Illustration by Jacqueline Morgado / Fred Hutch News Service
We’ve all heard that drinking booze – even in moderation – can bump your risk for breast cancer. As a result, many women and men diagnosed with the disease have either sworn off alcohol entirely or worry when they do imbibe.
“I feel guilty often for drinking,” said Maile Feuerman, 40-year-old, stay-at-home mom from Eureka, California, who was diagnosed with breast cancer two years ago. “I don’t want to have to wonder if it comes back because I did this. But I love my wine.”
A new study out of Fred Hutchinson Cancer Research Center offers a glimmer of good news for those who’ve been diagnosed and treated for the disease: moderate alcohol use after a breast cancer diagnosis won’t lead to a lethal recurrence.
Alcohol use among breast cancer survivors has been linked to increased risks of developing a breast cancer recurrence, i.e., finding more cancer in a breast that’s already been diagnosed and, say, had a lumpectomy. Drinking also ups your risk of being diagnosed with a second breast cancer in the opposite “healthy” breast.
However, when it comes to dying — usually the biggest concern for those who’ve been diagnosed — there’s not much of an association. According to epidemiologist and lead author Dr. Christopher Li, alcohol use after a breast cancer diagnosis does not increase your risk of dying of the disease.
“Moderation is very important but our study supports previous studies in suggesting that the occasional glass of wine does not seem to impact a woman’s risk of dying of breast cancer,” he said.
Fred Hutch file photo
Alcohol and cancer risk
There’s no question alcohol raises your cancer risk.
According to the American Cancer Society, it’s been linked to cancers of the mouth, throat, larynx, esophagus, liver, colon, rectum and breast. And research also shows the risk is “dose-dependent,” i.e., the more you drink, the more you’re at risk. One drink a day and your breast cancer risk goes up about 10 percent, Li said. Two drinks a day, it goes up 20 percent.
Women who imbibe are particularly at risk for estrogen-receptor-positive, or ER+ breast cancer, since studies have shown that alcohol increases the level of estrogen in postmenopausal women. Unfortunately, there’s no evidence on what booze does to pre-menopausal women’s estrogen level because there’s too much “variability” in their estrogen to nail down a finding.
“The effect of the ovary-producing hormones just overwhelms any other effect of alcohol,” Li said “It’s really postmenopausal ER+ breast cancer where the risk appears to be the strongest.”
So how can even light drinking be bad for healthy women and yet somehow not so bad for those who’ve been diagnosed with breast cancer?
It’s all about risk.
If you haven’t had breast cancer, drinking substantially ups your chances of getting it and having cancer substantially ups your chances of dying. But if you’ve already been diagnosed with breast cancer — and especially if you don’t have any breast tissue because you’ve had a double mastectomy — drinking moderately isn’t going to make that much more of a difference because the horse is basically out of the barn.
Li’s study is the single largest one yet to look at the relationship between alcohol use and mortality, breast cancer-related and otherwise. He and his team used data from the Women’s Health Initiative (Fred Hutch is WHI’s Clinical Coordinating Center), winnowing out a group of nearly 8,000 women who’d been diagnosed with breast cancer during the course of the large study.
After adjusting for a slew of potential “confounders” such as age, income, family history of breast cancer, smoking status and BMI, the results continually pointed to the same thing.
“Our findings, together with those of earlier studies, suggest that alcohol intake among women diagnosed with breast cancer has little to no impact on either breast cancer specific or all-cause mortality,” Li wrote in the study’s conclusion.
But what about recurrence?
Before you head to the bar, however, keep in mind that Li didn’t look at whether drinking alcohol could trigger a recurrence, either local or metastatic. He only looked at whether drinking could be linked to death — from breast cancer or something else.
“There are other studies that have linked alcohol consumption to risks of having both a breast cancer recurrence or of developing a second breast cancer,” he said. “These are also important outcomes because they typically lead to more treatment, potentially including surgery, radiation, and chemotherapy, and so they can take significant physical and emotional tolls.”
Li specifically studies how lifestyle factors like alcohol use, obesity and smoking can affect the risk of contracting breast cancer.
His 2009 study revealed breast cancer survivors who smoked and drank more than one drink a day were seven times more likely to get an ER+ breast cancer in their other breast than women who drank fewer than seven drinks a week and didn’t smoke.
Breast cancer oncologist and researcher Dr. Julie Gralow said she wasn’t surprised by Li’s findings.
“We’ve never had data about alcohol intake after a breast cancer diagnosis,” she said. “So this is new information. But frankly, I’m not surprised. I’ve always told my patients that data on alcohol intake was much stronger regarding incidence of breast cancer versus recurrence.”
Much like Li, Gralow also stressed women with breast tissue are still at risk if they drink.
“Most of my patients who’ve had breast cancer still have remaining breast tissue so I tell them that drinking in a limited to moderate amount — as opposed to heavier drinking — could still be contributing to a decreased incidence of a second breast cancer.”
The American Cancer Society’s guidelines for cancer prevention recommend low to moderate drinking, meaning one or two drinks a day for men and one drink a day for women. The type of alcohol doesn’t matter; it’s the ethanol that’s the culprit and that’s present in all alcohol. Generally, one drink is defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof hard liquor.
The ACS further recommends that patients going through active treatment avoid alcohol, as it can exacerbate side effects or adversely interact with drugs used in cancer treatment. As always, patients both in and out of active treatment should discuss the issue with their doctor.
Questions and conflicting advice
For survivors like Feuerman, parsing all the advice on cancer risk can be frustrating.
“I did all the jazz that they say reduces your risk,” she said. “I breastfed both of my kids, exercised my whole life. I don’t have a history of cancer in my family. When I was diagnosed with cancer, I thought it must be too much drinking. Although, there are plenty of people who drink heavily their entire lives and they never get cancer.”
Feuerman even asked an oncologist at Stanford about the connection when she went for a second opinion.
“I told her I drank a couple of drinks five times a week and she said, ‘That’s not that impressive.’”
On the private breast cancer Facebook group Beyond the Pink Moon, survivors reported conflicting advice from their health care providers. Some said their oncologists told them to abstain completely while others said their doctors encouraged them to drink moderately as a way to reduce stress and the long-term side effects of treatment.
Shell Cedrone, a 34-year-old breast cancer patient from Dover, New Hampshire, joked about all the advice survivors are given.
“If we all stopped eating, drinking or using everything that supposedly causes breast cancer, we'd smell horrible until we starved to death,” she said.
Feuerman said she gave up alcohol altogether while she was in active treatment — she had a lumpectomy, chemo, radiation, ovarian suppression and is currently taking tamoxifen to suppress her estrogen — but started again due to the stress of her diagnosis and treatment.
Lately, though, she’s started to think about cutting back to one drink a day or less.
“That guilty feeling is starting to overwhelm me again,” she said. “But it’s hard. My life is stressful and my six-month mammogram is coming up. I always feel stressed leading up to that test. I just want to have a drink and relax.”
Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she also writes the breast cancer blog doublewhammied.com. Follow her on Twitter @double_whammied. Email her at firstname.lastname@example.org.
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