Letter to the Editor Re: Diet and lung cancer mortality: a 1987 National Health Interview Survey cohort study Breslow et al. [1] studied the relationship between diet and lung cancer mortality among 20,004 subjects (158 lung cancer deaths.) Among their results, the authors mentioned an association between total alcohol con- sumption and lung cancer mortality among non-smok- ers, with a RR of 2.3 (95% CI: 1.1, 4.6) for the highest compared to the lowest quartile of consumption. This is an important ®nding that deserves a closer look. There is a growing number of studies indicating that alcohol consumption may increase lung cancer risk [2± 10]. However, the ®ndings were never deemed conclusive given the possibility of residual confounding by cigarette smoking. For this reason, ideally, studies should be conducted among never-smokers. Some studies attempted to conduct separate analyses in non-smokers but the number of lung cancer cases accrued among them was insucient to evaluate the association [3, 4, 9, 10]. The three case±control studies evaluating the association in never-smokers [2, 11] or non-smokers [12] presented con¯icting results. The only study in agreement with Breslow et al.'s results was conducted among Chinese women who smoked less than 20 cigarettes or pipes in the past. The odds ratio for those consuming alcohol at least once a week was 1.85 (95% CI: 0.93, 3.70), compared to those drinking less often, after adjusting for age, number of live birth, and schooling. Like the study by Breslow et al. [1], the study by Mayne et al. [12] was conducted among non-smokers, of which 55.9% were former smokers. They failed to ®nd an association between beer intake and lung cancer after adjusting for prior cigarette use. Not much information is provided in Breslow et al.'s manuscript regarding the association found among non- smokers. For instance, the de®nition of non-smoker is not described. They mentioned in their article that 47% were never-smokers, 21% were former smokers, and 29% were current smokers. If the non-smoking group included former smokers, and they did not adjust for past smoking when evaluating the relationship with alcohol, the observed association in non-smokers could be explained by confounding by cigarette smoking. On the other hand, if the relative risk presented for non- smokers was adjusted for prior cigarette smoking (assuming than non-smoker included former smokers), this study gives great support to the hypothesis that alcohol may increase lung carcinogenesis independent of cigarette smoking. An additional suggestion is that the authors evaluate the eect of the dierent alcoholic beverage types, since recent studies have indicated that beer [3±5, 8, 10] and liquor [5, 7, 9, 10] may increase lung cancer risk, while wine may be protective [10]. Based on these results, looking only at the eect of total alcohol is insucient to discard an alcohol eect. Elisa V. Bandera, M.D., Ph.D. Department of Nutritional Sciences Rutgers University New Brunswick, New Jersey References 1. Breslow RA, Graubard BI, Sinha R, Subar AF (2000). Diet and lung cancer mortality: a 1987 National Health Interview Survey cohort study. Cancer Causes Control 11: 419±431. 2. Koo LC (1988) Dietary habits and lung cancer risk among Chinese females in Hong Kong who never smoked. Nutr Cancer 11: 155±172. 3. Bandera EV, Freudenheim JL, Graham S, et al. (1992) Alcohol consumption and lung cancer in White males. Cancer Causes Control 3: 85±93. 4. De Stefani E, Correa P, Fierro L, et al. (1993) The eect of alcohol on the risk of lung cancer in Uruguay. Cancer Epidemiol Biomark Prev 2: 21±26. 5. De Stefani E, Deneo-Pellegrini H, Carzoglio JC, et al. (1996) Dietary nitrosodimethlyamine and the risk of lung cancer: A case- control study from Uruguay. Cancer Epidemiol Biomark Prev 5: 679±682. 6. Dosemeci M, Gokmen I, Unsal M, et al. (1997) Tobacco, alcohol use, and risks of laryngeal and lung cancer by subsite and histologic type in Turkey. Cancer Causes Control 8: 729±737. 7. Pollack ES, Nomura AM, Heilbrun LK, et al. (1984) Prospective study of alcohol consumption and cancer. N Engl J Med 310: 617± 621. 8. Potter JD, Sellers TA, Folsom AR, McGovern PG (1992) Alcohol, beer, and lung cancer in postmenopausal women. The Iowa Women's Health Study. Ann Epidemiol 2: 587±595. 9. Carpenter CL, Morgenstern H, London SJ (1998) Alcoholic beverage consumption and lung cancer risk among residents of Los Angeles county. J Nutr 128: 694±700. 10. Prescott E, Gronbaek M, Becker U, Sorensen A (1999) Alcohol intake and the risk of lung cancer: in¯uence of type of alcoholic beverage. Am J Epidemiol 149: 463±470. 11. Kabat GC, Wynder EL (1984) Lung cancer in nonsmokers. Cancer 53: 1214±1221. 12. Mayne ST, Janerich DT, Greenwald P, et al. (1994) Dietary beta- carotene and lung cancer risk in U.S. never smokers. JNCI 86: 33± 38. Cancer Causes and Control 12: 577, 2001. Ó 2001 Kluwer Academic Publishers. Printed in the Netherlands.