Joint tobacco smoking and alcohol intake exacerbates cancer risk in women – the Danish nurse cohort

Jette Heberg; Mette Kildevæld Simonsen; Anne Kjaergaard Danielsen; Tobias Wirenfeldt Klausen; Vibeke Zoffmann; Thordis Thomsen

doi:10.1016/j.ejon.2019.101675

Joint tobacco smoking and alcohol intake exacerbates cancer risk in women – the Danish nurse cohort

Jette Heberg^*, Mette Kildevæld Simonsen, Anne Kjaergaard Danielsen, Tobias Wirenfeldt Klausen, Vibeke Zoffmann, Thordis Thomsen

^*Corresponding author for this work

2 Citations (Scopus)

Abstract

Purpose: To explore separate and combined tobacco and alcohol use and risk of overall, smoking-related, alcohol-related, breast and gynecological cancers in women. Method: Questionnaires from 19,898 women in The Danish Nurse Cohort in 1993 were linked to registries on hospitalizations, death causes and migration until Dec 2016. Cancer risk by tobacco and alcohol was estimated using Cox proportional hazards models. Results: 16,106 nurses, aged >44 years (mean = 56), were eligible for analysis. Throughout 23 years (mean follow-up = 18.8 years) overall cancers counted 4,968. Of these, 1,897, 2,231, 1,407 and 579 events were smoking-related, alcohol-related, breast cancers and gynecological cancers. Increased risks of overall, smoking-related, and breast cancer were observed for current smoking and excess alcohol intake (>14 units/week), separately, compared to never smoking and light drinking (1–7 units/week) respectively. Moderate drinking (8–14 units/week) increased the risk of alcohol-related and breast cancer. Additional risk increases were observed among smokers drinking alcohol above light levels for overall, smoking-related, alcohol-related and breast cancer (HR = 1.40, 95% CI:1.30–1.51, HR = 1.72, 95% CI:1.52–1.94, HR = 1.33, 95% CI:1.26–1.40, HR = 1.32, 95% CI:1.15–1.53, respectively), compared to non-smokers drinking lightly. These risks increased further for smokers drinking above moderate levels (HR = 1.49, 95% CI:1.36–1.63, HR = 1.97, 95% CI:171.-2.26, HR = 1.40, 95% CI:1.22–1.60, HR = 1.33, 95% CI:1.12–1.57, respectively). No significant associations were found for gynecological cancer. Conclusions: Smoking and alcohol, both separately and combined, increased risks of overall, smoking-related, alcohol-related and breast cancer; combined use resulted in incremental risk increases. Co-use of smoking and alcohol represent an extensive threat to public health; thus, prevention could benefit from combined targeting.

Original language	English
Article number	101675
Journal	European Journal of Oncology Nursing
Volume	43
ISSN	1462-3889
DOIs	https://doi.org/10.1016/j.ejon.2019.101675
Publication status	Published - 2019

Keywords

Alcohol drinking
Cancer
Epidemiology
Health promotion
Lifestyle
Primary prevention
Risk factors
Sex
Smoking
Tobacco

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ejon.2019.101675

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@article{d5748c68458b424aaf781dbecd5df99a,

title = "Joint tobacco smoking and alcohol intake exacerbates cancer risk in women – the Danish nurse cohort",

abstract = "Purpose: To explore separate and combined tobacco and alcohol use and risk of overall, smoking-related, alcohol-related, breast and gynecological cancers in women. Method: Questionnaires from 19,898 women in The Danish Nurse Cohort in 1993 were linked to registries on hospitalizations, death causes and migration until Dec 2016. Cancer risk by tobacco and alcohol was estimated using Cox proportional hazards models. Results: 16,106 nurses, aged >44 years (mean = 56), were eligible for analysis. Throughout 23 years (mean follow-up = 18.8 years) overall cancers counted 4,968. Of these, 1,897, 2,231, 1,407 and 579 events were smoking-related, alcohol-related, breast cancers and gynecological cancers. Increased risks of overall, smoking-related, and breast cancer were observed for current smoking and excess alcohol intake (>14 units/week), separately, compared to never smoking and light drinking (1–7 units/week) respectively. Moderate drinking (8–14 units/week) increased the risk of alcohol-related and breast cancer. Additional risk increases were observed among smokers drinking alcohol above light levels for overall, smoking-related, alcohol-related and breast cancer (HR = 1.40, 95% CI:1.30–1.51, HR = 1.72, 95% CI:1.52–1.94, HR = 1.33, 95% CI:1.26–1.40, HR = 1.32, 95% CI:1.15–1.53, respectively), compared to non-smokers drinking lightly. These risks increased further for smokers drinking above moderate levels (HR = 1.49, 95% CI:1.36–1.63, HR = 1.97, 95% CI:171.-2.26, HR = 1.40, 95% CI:1.22–1.60, HR = 1.33, 95% CI:1.12–1.57, respectively). No significant associations were found for gynecological cancer. Conclusions: Smoking and alcohol, both separately and combined, increased risks of overall, smoking-related, alcohol-related and breast cancer; combined use resulted in incremental risk increases. Co-use of smoking and alcohol represent an extensive threat to public health; thus, prevention could benefit from combined targeting.",

keywords = "Alcohol drinking, Cancer, Epidemiology, Health promotion, Lifestyle, Primary prevention, Risk factors, Sex, Smoking, Tobacco",

author = "Jette Heberg and Simonsen, {Mette Kildev{\ae}ld} and Danielsen, {Anne Kjaergaard} and Klausen, {Tobias Wirenfeldt} and Vibeke Zoffmann and Thordis Thomsen",

year = "2019",

doi = "10.1016/j.ejon.2019.101675",

language = "English",

volume = "43",

journal = "European Journal of Oncology Nursing",

issn = "1462-3889",

publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Joint tobacco smoking and alcohol intake exacerbates cancer risk in women – the Danish nurse cohort

AU - Heberg, Jette

AU - Simonsen, Mette Kildevæld

AU - Danielsen, Anne Kjaergaard

AU - Klausen, Tobias Wirenfeldt

AU - Zoffmann, Vibeke

AU - Thomsen, Thordis

PY - 2019

Y1 - 2019

N2 - Purpose: To explore separate and combined tobacco and alcohol use and risk of overall, smoking-related, alcohol-related, breast and gynecological cancers in women. Method: Questionnaires from 19,898 women in The Danish Nurse Cohort in 1993 were linked to registries on hospitalizations, death causes and migration until Dec 2016. Cancer risk by tobacco and alcohol was estimated using Cox proportional hazards models. Results: 16,106 nurses, aged >44 years (mean = 56), were eligible for analysis. Throughout 23 years (mean follow-up = 18.8 years) overall cancers counted 4,968. Of these, 1,897, 2,231, 1,407 and 579 events were smoking-related, alcohol-related, breast cancers and gynecological cancers. Increased risks of overall, smoking-related, and breast cancer were observed for current smoking and excess alcohol intake (>14 units/week), separately, compared to never smoking and light drinking (1–7 units/week) respectively. Moderate drinking (8–14 units/week) increased the risk of alcohol-related and breast cancer. Additional risk increases were observed among smokers drinking alcohol above light levels for overall, smoking-related, alcohol-related and breast cancer (HR = 1.40, 95% CI:1.30–1.51, HR = 1.72, 95% CI:1.52–1.94, HR = 1.33, 95% CI:1.26–1.40, HR = 1.32, 95% CI:1.15–1.53, respectively), compared to non-smokers drinking lightly. These risks increased further for smokers drinking above moderate levels (HR = 1.49, 95% CI:1.36–1.63, HR = 1.97, 95% CI:171.-2.26, HR = 1.40, 95% CI:1.22–1.60, HR = 1.33, 95% CI:1.12–1.57, respectively). No significant associations were found for gynecological cancer. Conclusions: Smoking and alcohol, both separately and combined, increased risks of overall, smoking-related, alcohol-related and breast cancer; combined use resulted in incremental risk increases. Co-use of smoking and alcohol represent an extensive threat to public health; thus, prevention could benefit from combined targeting.

AB - Purpose: To explore separate and combined tobacco and alcohol use and risk of overall, smoking-related, alcohol-related, breast and gynecological cancers in women. Method: Questionnaires from 19,898 women in The Danish Nurse Cohort in 1993 were linked to registries on hospitalizations, death causes and migration until Dec 2016. Cancer risk by tobacco and alcohol was estimated using Cox proportional hazards models. Results: 16,106 nurses, aged >44 years (mean = 56), were eligible for analysis. Throughout 23 years (mean follow-up = 18.8 years) overall cancers counted 4,968. Of these, 1,897, 2,231, 1,407 and 579 events were smoking-related, alcohol-related, breast cancers and gynecological cancers. Increased risks of overall, smoking-related, and breast cancer were observed for current smoking and excess alcohol intake (>14 units/week), separately, compared to never smoking and light drinking (1–7 units/week) respectively. Moderate drinking (8–14 units/week) increased the risk of alcohol-related and breast cancer. Additional risk increases were observed among smokers drinking alcohol above light levels for overall, smoking-related, alcohol-related and breast cancer (HR = 1.40, 95% CI:1.30–1.51, HR = 1.72, 95% CI:1.52–1.94, HR = 1.33, 95% CI:1.26–1.40, HR = 1.32, 95% CI:1.15–1.53, respectively), compared to non-smokers drinking lightly. These risks increased further for smokers drinking above moderate levels (HR = 1.49, 95% CI:1.36–1.63, HR = 1.97, 95% CI:171.-2.26, HR = 1.40, 95% CI:1.22–1.60, HR = 1.33, 95% CI:1.12–1.57, respectively). No significant associations were found for gynecological cancer. Conclusions: Smoking and alcohol, both separately and combined, increased risks of overall, smoking-related, alcohol-related and breast cancer; combined use resulted in incremental risk increases. Co-use of smoking and alcohol represent an extensive threat to public health; thus, prevention could benefit from combined targeting.

KW - Alcohol drinking

KW - Cancer

KW - Epidemiology

KW - Health promotion

KW - Lifestyle

KW - Primary prevention

KW - Risk factors

KW - Sex

KW - Smoking

KW - Tobacco

U2 - 10.1016/j.ejon.2019.101675

DO - 10.1016/j.ejon.2019.101675

M3 - Journal article

C2 - 31644965

AN - SCOPUS:85073512457

SN - 1462-3889

VL - 43

JO - European Journal of Oncology Nursing

JF - European Journal of Oncology Nursing

M1 - 101675

ER -

Joint tobacco smoking and alcohol intake exacerbates cancer risk in women – the Danish nurse cohort

Abstract

Keywords

UN SDGs

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