Mediation analysis of the alcohol-postmenopausal breast cancer relationship by sex hormones in the EPIC cohort

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  • Nada Assi
  • Sabina Rinaldi
  • Vivian Viallon
  • S. Ghazaleh Dashti
  • Laure Dossus
  • Agnes Fournier
  • Iris Cervenka
  • Marina Kvaskoff
  • Renee Turzanski-Fortner
  • Manuela Bergmann
  • Heiner Boeing
  • Salvatore Panico
  • Fulvio Ricceri
  • Domenico Palli
  • Rosario Tumino
  • Sara Grioni
  • Maria Jose Sanchez Perez
  • Maria-Dolores Chirlaque
  • Catalina Bonet
  • Aurelio Barricarte Gurrea
  • Pilar Amiano Etxezarreta
  • Susana Merino
  • H. Bas Bueno de Mesquita
  • Carla H. van Gils
  • Charlotte Onland-Moret
  • Kim Overvad
  • Antonia Trichopoulou
  • Georgia Martimianaki
  • Anna Karakatsani
  • Tim Key
  • Sofia Christakoudi
  • Merete Ellingjord-Dale
  • Kostas Tsilidis
  • Elio Riboli
  • Rudolf Kaaks
  • Marc J. Gunter
  • Pietro Ferrari
Alcohol consumption is associated with higher risk of breast cancer (BC); however, the biological mechanisms underlying this association are not fully elucidated, particularly the extent to which this relationship is mediated by sex hormone levels. Circulating concentrations of estradiol, testosterone, their free fractions and sex-hormone binding globulin (SHBG), were examined in 430 incident BC cases and 645 matched controls among alcohol-consuming postmenopausal women nested within the European Prospective Investigation into Cancer and Nutrition. Mediation analysis was applied to assess whether individual hormone levels mediated the relationship between alcohol intake and BC risk. An alcohol-related hormonal signature, obtained by partial least square (PLS) regression, was evaluated as a potential mediator. Total (TE), natural direct and natural indirect effects (NIE) were estimated. Alcohol intake was positively associated with overall BC risk and specifically with estrogen receptor-positive tumors with respectively TE = 1.17(95%CI: 1.01,1.35) and 1.36(1.08,1.70) for a 1-standard deviation (1-SD) increase of intake. There was no evidence of mediation by sex steroids or SHBG separately except for a weak indirect effect through free estradiol where NIE = 1.03(1.00,1.06). However, an alcohol-related hormonal signature negatively associated with SHBG and positively with estradiol and testosterone was associated with BC risk (odds ratio [OR] = 1.25 [1.07,1.47]) for a 1-SD higher PLS score, and had a statistically significant NIE accounting for a mediated proportion of 24%. There was limited evidence of mediation of the alcohol-BC association by individual sex hormones. However, a hormonal signature, reflecting lower levels of SHBG and higher levels of sex steroids, mediated a substantial proportion of the association.
OriginalsprogEngelsk
TidsskriftInternational Journal of Cancer
Vol/bind146
Udgave nummer3
Sider (fra-til)759-768
Antal sider10
ISSN0020-7136
DOI
StatusUdgivet - 2020

ID: 241877820