Letter to the editor in response to: Moderate Alcohol Intake and Cancer Incidence in Women


Naomi E. Allen, Valerie Beral, Delphine Casabonne, Sau Wan Kan, Gillian K. Reeves, Anna Brown, Jane Green on behalf of the Million Women Study Collaborators Affiliation of authors: Cancer Epidemiology Unit, University of Oxford, Oxford,UK

Oxford Journals Medicine JNCI J Natl Cancer Inst Volume 101, Number 5 pp. 296-305.

We take strong exception with publications that study one parameter and report conclusions on another outcome, so we felt moved to respond to the Allen et al article “Moderate Alcohol Intake and Cancer incidence in Women”. This article has taken the press by storm and appears to link a higher incidence of aero digestive cancers with moderate alcohol consumption. It is flawed from the start. The authors choose a selected cohort (an older population at that with the mean age of 55 and predominantly menopausal), already attending breast clinics, which we already know have a higher rate of breast cancers due to more screening. Although they site this as a prospective study, it asks participants to recall alcohol consumption history 3 years after recruitment! It only follows them for 5 years, although it takes 11 years to develop an
invasive breast cancer.

Furthermore, the groups studied were not equal: younger, leaner, more affluent and athletic women also consumed more alcohol. Although smoking was controlled for and was associated with a higher rate of alcohol consumption, according to the authors “increasing alcohol intake was not associated with an increased risk of cancers of the upper aero digestive tract in never smokers or past smokers, but was strongly associated with an increased risk among current smokers."

This is a study about SMOKING and NOT ALCOHOL CONSUMPTION. Among smokers it didn’t matter if they drank alcohol, spirits or wine. This is not new information. We in the medical community are already aware that smoking increases all forms of morbidity, mortality, and cancers. We already know that current smokers have higher risks of aero digestive cancers1, and can probably associate breathing as a concurrent risk factor as these authors have linked low to moderate alcohol consumption. The interesting new information we have learned in this study is that breast cancers in the UK accounts for 11% of breast cancers. We can’t seem to establish this very complicated link in this country. We also don’t assume that individuals who stop drinking do this due to ill health. Economics and expenses, dietary habits, and codependency are among the many possibilities which come to mind.

The study also fails to control for smoking in the rectal, liver and breast cancer cohort. The erroneous conclusion of increased rates of cancers in drinkers (failing the cite that smoking was the link), draws into question the credibility of this citation. It is one thing to report the news and another to read the fine print. We might just have to conclude that Neo-prohibition is alive and well in the UK.

1 Eur J Cancer Prev. 2008 Aug;17(4):340-4


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