Alcohol Consumption by Beverage Type and Risk of Breast Cancer

A Dose-Response Meta-Analysis of Prospective Cohort Studies

Qiuyu Sun; Weihong Xie; Yanli Wang; Feifei Chong; Mengmeng Song; Tiandong Li; Linping Xu; Chunhua Song


Alcohol Alcohol. 2020;55(3):246-253. 

In This Article

Abstract and Introduction


Aims: Alcohol intake has been shown to increase the risk of breast cancer. However, the dose-response analysis of different alcoholic beverages (spirits, wine and beer) is not clear. Our meta-analysis aims to provide a dose-response estimation between different alcohols and breast cancer risk.

Methods: Search of PubMed and Web of Science and manual searches were conducted up to 1 December 2018, and summary relative risks (RRs) and attributable risk percentage (ARP) for alcohol intake on the development of breast cancer were calculated. Dose-response meta-analysis modeled relationships between drinking type and breast cancer risk. Sources of heterogeneity were explored, and sensitivity analyses were conducted to test the robustness of findings.

Results: In total, 22 cohort studies and 45,350 breast cancer cases were included. Current drinkers for ER+ had an increased risk compared with never drinkers. In dose-response analysis, there was a statistically significant linear trend with breast cancer risk increasing gradually by total alcohol and wine dose: when adding 10 g per day, the risk increased by 10.5% (RR = 1.10, 95%CI = 1.08–1.13) in total alcohol and 8.9% (RR = 1.08, 95%CI = 1.04–1.14) in wine. For postmenopausal women, the risk increases by 11.1% (RR = 1.11, 95%CI = 1.09–1.13) with every 10 g of total alcohol increase. Furthermore, the breast cancer alcohol-attributed percentage is higher in Europe than in North America and Asia.

Conclusions: The effect of drinking on the incidence of breast cancer is mainly manifested in ER+ breast cancer. Quantitative analysis showed total drinking had a significant risk for breast cancer, especially for postmenopausal women. However, for different alcohols, just wine intake has the similar results.


Breast cancer is estimated to be the second most incident cancer worldwide (Bray et al., 2018), with around 2.1 million new cases in 2018, accounting for almost one in four cancer cases among women (Bray et al., 2018). Breast cancer is also the most frequently diagnosed cancer in the majority of countries (154 of 185) and is the leading cause of female cancer death in China (Bray et al., 2018). The hereditary and genetic factors, including a personal or family history of breast cancer and inherited mutations (in BRCA1, BRCA2 and other breast cancer susceptibility genes), such as published research (Hong et al., 2010) find alcohol consumption has been shown to promote mammary tumor growth and insulin sensitivity. Alcohol promotes breast cancer cell invasion by regulating the Nm23-ITGA5 pathway (Wong et al., 2011) and so on, accounting for 5–10% of breast cancer cases (Bray et al., 2018). However, identifying lifestyle-changing factors that can reduce lifestyles remains critical for women diagnosed with breast cancer.

Past research (Corrao et al., 2004; Gao et al., 2013; Gou et al., 2013; Chen et al., 2016; White et al., 2017; Ziembicki et al., 2017; Baglia et al., 2018; Choi et al., 2018) studying total alcohol and wine intake with the breast cancer risk have shown that total alcohol intake increased the morbidity of breast cancer. In 2016, a meta-analysis (Chen et al., 2016) explored the association of wine intake with breast cancer risk, and the results showed a dose-response relationship between wine intake and breast cancer morbidity. Based on previous research, this paper is dedicated to further study the impact of different types of alcohol consumption on the incidence of breast cancer. Moreover, the impact trend of total alcohol consumption on breast cancer incidence was analyzed by incorporating the previous and latest research.

The aim of the study was to provide an up-to-date estimation of the role of drinking and breast cancer risk and to gain a more detailed quantification of drinking characteristics by performing dose-response meta-analyses (least squares (GLS) regression methods and restricted cubic splines). Furthermore, the ARP was comprehensively examined for alcohol intake on the development of breast cancer.