Coffee and Tea Consumption and Risk of Pre- and Postmenopausal Breast Cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC) Cohort Study

Nirmala Bhoo-Pathy; Petra HM Peeters; Cuno SPM Uiterwaal; H Bas Bueno-de-Mesquita; Awang M Bulgiba; Bodil Hammer Bech; Kim Overvad; Anne Tjønneland; Anja Olsen; Françoise Clavel-Chapelon; Guy Fagherazzi; Florence Perquier; Birgit Teucher; Rudolf Kaaks; Madlen Schütze; Heiner Boeing; Pagona Lagiou; Philippos Orfanos; Antonia Trichopoulou; Claudia Agnoli; Amalia Mattiello; Domenico Palli; Rosario Tumino; Carlotta Sacerdote; Franzel JB van Duijnhoven; Tonje Braaten; Eiliv Lund; Guri Skeie; María-Luisa Redondo; Genevieve Buckland; Maria José Sánchez Pérez; Maria-Dolores Chirlaque; Eva Ardanaz; Pilar Amiano; Elisabet Wirfält; Peter Wallström; Ingegerd Johansson; Lena Maria Nilsson; Kay-Tee Khaw; Nick Wareham; Naomi E Allen; Timothy J Key; Sabina Rinaldi; Isabelle Romieu; Valentina Gallo; Elio Riboli; Carla H van Gils

Disclosures

Breast Cancer Res. 2015;17(15) 

In This Article

Results

A great majority of the study participants consumed coffee, with a median total coffee intake ranging from 93 ml/day in Italy to 900 ml/day in Denmark (not shown). Decaffeinated coffee was consumed by about 50% of the study population. Median decaffeinated coffee intake ranged from 2 ml/day in Spain and United Kingdom to 140 ml/day in France. Tea was consumed by approximately 66% of the total cohort resulting in a median intake ranging from close to 0 ml/day in Greece to up to 475 ml/day in United Kingdom.

The mean age at recruitment was 51 years with 43% of the participants being postmenopausal. Based on body mass index (BMI) classification by the World Health Organization, 58% of participants were of normal weight, 29% overweight and 13% obese.

Compared to the low coffee consumers, those with high coffee consumption were more likely to have ever smoked, used oral contraceptives, be physically active, and consumed more alcohol but less tea (Table 1). They were also more likely to comprise women attaining early menarche, and those with very young age at first childbirth (<20 years). In contrast, participants with high decaffeinated coffee intake were less likely to have used oral contraceptives, and more likely to be postmenopausal, and use hormone replacement therapy, compared to the low consumers. They also less frequently attained tertiary education, and were more likely to have breastfed their offspring. However, compared to non-consumers, consumers of (any) decaffeinated coffee were more likely to have attained tertiary education, be physically active, be non-smokers, and less likely to be very young at first childbirth (not shown). Compared to low tea intake, those with high tea intake were more likely to be older at recruitment, have higher education status, be more active physically, use more oral contraceptives, be older at first delivery, be postmenopausal, and use hormone replacement therapy.

During an average 11 years of follow-up, 10,198 first incidences of primary invasive breast cancer were observed among 335,060 women. Of these, 1,064 were premenopausal breast cancers. Hormone receptor status was available in approximately 70% (7,053) of total breast cancer cases, out of which 50% were double hormone receptor positive tumors (ER+ PR+), followed by 33% of single hormone receptor positive tumors (ER+ or PR+), whereas 17% were double negative tumors (ER- PR-).

Table 2, Table 3, Table 4, Table 5 and Table 6 show the numbers of participants, cases, and multivariable adjusted HRs for each category of coffee (total, caffeinated, decaffeinated intake) and tea intake. For analysis of beverages as continuous value (per 100 ml increment), the observed and calibrated HRs were identical. We only present the observed HR.

Total Coffee

While moderately low intake of total coffee consumption seemed to be associated with higher risk of premenopausal breast cancer (adjusted HR:1.23, 95% CI: 1.02 to 1.48, compared to low intake), no dose response relationship was observed; P trend = 0.272 (Table 2). Overall, intake of total coffee was associated with a borderline statistically significantly lower risk of postmenopausal breast cancer. Multivariable HR comparing high total coffee intake to low intake was 0.95 (95% CI: 0.89 to 1.01). The linear trend test was not significant; P trend = 0.055. Each 100 ml increase in daily intake of total coffee was inversely associated with breast cancer risk (HR continuous 0.99, 95% CI: 0.98 to 0.99).

Caffeinated Coffee

There seemed to be no association between caffeinated coffee intake and premenopausal breast cancer (Table 3). However, higher intakes of caffeinated coffee were associated with lower risk of postmenopausal breast cancer (adjusted HR for high intake compared to low intake: 0.90; 95% CI: 0.82 to 0.98). A linear trend for the inverse associations of caffeinated coffee intake with postmenopausal breast cancer risk was also apparent in this analysis; P trend = 0.029 (Table 3). While there was no significant effect modification by hormone receptor status (P = 0.711), a linear trend for lower risk of breast cancer with increasing caffeinated coffee intake was clearest for ER- PR- breast cancer (P = 0.008). For every 100 ml higher caffeinated coffee consumption, the risk of ER- PR- breast cancer was lower by 4% (adjusted HR: 0.96, 95% CI: 0.93 to 1.00). The risk of ER+ PR+ breast cancer was lowered by 2% per 100 ml (adjusted HR: 0.98, 95% CI: 0.96 to 0.99). However, the P value for trend test of categorical analyses was not significant (Table 3).

Decaffeinated Coffee

No association was observed between decaffeinated coffee intake and premenopausal breast cancer (Table 4). Non-consumers compared to low consumers of decaffeinated coffee did show a significantly lower postmenopausal breast cancer risk (adjusted HR: 0.89; 95% CI: 0.80 to 0.99). There was, however, no difference in risk of breast cancer between high decaffeinated coffee consumers, compared to low consumers (Table 4). Post-hoc analysis comparing non-consumers of decaffeinated coffee against the consumers (no intake versus any intake, irrespective of caffeinated coffee intake) showed a modest decrease in risk of postmenopausal breast cancer; adjusted HR: 0.90, 95% CI: 0.82 to 0.98. There was no dose response relationship (P trend = 0.128).

Compared to low decaffeinated coffee consumers, it seemed that the non-consumers of decaffeinated coffee had a lower risk of developing ER- PR- breast cancer (adjusted HR:0.69, 95% CI: 0.50 to 0.94), than ER+ PR+ breast cancer (adjusted HR: 0.88, 95% CI:0.73 to 1.05). However, test for interaction with hormone receptor status was not statistically significant (P = 0.716).

Cross-classification of Caffeinated and Decaffeinated Coffee

As compared to decaffeinated coffee consumers with low caffeinated coffee intake, non-consumers of decaffeinated coffee with higher intakes of caffeinated coffee had significantly lower risk of postmenopausal breast cancer. Within consumers of decaffeinated coffee, no such association with higher intakes of caffeinated coffee was observed. Exclusive decaffeinated coffee consumption was also not associated with risk of postmenopausal breast cancer compared to decaffeinated coffee consumption with low caffeinated coffee intake (Table 5). Post-hoc analysis within women who did not consume any caffeinated coffee, showed no difference in risk of postmenopausal breast cancer between 21,239 non-consumers of decaffeinated coffee and 9,810 decaffeinated coffee consumers (adjusted HR: 0.96; 95%: 0.82 to 1.14).

Tea

Tea consumption was neither statistically significantly associated with risk of premenopausal nor postmenopausal breast cancer (Table 6). The adjusted HR for high tea intake versus low intake was 0.98 (95% CI: 0.77 to 1.26) for premenopausal breast cancer, and 0.95 (95% CI: 0.88 to 1.03) for postmenopausal breast cancer. Analysis by hormone receptor status did not show any significant results.

Sensitivity Analysis

Our sensitivity analyses showed that results remain essentially unchanged when analysis of beverage intake was conducted using cohort wide categories of intake instead of country specific categories (Table 2, Table 3, Table 4, and Table 6). We did not observe any effect modification by BMI. There was no statistically significant heterogeneity between countries for the association between total coffee, caffeinated coffee, decaffeinated coffee, and tea intake and breast cancer. None of the associations were substantially altered when family history of breast cancer was included in the analyses, or when analysis was restricted to follow-up experience after two years of recruitment into the study (not shown).

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....