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Synergy Between Moderate Alcohol Use and HRT for Breast Cancer Risk

Postmenopausal women who took hormones and who drank alcohol were at increased risk for breast cancer.

Alcohol consumption and hormone replacement therapy each elevate breast cancer risk. In this prospective cohort study, investigators from the Nurses' Health Study followed 44,186 postmenopausal registered nurses without cancer to further examine the effects of these risk factors.

During a maximum 16 years of follow-up (557,984 person-years), invasive breast cancer developed in 1722 women. In analyses that were adjusted for HRT use and other risk factors for breast cancer, 10-19.9 g of alcohol daily (1 drink) and 20 g of alcohol daily (2 drinks) were associated with increased risk for breast cancer (relative risks compared with no alcohol use, 1.2 and 1.3, respectively). Compared with no HRT use, current HRT use of <5 years and 5 years also increased breast cancer risk (RRs, 1.4 and 1.5, respectively). The risk for breast cancer was higher for HRT users who drank alcohol than for nonusers who did not drink: At 5-9.9 g and 10-19.9 g alcohol daily, 5 years of HRT conferred RRs of 1.6 and 1.9, respectively; at 20 g daily, <5 years and 5 years of HRT conferred RRs of 2.1 and 2, respectively.

Comment: Results from observational studies are consistent on this point: Moderate drinking increases risk for breast cancer. The findings of this study are biologically plausible, as concomitant HRT and alcohol use elevates estrogen levels. HRT users should be aware of this interaction when they make decisions about drinking alcohol and about taking HRT.

— Richard Saitz, MD, MPH

Published in Journal Watch General Medicine December 27, 2002

Citation(s):

Chen WY et al. Use of postmenopausal hormones, alcohol, and risk for invasive breast cancer. Ann Intern Med 2002 Nov 19; 137:798-804.

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