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From: rkrw11/5/2011 9:37:25 PM
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Good news for drinkers who also smoke.

AACR-FCPR: Liquor, Smoking Linked to Lower Myeloma Risk
This report is part of a 12-month Clinical Context series.
By Charles Bankhead, Staff Writer, MedPage Today
Published: October 27, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner


BOSTON -- The combination of smoking and drinking appeared to reduce the risk of multiple myeloma, with most of the effect coming from alcohol consumption, according to pooled data from 15 case-control studies.

As compared with people who neither smoked nor drank alcohol, people who did both had a 30% lower odds for myeloma. Separate analysis of each behavior showed a significant effect of alcohol consumption compared with never-drinkers and a nonsignificant trend toward lower risk for ever- versus never-smokers.

Neither dose nor duration of alcohol consumption and smoking affected the results, as reported here at the American Association for Cancer Research's Frontiers in Cancer Prevention Research meeting.
Action Points
    Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.


    Explain that the combination of smoking and drinking appeared to reduce the risk of multiple myeloma, with most of the effect coming from alcohol consumption.


    Note that neither dose nor duration of alcohol consumption and smoking affected the results.

"The association of smoking and alcohol consumption with multiple myeloma risk is not a new finding," Gabriella Andreotti, PhD, of the National Cancer Institute in Bethesda, Md., told MedPage Today. "Our results are consistent with what has been previously reported.

"However, this study is the first report from a large population of patients with myeloma, which is not a common disease. We had the statistical power to adjust for confounding factors, whereas smaller studies did not."

Myeloma has several established risk factors -- older age, male sex, and African-American race -- none of which is modifiable. However, suspected risk factors include obesity, smoking, and alcohol consumption.

To increase the statistical power to examine alcohol and smoking as myeloma risk factors, investigators combined data from individual case-control studies.

The resulting population consisted of 4,146 myeloma cases and a composite control group of 18,432 participants.

The 15 studies included in the analysis comprised six investigations with alcohol data for 1,484 myeloma cases and 6,542 controls, and nine studies with smoking data on 2,662 cases and 11,890 controls.

For the analysis of smoking and myeloma risk, Andreotti and colleagues grouped patients and controls by sex, smoking status, age at start of smoking, frequency (cigarettes per day), pack-years, duration of smoking, age at smoking cessation (for former smokers), and years since smoking cessation.

Among men and women, current smokers had about a 20% reduction in the odds for myeloma as compared with never smokers. The difference achieved statistical significance for women (95% CI 0.68-0.95).

Former smokers had a myeloma risk similar to that of never smokers.

Age at start of smoking and at smoking cessation, frequency, pack-years, duration, and years since smoking cessation had no effect on myeloma risk in men or women.

For the alcohol analysis, the investigators grouped cases and controls by sex, frequency and duration of drinking, and estimated cumulative number of drinks consumed in lifetime.

Similar to the smoking analysis, only the comparison of drinker versus nondrinker yielded a statistically significant effect on myeloma risk.

Male drinkers had a 25% lower odds for myeloma as compared with nondrinkers (95% CI 0.61-0.92). Female drinkers had a nonsignificant 12% lower risk of myeloma (95% CI 0.74-1.04).

Exclusion of participants in an ongoing study of alcohol consumption and myeloma risk in Utah strengthened the association in men (OR 0.70, 95% CI 0.57 to 0.87) and resulted in a statistically significant association in women (OR 0.81, 95% CI 0.68 to 0.97).

Exclusion of the Utah study from the analysis also resulted in a significant association of myeloma with increasing duration of drinking history in men and women (P=0.001).

Andreotti and colleagues also examined the joint effects of alcohol and smoking on myeloma risk. Participants who smoked and drank had 30% lower odds for myeloma than participants who did neither (OR 0.70, 95% CI 0.60 to 0.82).

The results are similar to those obtained from a pooled analysis of case-control studies examining the effect of smoking and alcohol on the risk of non-Hodgkin lymphoma (Lancet Oncol 2005; 6: 469-476, Cancer Epidemiol Biomarkers Prev 2005; 14: 925-933).

The results also are consistent with previous prospective cohort studies of alcohol consumption and myeloma (Am J Epidemiol 2010; 172: 1373-1383, Cancer Epidemiol Biomarkers Prev 2006; 15: 1109-1114), as well as alcohol consumption and NHL (Am J Epidemiol 2010; 171: 1270-1281).
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