1216
Alcohol and breast
cancer
SiR,—Your March 17 editorial on alcohol and cancer notes the strong evidence linking alcohol and upper aerodigestive cancer. It also implies that alcohol is a risk factor for breast cancer. Our meta-analysis (based on published material up to 1987) was less certain.’ A review of Medline indexed articles on alcohol and breast cancer for 1989 and the first quarter of 1990 reveals eight case-control series-four negative and four positive, one positive in premenopausal but not in postmenopausal women. Of considerable interest is the prospective Framingham study, with a follow-up of up to 32 years: the adjusted relative risk of breast cancer for alcohol consumers versus non-consumers was 0-8 (95 % confidence interval 05-11). Clearly alcohol can be linked to cancers of the oropharynx, larynx, oesophagus, and liver, but it may be premature to include breast cancer. Department of Surgery, New York Medical College,
ALBERT B. LOWENFELS
Valhalla, New York 10595, USA
1. Lowenfels AB, Zevola SA. Alcohol and breast cancer: an overview. Alcoholism Clin Exp Res 1989; 13: 109-11. 2. Schatzkin A, Carter CL, Green SB, et al. Is alcohol consumption related to breast cancer? Results from the Framingham Heart Study. J Natl Cancer Inst 1989; 81: 31-35.
Screening for hepatitis C virus antibody in plasma for fractionation SIR,-Dr Habibi and Dr Garretta (April 7, p 855) raise an important scientific and pressing operational issue, and do so in a way that will be of significant assistance to many European countries, especially those which rely on fractionated products of plasma from local blood donors. Unlike the USA, Europe relies heavily on plasma recovered from ordinary blood donations. Thus, with the introduction of routine testing of blood donations for antibody to hepatitis C virus throughout Europe over the next twenty months, any attempt to adopt US Food and Drug Administration (FDA) policy in Europe could be seen as a major breach of good manufacturing practice-namely, the deliberate inclusion of infected plasma into a manufacturing environment. If the rest of Europe does adopt the policy now in place in France-and especially where significant quantities of plasma products manufactured in the USA are imported-the FDA may wish to review its position. This, no doubt, would be encouraged by US commercial manufacturers of plasma derivatives, for it was they who introduced transaminase screening in 1985-not on the basis of proven scientific value but to meet the requirements of the West German market.’ Scottish National Blood Transfusion Service, Edinburgh EH1 1JR, UK 1. Menache D, Barker LF. Factor clarification. Blood 1990; 75: 810.
concentrates
Diagnostic Systems, Raritan, New Jersey, USA) after urea washing.2 In the absence of a clear cut-off value of the optical densities (OD), results were expressed as positive (OD>1), indeterminate (05 OD 1), or negative (OD
Alcohol and breast
cancer
SiR,—Your March 17 editorial on alcohol and cancer notes the strong evidence linking alcohol and upper aerodigestive cancer. It also implies that alcohol is a risk factor for breast cancer. Our meta-analysis (based on published material up to 1987) was less certain.’ A review of Medline indexed articles on alcohol and breast cancer for 1989 and the first quarter of 1990 reveals eight case-control series-four negative and four positive, one positive in premenopausal but not in postmenopausal women. Of considerable interest is the prospective Framingham study, with a follow-up of up to 32 years: the adjusted relative risk of breast cancer for alcohol consumers versus non-consumers was 0-8 (95 % confidence interval 05-11). Clearly alcohol can be linked to cancers of the oropharynx, larynx, oesophagus, and liver, but it may be premature to include breast cancer. Department of Surgery, New York Medical College,
ALBERT B. LOWENFELS
Valhalla, New York 10595, USA
1. Lowenfels AB, Zevola SA. Alcohol and breast cancer: an overview. Alcoholism Clin Exp Res 1989; 13: 109-11. 2. Schatzkin A, Carter CL, Green SB, et al. Is alcohol consumption related to breast cancer? Results from the Framingham Heart Study. J Natl Cancer Inst 1989; 81: 31-35.
Screening for hepatitis C virus antibody in plasma for fractionation SIR,-Dr Habibi and Dr Garretta (April 7, p 855) raise an important scientific and pressing operational issue, and do so in a way that will be of significant assistance to many European countries, especially those which rely on fractionated products of plasma from local blood donors. Unlike the USA, Europe relies heavily on plasma recovered from ordinary blood donations. Thus, with the introduction of routine testing of blood donations for antibody to hepatitis C virus throughout Europe over the next twenty months, any attempt to adopt US Food and Drug Administration (FDA) policy in Europe could be seen as a major breach of good manufacturing practice-namely, the deliberate inclusion of infected plasma into a manufacturing environment. If the rest of Europe does adopt the policy now in place in France-and especially where significant quantities of plasma products manufactured in the USA are imported-the FDA may wish to review its position. This, no doubt, would be encouraged by US commercial manufacturers of plasma derivatives, for it was they who introduced transaminase screening in 1985-not on the basis of proven scientific value but to meet the requirements of the West German market.’ Scottish National Blood Transfusion Service, Edinburgh EH1 1JR, UK 1. Menache D, Barker LF. Factor clarification. Blood 1990; 75: 810.
concentrates
Diagnostic Systems, Raritan, New Jersey, USA) after urea washing.2 In the absence of a clear cut-off value of the optical densities (OD), results were expressed as positive (OD>1), indeterminate (05 OD 1), or negative (OD
