Non–Small-Cell Lung Cancer mRNA Expression Signature Predicting Response to Adjuvant Chemotherapy

98% of those with localized disease and 84% of those with spread to regional lymph nodes.Even for those diagnosed in the early 1980s, more than half are alive 20 years later.19 Clearly, women with breast cancer are living long enough to be vulnerable to death as a result of cardiovascular disease, which is still the number one cause of death among US women.20 In addition, there is some evidence that breast cancer treatments may increase the risk of cardiovascular disease or its antecedents.The risk of metabolic disease may be increased by treatment-induced estrogen deficiency, 21 and radiation may cause direct damage to the myocardium and coronary arteries.22 The study by Kwan et al 1 is important because it elucidates a mystery in the literature concerning lifestyle factors that affect breast cancer survival.Their data showed the expected decrease in survival when recurrence and breast cancer death were used as end points, and no decrease in overall survival with alcohol intake.Of interest, the cut point of Ͻ 6.0 and Ն 6.0 g/d used in the Kwan et al study falls squarely in the range of 5.0 to 14.9 g/d, which represented the optimum balance between increased breast cancer mortality and decreased cardiovascular mortality among initially healthy women in the Fuchs et al study.18 The fact that most previous studies of alcohol and breast cancer survival used total mortality as the end point explains the previous null results.The study by Kwan et al 1 is also important because it gives guidance to women living with breast cancer and their clinicians.Their decision is the same as that facing women without breast cancer; the answer is not a clear-cut yes or no.Moderate consumption of alcohol is likely to increase a woman's risk of dying as a result of breast cancer while decreasing her risk of dying as a result of heart disease.Whether to consume alcohol is an individual decision and is dependent on each woman's evaluation of and comfort level with those risks.