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Prospective cohort of pre- and post-diagnosis alcohol consumption and cigarette smoking on survival outcomes: an Alberta Endometrial Cancer Cohort Study

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Abstract

Purpose

To examine the independent and joint relationships between cigarette smoking and alcohol consumption with survival outcomes after endometrial cancer diagnosis.

Methods

Pre- and post-diagnosis smoking and drinking histories were obtained from endometrial cancer survivors diagnosed between 2002 and 2006 during in-person interviews at-diagnosis and at ~ 3 years post-diagnosis. Participants were followed until death or January 2022. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards regression for associations with disease-free survival (DFS) and overall survival (OS).

Results

During a median 16.9 years of follow-up (IQR = 15.5–18.1 years), 152 of the 540 participants had a DFS event (recurrence: n = 73; deaths: n = 79) and 134 died overall. Most participants in this cohort were current drinkers (pre = 61.3%; post = 64.7%) while few were current cigarette smokers (pre = 12.8%; post = 11.5%). Pre-diagnosis alcohol consumption was not associated with survival, yet post-diagnosis alcohol intake ≥ 2 drinks/week was associated with worse OS compared with lifetime abstention (HR = 2.36, 95%CI = 1.00-5.54) as well as light intake (HR = 3.87, 95% CI = 1.67–8.96). Increased/consistently high alcohol intake patterns were associated with worse OS (HR = 2.91, 95% CI = 1.15–7.37) compared with patterns of decreased/ceased intake patterns after diagnosis. A harmful dose-response relationship per each additional pre-diagnosis smoking pack-year with OS was noted among ever smokers. In this cohort, smoking and alcohol individually were not associated with DFS and combined pre-diagnosis smoking and alcohol intakes were not associated with either outcome.

Conclusion

Endometrial cancer survivors with higher alcohol intakes after diagnosis had poorer OS compared with women who had limited exposure. Larger studies powered to investigate the individual and joint impacts of cigarette smoking and alcohol use patterns are warranted to provide additional clarity on these modifiable prognostic factors.

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Data Availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

We would like to thank the participants and staff of the Endometrial Disease and Physical Activity Study and Alberta Endometrial Cancer Cohort Study for their contributions to the original case-control and follow-up cohort study.

Funding

This work was supported by three separate grants from the National Cancer Institute of Canada through the Canadian Cancer Society (NCIC No. 12018, NCIC No 13010, NCIC Grants No 17323) and from one grant awarded by the former Alberta Cancer Board (ACB Grant 22190). CM Friedenreich received career awards from the Canadian Institutes of Health Research and the Alberta Heritage Foundation for Medical Research/Alberta Innovates (AHFMR/Alberta Innovates). LS Cook and KS Courneya held Canada Research Chairs and LS Cook also received career award funding from AHFMR. LS Cook receives support from the US National Cancer Institute (NCI P30CA118100).

Author information

Authors and Affiliations

  1. Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada

    Renée L. Kokts-Porietis, Andria R. Morielli & Christine M. Friedenreich

  2. Department of Kinesiology, Faculty of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, NC, USA

    Jessica McNeil

  3. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Jamie L. Benham

  4. Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada

    Kerry S. Courneya

  5. Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA

    Linda S. Cook

  6. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Jamie L. Benham, Linda S. Cook & Christine M. Friedenreich

  7. Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Christine M. Friedenreich

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  1. Renée L. Kokts-Porietis
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  3. Jessica McNeil
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Contributions

KSC, LSC, CMF: Funding acquisition, Investigation, Methodology; KSC, LSC: Project administration; CMF: Data curation; Resources, Supervision; RLKP: Formal analysis, Visualization, Writing—original draft; RLKP, ARM, JM, JLB, KSC, LSC, CMF: Conceptualization, Writing—review & editing.

Corresponding author

Correspondence to Christine M. Friedenreich.

Ethics declarations

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. The Ethics Committee of the University of Calgary, University of Alberta, and former Alberta Cancer Board provided ethical approval for this study and follow-up assessments.

Consent to participate

Informed written consent was obtained from all individual participants included in the study.

Competing interests

The authors have no relevant financial or non-financial interests to disclose. The funders had no role in study design and conduct of the study, data collection and analysis, data interpretation, or manuscript preparation and decision to submit the manuscript for publication.

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Kokts-Porietis, R.L., Morielli, A.R., McNeil, J. et al. Prospective cohort of pre- and post-diagnosis alcohol consumption and cigarette smoking on survival outcomes: an Alberta Endometrial Cancer Cohort Study. Cancer Causes Control 35, 121–132 (2024). https://doi.org/10.1007/s10552-023-01777-w

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