Alcohol and breast cancer – How big is the risk? ~ Report from the World Cancer Research Fund

Half a glass of wine a day increases breast cancer‘ was just one of the headlines this WCRF_main-150x150week, which discussed a report that reinforced the evidence that alcohol can increase a woman’s risk of developing breast cancer.

The report from the World Cancer Research Fund outlined the latest evidence on how we can reduce that risk – focusing on weight, physical activity and drinking.

The WCRF studies all the evidence on a potential risk and decides whether it’s strong enough to be a basis for making recommendations to the public.

Breast cancer is the most common cancer in the UK, and 1 in 8 women will be diagnosed with breast cancer at some point in their lives. And since we know that almost a third of breast cancer cases in the UK could be prevented, largely by changes to lifestyle, this is important stuff.

While the cause of an individual’s cancer can never be certain, there are still things you can do to reduce your risk. And evidence like this is the first step to helping women to do just that.

So what exactly does the report say?

Alcohol

The report backs up previous research showing that drinking alcohol can cause 7 types of cancer  including breast cancer. Even though it’s in the headlines, this is nothing new.

While the reports may sound alarming, we also know that the more you cut down, the more you’re reducing your risk.

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Although most women don’t regularly drink very large amounts of alcohol, thousands of cases of cancer – including breast – are linked to alcohol each year.

There are 3 good theories on the link between alcohol and cancer which we’ve written about before.

  • When we drink alcohol, it’s broken down into a toxic chemical called acetaldehyde. Acetaldehyde can damage the DNA inside our cells, and then prevent damage from being repaired. This is important because it allows cancer to develop.
  • Alcohol can increase the levels of certain hormones in the body, including oestrogen. We know that high levels of oestrogen can fuel the development of breast cancer, so this might be particularly important here.
  • Alcohol also makes it easier for cells in the mouth and throat to absorb other cancer-causing chemicals. This is probably more important for other cancer types linked to alcohol rather than breast cancer.

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Physical activity

The evidence on the link between breast cancer risk and both weight and physical activity is a bit more complicated. This is because there is evidence that the causes of breast cancer that occur in women before the menopause, compared to after the menopause, are different.

But overall there is strong evidence that keeping a healthy weight and being physically active, can help prevent breast cancer.

Unlike its previous report, this time WCRF says that some forms of physical activity probably reduce the risk for pre-menopausal breast cancer But the finding is only true for ‘vigorous’ activity – exercise which gets you breathing hard and your heart beating fast, so that you won’t be able to say more than a few words without pausing for breath.

The report also adds to the existing evidence that physical activity at any age is related to a lower risk of breast cancer in women after the menopause. This can be anything that gets you a bit hot and out of breath – from fast walking, to cycling, or even heavy housework. And the more you do the better.

Body weight

The evidence on weight and breast cancer is also complicated: as your risk changes depending on the ages at which you were overweight.

But overall the report agrees with previous work showing that being overweight or obese throughout adulthood causes postmenopausal breast cancer, something that is already well established.

Bringing it all together

Other things that affect a woman’s breast cancer risk are less easy to control. As with most cancers, the risk of developing the disease increases with age. Having a family history of the disease can increase a woman’s risk, and breastfeeding can reduce it.

All the different things that can increase the risk of breast cancer are held together by a common thread: they all affect the hormones circulating around in the body in some way.

Hormones help control what happens inside our bodies by sending messages from one place to another – including instructing cells when to stop and start multiplying.

If this system goes wrong, cells can get too many messages telling them to make more cells. And that can lead to cancer.

Overall the best advice is the same as at the start of the week: to keep active, keep a healthy weight throughout life, and limit alcohol.

Originally posted on CRUK, taken from Cancer Research UK Cambridge Institute

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10th annual Global Research Awards for Nicotine Dependence (GRAND) program

GRAND is a Pfizer-supported independently reviewed competitive grants program awarding individual grants of up to $200,000 from a total fund in 2017 of $1 million to support projects which directly advance the use of pharmacotherapy for treating users of any nicotine or tobacco product in clinical practice. Of 486 applications received since 2008, 62 grants have been awarded.

Pfizer has called for Clinical research proposals that aim to increase the understanding of the mechanisms of tobacco and nicotine dependence and its treatment. The overall mission of the GRAND program is to advance the pharmacological treatment of tobacco and nicotine dependence.

Each proposal should fall into one of the following areas:

  • Human laboratory (e.g., pharmacokinetics, pharmacodynamics, cravings, withdrawal);
  • Pharmacotherapy of smoking cessation and relapse, and / or its interaction with behavioral support;
  • Characterization of subtypes of smokers; suitability for appropriate interventions.

Research projects should aim to provide information that could directly advance the use of pharmacotherapy for treating users of any nicotine or tobacco product in clinical practice. Examples could include:

  • Observational or interventional studies of pharmacotherapy
  • Optimization of the use of currently available medication
  • Effectiveness of pharmacotherapy in real-life settings
  • Development or use of new medications for cessation or harm reduction
  • Specifically designed pharmacotherapy in subtypes of tobacco/nicotine users
  • Use of existing databases to inform the clinical use of pharmacotherapy
  • Policy interventions to increase use of pharmacotherapy.

The intent of the program is to fund at least 6 awards of between $50,000 and $200,000 in value, totaling $1.2 million. The awards are open to all investigators and they would strongly encourage applications from junior investigators.

Applications will be formally assessed by, and only by, the GRAND Review Committee, an independent committee comprising internationally prominent researchers in the field. The final responsibility for selection of Awardees rests with the Co-Chairs of the Review Committee, John Hughes and Karl Fagerstrom. The whole process is completely independent of Pfizer, including the final selection of Awardees.

GRAND is open to all investigators from around the world holding an MD, a PhD, or equivalent.

Application deadline: July 3, 2017

To apply for the grant and for more information on the application process click here!

 

Tobacco Control in England: Reducing Inequalities and Improving NHS Sustainability

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Public Health England and NHS England are hosting three one-day events with a practical focus on the current challenges and how they can be met, discussing implementation of tobacco control interventions and how the NHS can make its contribution, to the benefit not only of millions of smokers but its own sustainability.

London – Tuesday 4 April

Leeds – Wednesday 26 April

Birmingham – Thursday 4 May

Smoking rates in England have been declining steadily in the general adult population in recent years (17%), falling further and faster among young people (8%). However, hidden behind this success is slower progress among certain population groups, including individuals with mental health problems and those on lower incomes. Large geographical variations also remain, including amongst women who smoke during pregnancy.

Smokers from all groups are likely to be high users of healthcare services, with significant financial and capacity related implications. Addressing this will be key to ensuring NHS sustainability.

Reducing smoking is key to ensuring NHS sustainability and with the new national CQUIN for addressing risky behaviours (alcohol and tobacco) and local Sustainability and Transformation Plans, there is a fresh impetus for collective action to reduce the health inequalities caused by smoking.

Aim:

  • to explore opportunities for action across the local system to engage with smokers and support them to quit, tackling health inequalities and reducing the burden on the NHS and social care of smoking-related disease.

Objectives:

  • identify key areas for joint action to tackle smoking and reduce health inequalities
  • understand where smokers are accessing the healthcare system and how this impacts on primary and secondary care services
  • consider the ways in which healthcare professionals can integrate treatment for tobacco dependence into routine care and support smokers to quit

Who should attend?

  • local authority and NHS commissioners
  • CCG leads for acute care, mental health and maternity
  • healthcare and service providers
  • those with responsibility for managing: Commissioning for Quality and Innovation (CQUINS), delivery of Sustainability and Transformation Plans (STPs), implementation of the stillbirth reduction care bundle
  • regional strategic leads for health improvement and clinical networks

More information and registration!

University of Oxford PhD Studentship ~ Developing and testing peer-led interventions to promote switching from smoking to vaping.

Developing and testing peer-led interventions to promote switching from smoking to vaping.

PhD Studentship ~ Closing date: 26th May 2017

Applications are invited from individuals with a strong academic record who wish to develop a career in behavioural or primary care research. The student will join the thriving Health Behaviours team in the Nuffield Department of Primary Care Health Sciences who are working on range of interventions to support harm reduction and smoking cessation.

The project: The rise in popularity of electronic cigarettes (‘e-cigarettes’) in recent years has been accompanied by a growth in the number of virtual ‘vaper’ communities, with people sharing their advice and experiences of e-cigarettes with peers on internet support groups and discussion forums, many of which address ways of reducing or stopping smoking. The rise of peer to peer support is unique to e-cigarettes; no other means of stopping or reducing smoking attracts such passionate engagement from members of the public. This raises the possibility that we could better harness this peer support to enable more people to reduce or stop smoking using e-cigarettes and this project examines this. Continue reading

Healthier central England or North–South divide? Analysis of national survey data on smoking and high-risk drinking

In England, around 20% of the population are smokers and 13% drink excessively. These behaviours are leading risk factors for several non-communicable diseases, including cancer, diabetes and chronic respiratory and cardiovascular conditions. It is estimated that around 8000 deaths/year are alcohol-related and 80 000 deaths of adults aged 35 and over are attributed to smoking annually. The prevalence and adverse effects of high-risk drinking and tobacco use are not equally distributed across the country, with large regional variations.

A North–South divide exists for smoking, with higher rates of tobacco use, smoking-related deaths and smoking-related harm in northern regions. 

In contrast, excessive alcohol consumption tends to be lowest in central and eastern regions, while an East versus West divide is seen in the prevalence of alcohol dependency and alcohol sales. These regional variations in consumption do not always map onto experienced harm, a phenomenon known as the Alcohol Harm Paradox. In 2014, alcohol-related death rates were significantly higher among regions in the north of England compared with those in the south.

Objectives: This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics.

Design: Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.

Measures: Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT.

Results: In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p<0.001; RR 0.91, p<0.05), East of England (RR 0.86, p<0.001), South East (RR 0.92, p<0.05) and London (RR 0.85, p<0.001). High-risk drinking was more common in the North but was less common in the Midlands, London and East of England. Adjustment for sociodemographics had little effect. There was a higher prevalence in the North East (RR 1.67, p<0.001), North West (RR 1.42, p<0.001) and Yorkshire and the Humber (RR 1.35, p<0.001); lower prevalence in the East Midlands (RR 0.69, p<0.001), West Midlands (RR 0.77, p<0.001), East of England (RR 0.72, p<0.001) and London (RR 0.71, p<0.001); and a similar prevalence in the South East (RR 1.10, p>0.05)

Figure 2Figure 2: Association between Government Office Region and high-risk drinking: (A) unadjusted;
(B) adjusted for gender, age, ethnicity and socioeconomic status (reference region: South West). Note: this shows the relative risk difference for each region relative to the South West (dotted reference region). Increasing red tones reflect increasingly higher significant risk and increasing blue tones reflect increasingly lower significant risk. Regions shaded white have a similar risk to the South West. Online supplementary figure S9 labels the Government Office Regions in England.
Expand Image – More diagrams in the main report

Conclusions: In adjusted analyses, smoking and high-risk drinking appear less common in ‘central England’ than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities.

Strengths and limitations of this study

  • Used a representative survey about smoking and drinking conducted on a large sample of the adult population in England.

  • Based on the most up-to-date information in England on regional differences in smoking and high-risk drinking accounting for disparities in gender, socioeconomic status (SES), ethnicity and age.

  • Respondents may have underestimated or failed to report their drinking and smoking.

  • Patterns of smoking and alcohol use were only available at the Government Office Region level, whereas important variation may occur at a more micro-geographical level.

bmj

Copyright information:
Published by the BMJ Publishing Group Limited.

 

Read the full report here!

Cigarette smoking increases coffee consumption: findings from a Mendelian randomisation analysis

Marcus Munafò and his colleagues at the University of Bristol, have looked into the smoking and drinking habits of about 250,000 people. They found that smoking makes you drink more caffeinated drinks, possibly by changing your metabolism so that you break down caffeine quicker, pushing you to drink more to get the same hit.

It’s impossible to do a randomised controlled trial (the most rigorous kind of scientific trial) when it comes to smoking, because it would be unethical to ask a randomly selected group of people to smoke. The next best thing is to study huge biobanks of health data. These biobanks contain information about people’s genes, diets and lifestyles.
coffee-cigarettes-smoking-400x400.jpgTo explore the relationship between smoking and caffeine, Munafo and his colleagues analysed data from biobanks in the UK, Norway and Denmark. They were particularly interested in people who had inherited a variant of a gene that has already been shown to increase cigarette smoking.

Chain drinking

The team found that people who had this gene variant also consumed more coffee – but only if they smoked. British people with the same variant also drank more tea, although their Danish and Norwegian counterparts didn’t. This is probably due to cultural differences, says Munafò. “People in Norway and Denmark don’t chain drink tea in the same way that people in the UK do,” he says.

The genetic variant seems to influence how much nicotine a person consumes. You can have zero, one or two copies – and each additional copy is linked to an increase in smoking of about one cigarette per day. Each copy also appears to increase coffee consumption by 0.15 cups per day.

“You could extrapolate from that and say that if you smoked 10 cigarettes per day more than the next person, you would be drinking the equivalent of about one and a half extra cups of coffee per day,” says Munafò. He is wary of doing so, though, because the amount of nicotine a person gets from a cigarette will depend on the type of cigarette and the way it is smoked.

The gene variant codes for a nicotine receptor, which is not known to directly interact with caffeine. This suggests that cigarette smoking increases caffeine consumption and not the other way around.

“The team have used a rather clever technique to establish causality, which normally you wouldn’t stand a cat in hell’s chance of doing with an epidemiological study,”

Robert West – University College London.

What’s the link?

There’s a chance that cigarette smoking and caffeine consumption are linked through habit – that smokers tend to pair the two. But Munafò thinks that the nicotine in cigarettes might also influence the way a person metabolises caffeine. “It’s possible that smokers metabolise caffeine more quickly,” he says. If that is the case, smokers might need to consume more caffeine to get the same effects that a non-smoker would experience.

It’s also possible that the apparent link between smoking and coffee drinking could be down to some unknown function of the genetic variant, says West. “It evolved for a purpose, and it wasn’t to smoke,” he says.

A relationship between smoking and coffee might make it harder for smokers to quit, says Munafò. If a smoker stops smoking, but continues to drink plenty of coffee, they might start to experience unpleasant side effects, such as jitteriness. This might be misinterpreted as a symptom of smoking withdrawal, says Munafò. His team plans to investigate this.

newscience
By Jessica Hamzelou

Journal reference: bioRxiv, DOI: 10.1101/107037

Participants needed: A pilot study into the determinants of behaviour change in alcohol use disorder.

Queen Mary University is looking for people with problematic drinking who are currently trying to stop drinking, but unable to do so.

A pilot study into the determinants of behaviour change in alcohol use disorder.

We would like to invite you to be part of this research project.  It is entirely up to you if you want to take part. If you choose not to take part there won’t be any disadvantages for you and you will hear no more about it.

Please read the following information; this will tell you why the research is being done and what you will be asked to do. Please ask if anything is not clear or you would like more information.

The Study.

Achieving and maintaining abstinence from alcohol can be difficult. Scientific study into the reasons behind these difficulties has identified a number of factors which may play a role in the inability to stop drinking. This project examines several of these to further clarify their role.

Why have I been invited to take part?

We are looking for two groups of people. Those who have successfully managed to stop drinking for 12 months or more, and those who cannot maintain abstinence for more than 30 days, despite a desire to stop.

What will happen if I take part?

If you wish to participate we will arrange an appointment that will take about 1-1.5 hours. This will consist of a series of questionnaires and behavioural tasks including holding your breath for as long as you can; a hand grip task; and a computer task where you will trace the outline of a shape. You will receive £10 to put towards any travel costs you may incur.

If you live outside of London you will be able to complete the study remotely and will receive payment by mail.

The session will be conducted by PhD student Daisy Thompson-Lake who is under the supervision of Professor Peter Hajek and Professor De La Garza.

If you agree to give contact details we will also contact you in the future to ask you for your breath holding time via email or telephone. This is not compulsory and you will receive the compensation should you decide to give no contact details.

What are the risks of taking part?

There are no risks associated with taking part in the study.

What are the benefits of taking part?

There are no direct benefits to you for taking part. However, the information you provide may contribute towards better understanding of factors contributing to stopping drinking, and future treatments.

Will my data be kept confidential?

Yes, if you agree to take part all information you give us will be kept confidential and only study staff will have access to this data. All data will be anonymised and there will be no information included in the study which could identify you.

What if I want to leave the study?

Your participation is entirely voluntary, and you are free to leave the study at any time for any reason. We will request your permission to keep the information you have given us until the time you decide to leave the study.

What happens if you are concerned or have any questions?

You will be able to contact Daisy Thompson-Lake (02078828244, d.g.y.thompson-lake@qmul.ac.uk ) if you are worried about anything or have any questions.

The Chief Investigator of this study is Professor Peter Hajek, Tobacco Dependence Research Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, 2 Stayner’s Road, Stepney Green, E1 4AH, Email: p.hajek@qmul.ac.uk Tel:  020 7882 8230.

A summary of the report from this study will be available upon request.

We would like to thank you for your interest in this study.

 

If interested please call or email Daisy on :

02078828244 or d.g.y.thompson-lake@qmul.ac.uk