Short Communication Intake of Alcohol and Alcoholic Beverages and the Risk of Basal Cell Carcinoma of the Skin 1 Teresa T. Fung, 2 David J. Hunter, Donna Spiegelman, Graham A. Colditz, Eric B. Rimm, and Walter C. Willett Department of Nutrition, Simmons College [T. T. F.]; Departments of Nutrition [T. T. F., E. B. R., W. C. W.], Epidemiology [D. J. H., D. S., G. A. C., E. B. R., W. C. W.], Biostatistics [D. S.], and the Harvard Center for Cancer Prevention [D. J. H., G. A. C., W. C. W.], Harvard School of Public Health; and Channing Laboratory, Department of Medicine, Bringham and Women’s Hospital and Harvard School of Medicine [D. J. H., G. A. C., W. C. W.], Boston, Massachusetts 02115 Abstract We prospectively examined the intake of alcoholic beverages in relation to the risk of basal cell carcinoma BCC in two large cohorts of men and women. Alcohol intake was assessed with food frequency questionnaires every 2– 4 years, and BCC was ascertained by self-report. We used a pooled logistic regression to model the association between alcohol intake and BCC adjusting for various health, sun exposure, and sun-sensitivity factors. During 8 years of follow-up in women (1986 –1994) we recorded 3060 cases of BCC, and during 10 years (1986 – 1996), we recorded 3028 cases in men. Significant positive associations were observed between total alcohol intake (P for trend <0.0001), alcohol from liquor (P for trend  0.003), and white wine (P for trend  0.01) intake and risk of BCC. Compared with those who abstained, those who drank 0.1– 4.9 g, 5.0 –14.9 g, 15.0 –14.9 g, and 30 g or more alcohol a day had multivariate relative risks of 1.11 [95% confidence interval (CI), 1.03, 1.19], 1.26 (95% CI, 1.12, 1.41), 1.29 (95% CI, 1.18, 1.42), and 1.12 (95% CI, 1.01, 1.26), respectively. Alcohol from beer had no association with BCC in either cohort, and red wine appeared to have an inverse association in women (P for trend  0.004) but not in men. These associations remained unchanged after adjustment for individual vitamins, multivitamin use, outdoor walking, and exclusion of follow-up time after last physical examination among those who never had BCC. Alcohol intake was associated with BCC, but the association appeared to be different for each type of alcoholic beverage. Other studies are needed to confirm these results. Introduction BCC 3 of the skin is the most common cancer in Caucasians (1). Although BCC is usually nonfatal, it nevertheless results in recurrence and disfigurement (2). Also, incidence may have increased over the past 20 years (3). Established risk factors include fair skin, light hair and eye color, a tendency to burn, and history of severe sunburns (4). Among these, only sun expo- sure is modifiable. Alcohol intake is a risk factor for several cancers, including hepatocellular carcinoma, oral, pharynx, esoph- agus, and breast cancer (5). A 9% increase in risk of breast cancer is observed with every 10-g increase in daily alcohol intake. Human studies on alcohol consumption and risk of BCC are few. Two case-control studies did not find any association between alcohol intake and BCC, possibly because of crude classification of alcohol consumption and lack of adjustment for confounders (6, 7). In an unpublished study on fat intake and BCC, we observed a positive association with total alcohol when alcohol was included in regression models. Therefore, we conducted this exploratory analysis to assess the associations among intakes of total alcohol, specific alcoholic beverages, and risk of BCC in two large cohorts of men and women. Materials and Methods Study Cohorts NHS. The NHS began in 1976 when 121,700 female nurses in 11 United States states ages 30 –55 returned a questionnaire providing health and lifestyle data. Similar questionnaires were sent every 2 years to update information. Follow-up response was 95% of the potential person-years. For this analysis, women were eligible if they completed the 1986 semiquanti- tative FFQ with 70 missing items and a total energy intake between 500 and 3,500 kcal/day. We excluded women diag- nosed previously with any cancer, including skin cancer, leav- ing 65,358 women for analysis. HPFS. In 1986, 52,000 male health professionals, between 40 and 75 years of age were recruited for a prospective study of diet, lifestyle, and disease. A questionnaire similar to the NHS has been sent to participants every 2 years. Completion of ques- tionnaire has been 90% at each cycle, and reports of health information were accurate (8). Members of the HPFS cohort were eligible for this analysis if they completed the 1986 FFQ with 70 missing items and total energy between 800 and 4,200 kcal/day. Men with any cancer, including any skin cancer, diagnosis at baseline were excluded, leaving 42,617 for analysis. Assessment of Nutrient Intake Dietary intake information was collected using a FFQ designed to assess average food intake over the previous year. Cohort Received 10/27/00; revised 5/8/02; accepted 5/30/02. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. 1 This work was supported by Grants HL35464, CA55075, and CA87969. 2 To whom requests for reprints should be addressed, at Department of Nutrition, Simmons College, 300 The Fenway, Boston, MA 02115. 3 The abbreviations used are: BCC, basal cell carcinoma; NHS, nurses health study; FFQ, food frequency questionnaire; HPFS, health professionals follow-up study; BMI, body mass index; RR, relative risk; CI, confidence interval. 1119 Vol. 11, 1119 –1122, October 2002 Cancer Epidemiology, Biomarkers & Prevention on December 8, 2021. © 2002 American Association for Cancer Research. cebp.aacrjournals.org Downloaded from