Mediation analysis of the alcohol-postmenopausal breast cancer relationship by sex hormones in the EPIC cohort
File(s)Manuscript_SexSteroids_AlcBC_Mediation_Supl_Accepted.pdf (359.54 KB) Manuscript_SexSteroids_AlcBC_Mediation_Accepted.pdf (688.47 KB)
Supporting information
Accepted version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2020-02-01
Date Acceptance
2019-03-13
Citation
International Journal of Cancer, 2020, 146 (3), pp.759-768
ISSN
0020-7136
Publisher
Wiley
Start Page
759
End Page
768
Journal / Book Title
International Journal of Cancer
Volume
146
Issue
3
Copyright Statement
© 2019 UICC. This is the accepted version of the following article, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.32324
Sponsor
Commission of the European Communities
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30968961
Grant Number
SP23-CT-2005-006438
Subjects
EPIC
alcohol
breast cancer
hormonal signature
mediation analysis
sex steroids
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-04-10