An analysis of two recent epidemilogic report in the New England Journal of Medicine associating breast cancer in women with moderate alcohol consumption

1988 ◽  
Vol 17 (6) ◽  
pp. 672-675 ◽  
Author(s):  
Nathan Mantel
2005 ◽  
Vol 23 (16_suppl) ◽  
pp. 515-515 ◽  
Author(s):  
W. Y. Chen ◽  
W. C. Willett ◽  
B. Rosner ◽  
G. A. Coldtiz

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1521-1521
Author(s):  
Roni Falk ◽  
Paige Maas ◽  
Catherine Schairer ◽  
Saundra S. Buys ◽  
Nilanjan Chatterjee ◽  
...  

1521 Background: Moderate alcohol consumption is an established breast cancer (BC) risk factor. Invasive BC is a heterogeneous disease comprised of several histological subtypes with distinct biological features that suggest etiologic differences. Several studies show the alcohol link may be stronger for estrogen receptor-positive tumors (ER+/PR+ and ER+/PR-) and for lobular BC. Few have evaluated the role of alcohol consumption by BC histology and hormone receptor status combined. Methods: We evaluated the risk of BC by baseline alcohol consumption in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial cohort (54649 participants, 1786 incident invasive breast cancers) by histology and hormone receptor status. Histologic subtype-specific associations were evaluated using a recently developed Cox proportional hazards model to calculate multivariate hazards ratios (HR) and 95% confidence intervals (CI). Results: 1444 ductal (81%), 233 lobular (13%) and 109 mixed ductal lobular (6%) cases were identified. The majority were ER+/PR+ (ductal: 959 ER+/PR+, 136 ER+/PR-, 229 ER-/PR-; lobular: 179 ER+/PR+, 37 ER+/PR-, 6 ER-/PR-; mixed ductal/lobular: 88 ER+/PR+, 6 ER+/PR-, 5 ER-/PR-). For ductal and lobular BC, risks for alcohol consumption were modestly elevated; compared to never drinkers, women consuming 7-14 drinks/week had a 40% increase in HR in both histologic subtypes. Risks for mixed ductal lobular cancer were significantly higher, particularly for women consuming 7-14 drinks per week (HR=3.0; 95% CI=1.5, 6.1). For all histologies combined, alcohol risks were confined to ER+/PR+ cancers with HR=1. 6 (95% CI=1.3, 2.1) for women consuming 7-14 drinks/ week; p trend=0.0005. Similarly, for each histologic subtype, the risk for alcohol consumption was limited to ER+/PR+ tumors, and notably, very few cases with pure lobular or mixed ductal lobular cancer were either ER+/PR- or ER-/PR-. Conclusions: Moderate alcohol consumption is associated with risk of ER+/PR+ BC in each of the predominant histologic subtypes, but not with hormone receptor-negative cancer. Unlike other studies, we did not find a link between alcohol consumption and ER+/PR- BC.


Cancers ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 349 ◽  
Author(s):  
Samir Zakhari ◽  
Jan Hoek

Epidemiological studies have been used to show associations between modifiable lifestyle habits and the incidence of breast cancer. Among such factors, a history of alcohol use has been reported in multiple studies and meta-analyses over the past decades. However, associative epidemiological studies that were interpreted as evidence that even moderate alcohol consumption increases breast cancer incidence have been controversial. In this review, we consider the literature on the relationship between moderate or heavy alcohol use, both in possible biological mechanisms and in variations in susceptibility due to genetic or epigenetic factors. We argue that there is a need to incorporate additional approaches to move beyond the associations that are reported in traditional epidemiological analyses and incorporate information on molecular pathologic signatures as a requirement to posit causal inferences. In particular, we point to the efforts of the transdisciplinary field of molecular pathological epidemiology (MPE) to evaluate possible causal relationships, if any, of alcohol consumption and breast cancer. A wider application of the principles of MPE to this field would constitute a giant step that could enhance our understanding of breast cancer and multiple modifiable risk factors, a step that would be particularly suited to the era of “personalized medicine”.


1987 ◽  
Vol 316 (19) ◽  
pp. 1174-1180 ◽  
Author(s):  
W.C. Willett ◽  
M.J. Stampfer ◽  
G.A. Colditz ◽  
B.A. Rosner ◽  
C.H. Hennekens ◽  
...  

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0144680 ◽  
Author(s):  
Loreta Strumylaite ◽  
Stephen J. Sharp ◽  
Rima Kregzdyte ◽  
Lina Poskiene ◽  
Algirdas Bogusevicius ◽  
...  

2018 ◽  
Vol 17 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Heather Towery ◽  
Michael Hough

Purpose Digital transformation holds promise for addressing one of the biggest challenges in health care – misdiagnosis. About 30 per cent of health spending in 2009, i.e. roughly $750bn, was wasted on unnecessary services, excessive administrative costs, fraud and other problems. Moreover, inefficiencies cause needless suffering, states the Institute of Medicine. Leveraging emerging digital technologies in this sector stands to save thousands of lives and billions of dollars. Digital technology is being applied to this field owing to the great demand for a solution. Misdiagnosis is causing a major hemorrhaging hundreds of billions of dollars in the health industry – an estimated 10-20 per cent of cases are misdiagnosed, sometimes resulting in death or permanent disability, according to studies cited by the National Center for Policy Analysis. Additionally, experts believe as many as 31 per cent of all breast cancer cases are misdiagnosed, according to the New England Journal of Medicine, and 90,000 women are misdiagnosed with invasive breast cancer, according to Susan G. Komen. Design/methodology/approach Digital technology is being applied to this field owing to the great demand for a solution. Misdiagnosis is causing a major hemorrhaging hundreds of billions of dollars in the health industry – an estimated 10-20 percent of cases are misdiagnosed, sometimes resulting in death or permanent disability, according to studies cited by the National Center for Policy Analysis. Additionally, experts believe as many as 31 percent of all breast cancer cases are misdiagnosed, according to the New England Journal of Medicine, and 90,000 women are misdiagnosed with invasive breast cancer, according to Susan G. Komen. Findings Advance Medical’s experience is that 39 per cent of a self-selecting group of medical advocacy seekers are misdiagnosed. Directly related to this challenge, a major battleground where the war on escalating healthcare costs is being fought is in the space of utilization management tools, which help ensure insurers are paying for the right care. These tools depend on the doctor making the right diagnosis and that the treatment matches the diagnosis. But these tools are broken. Instead of checking accuracy of diagnosis (e.g. the right test was done and interpreted accurately), they are at best checking to see if the “box was checked” for any testing being done. The solution is to not only to ensure that the diagnosis is correct by having it reviewed independently but also to use technology to aid diagnosis and the physician’s overall job. Using tools such as patient portals and data management technology can aid doctors to not burn out from sorting through data but rather using healthcare technology to reduce physician exhaustion and thus misdiagnosis. Originality/value New and old tools hold promise for addressing one of the costliest and most able-to-be-impacted challenges in health care – misdiagnosis. Because of misdiagnosis, the health industry is hemorrhaging hundreds of billions of dollars and causing patients undue stress and negative medical impact. Not only does misdiagnosis have a strong effect on the economy and the solvency of the US health care system, it also has a profound effect on the people who are being misdiagnosed, as well as their families and loved ones.


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