Alcoholic beverages and breast cancer: some observations on published case-control studies

We identified 38 case-control studies investigating possible associations between alcoholic beverage consumption and cancer of the female breast. Each study was characterized according to design features such as: control type (hospital or community based), risk factors controlled for, matching strategy, and statistical power. We examined the effect of these design variables on several outcome variables including identification of any significant elevation in odds ratio and characterization of any dose-response effect. The major finding of this study is that of a striking difference between hospital and community based controlled studies with respect to (1) the level of any estimated dose-response effect, and (2) the finding of statistically significant elevations in odds ratios at levels of consumption below 4 drinks per week. In summary, the generally weak associations reported in these case-control studies along with the measurement and/or selection biases implied by our findings would lead one to the conclusion that present evidence does not support a causal association. This conclusion seems to be in accord with results from cohort studies and with similar conclusions from several other reviews.