data.  Caffeine consumption patterns are also omitted from the data.  All of these variables have had much more consistent reporting with regard to the diagnosis of benign breast disease in medical literature than the absolute reported by the authors of alcohol consumption as the “massive body of evidence correlating alcohol intake with the incidence of breast cancer”.  Dietary fat intake does not appear to have been documented either.

The  self-reporting model appears to be the time-honored method regarding alcohol consumption collection data and is quite credible.  Unfortunately, what appears to invalidate the entire report is the 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 have greater risk for acquiring breast cancer in their lifetimes.  They are reported with great frequency in the general population with reports often greater than a 50% incidence. 

Incidence of benign breast disease have also been well-studied and reported and predominantly alcohol-abstinent/Muslim cultures, as in Nigeria. This suggests what we  continue to know about benign breast disease:  it is a multifaceted, complex condition of the breasts which all women are at significant risk for.

1. Arch Gynecol Obstet. 2009 Aug;280(2):249-53. Epub 2009 Jan 3.

2. Ferrini RL, Barrett-Connor E (October 1996). "Caffeine intake and endogenous sex steroid levels in postmenopausal women. The Rancho Bernardo Study". Am. J. Epidemiol. 144 (7): 642–4. PMID 8823059.

3.  World J Surg. 1989 Nov-Dec;13(6):680-4

4. Santen RJ, Mansel R (July 2005). "Benign breast disorders". N. Engl. J. Med. 353 (3): 275–85. doi:10.1056/NEJMra035692

5. African Journal Pediatric Surgery.  2010 May-Aug; 7(2):78-80.