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epidemiological data
Type of information:
experimental study
Adequacy of study:
supporting study
2 (reliable with restrictions)
Rationale for reliability incl. deficiencies:
other: No guideline, but data are scientifically acceptable.

Data source

Reference Type:
Patterns of alcohol (especially wine) consumption and breast cancer risk: a case-control study among a population in Southern France
Bessaoud F & Daures JP
Bibliographic source:
Annals of Epidemiology 18: 467-475

Materials and methods

Study type:
case control study (retrospective)
Endpoint addressed:
Test guideline
no guideline required
Principles of method if other than guideline:
A case control study was performed among a population of women residing in Southern France in an attempt to ascertain the relationship between patterns of alcohol consumption and risk of breast cancer.
GLP compliance:

Test material

Constituent 1
Reference substance name:
alcoholic beverages
alcoholic beverages
Details on test material:
Alcoholic beverages (wine, aperitifs, beer, spirits)


Details on study design:
A population-based case-control study was performed among 1359 French women aged 25 to 85 years. Case subjects (average age 58.1 years) were patients (with no former history of breast cancer) residing in the South of France, with newly diagnosed primary breast cancer (confirmed histologically between June 2002 and December 2004). The average time between diagnosis and interview was 3 months. Controls (average age 57.4 years; randomised from the electoral roll), were matched according to age and area of residence to each case recruited. A total of 437 cases and 922 controls were enrolled in the study.

Data were obtained by means of a structured questionnaire administered by two trained interviewers. The first part related to demographic characteristics, reproductive and menstrual factors, oral contraception, hormone replacement therapy, family history of cancer, physical activities and smoking history. The second part related to diet and alcohol consumption (assessing the subjects "usual drinking" habits). Subjects were asked to report drinking status (nondrinker, ex-drinker or current drinker). Non-drinkers were defined as women who had never drunk. Ex-drinkers were defined as women who had stopped drinking before the study started (controls) or before breast cancer diagnosis (cases). Current and ex-drinkers were then asked about their consumption of alcoholic beverages during the week, at the weekend, and at parties/family gatherings. For each specific type of alcoholic beverage (wine, aperitifs, beer, and spirits) subjects indicated how much they drank and how often. Five categories of frequency were defined, "abstinence", "exceptional consumption" (less than once/month), " occasional consumption" (more than once/month, but less than weekly), "regular consumption" (at least weekly), and "almost every day" (more than five times/week).

From this three groups of drinkers were formed, "abstinent", "sporadic" drinkers (drank four times/week or less), and "frequent" drinkers (drank five times/week or more) (see Table 1 for details). Alcohol consumption was standardised and recorded according to drink units (one unit corresponds to 10 g ethanol).

Exposure assessment:

Results and discussion

No statistically significant association was found between the frequency of alcohol consumption (never, sporadic or frequent) and breast cancer risk. When the alcohol intake was measured as grams per day (approximately 0-5, 5-10, 10-15, >15 g ethanol/day) no increase in breast cancer risk was seen when compared to non-drinkers. In fact a slight decrease in risk was seen in all groups compared to non-drinkers, which reached statistical significance in women who reported an average consumption of between 1-1.5 drinks/day (corresponding to 10 and 15 g ethanol/day), with an unadjusted Odds Ratio (OR) of 0.58 (95% Confidence Intervals (CI) 0.34-0.97) and an adjusted OR of 0.21 (95% CI 0.1-0.91). For each 10 g/day of total alcohol intake, the unadjusted OR was 0.97 (95% CI, 0.88-1.10) and the adjusted OR was 0.94 (95% 0.75-1.17).

No statistically significant effect between drinking pattern of total alcohol consumption (sporadic and frequent drinkers compared to never drinkers) and breast cancer risk was seen. Similarly, the beverage-specific intakes of alcohol for wine, beer, aperitifs, and spirits were not significantly associated with breast cancer risk. In addition, when the beverage-type was seperated (wine, or other than wine) into the three categories of drinking pattern (never, sporadic, or frequent), no statistically significant increase in breast cancer risk was seen at any of the intake levels (including >10 g ethanol/day). In contrast, a statistically significant decrease in breast cancer risk was seen in women who frequently consumed between 10 and 12 g ethanol/day in wine when compared with non-wine drinkers, with an unadjusted OR 0.44 (95% CI 0.27-0.72) and an adjusted OR 0.51 (95% CI 0.3-0.91).
Confounding factors:
History of breast cancer, parity, education, age at first full-term pregnancy, breast-feeding, duration of ovulatory activity, body mass index (BMI), physical activity, diet, total energy intake.
Strengths and weaknesses:
The strength of the study was the ability to examine the association between breast cancer and drinking patterns of alcoholic beverage, particularly wine. Several confounding factors were taken into account.

A weakness is the possible recall bias inherent in retrospective studies. There was also a lack of statistical power to examine the relationship between heavy alcohol consumption and breast cancer risk, as frequent and moderate to heavy consumption of alcohol were rare in the study population. It was also not possible to compare non-participants and study participants, in particular concerning alcohol consumption.

Applicant's summary and conclusion

No statistically significant increase between the pattern of or average alcohol consumption and breast cancer risk was found in this case-control study. Women with an average consumption of 1 -1.5 drinks/day (10 -15 g ethanol/day) had a statistically significant lower risk of breast cancer when compared with non-drinkers. Women who consumed between 10 and 12 g ethanol/day from wine had a lower risk of breast cancer compared to non-wine drinkers.
Executive summary:

To examine the association between drinking patterns of alcoholic beverages, particularly wine, and breast cancer, a case-control study was conducted among 437 newly-diagnosed breast cancer cases and 922 residence and age-matched controls. Details on drinking patterns were obtained by questionnaire. Women who reported an average consumption of less than 1.5 drinks per day (equivalent to 10 - 15 g ethanol/day) had a lowered risk of breast cancer (Odds Ratio (OR) 0.58; 95% Confidence Intervals (CI) 0.34 -0.97) when compared to non-drinkers. The effect appeared due primarily to wine consumption, as the proportion of regular wine drinkers was predominant in the study population; women who consumed between 10 and 12 g ethanol/day as wine had a lower risk of breast cancer compared to non-wine drinkers (OR 0.51; 95% CI 0.30 -0.91).