Moderate Drinking and Recurrence Risk
Posted 1/30/2010
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It would be an understatement to say that I have been obsessing about this report. When it came out, at last month's San Antonio Breast Cancer meeting, I was in Paris, completely enjoying the food and wine. No where else, ever, do I have a glass of wine with lunch, but, in Paris, it seems criminal not to do so. My very favorite lunch there is a cheese omelet (and why can't I figure out how to make them the way they do?), small green salad with marvelous vinaigrette, a slice of perfect baguette, and a glass of red wine. Heaven.
During that week, I made the sensible decision to ignore this study and deal with it later. Which I now have--repeatedly. The bottom line seems to be that even moderate alcohol use (defined as more than 3 drinks a week of anything alcoholic) may increase the risk of recurrence by as much as 30%. Here is where my obsessive reading and thinking and rationalizing stepped in: First, this does not mean that your recurrence risk jumps to 30%. Instead, it means that, whatever the risk was before (different for everyone), that number is increased by 30%--usually this translates to a few percentage points. Second, the women whose recurrence rate increased were all post-menopausal and obese. I do fit the first criteria, but not the second. Third, it is unclear what the role of anti-estrogen therapy (tamoxifen and/or the AIs) might be. Fourth, and maybe most important, this was a retrospective study based on self-report of alcohol uses--notoriously inaccurate and under-reported.
Please do not interpret my comments as a suggestion that we all open the liquor bottles and start to party. This is a serious conversation and decision that each of us must make. I have been in discussion with a number of my distressed patients about this---understand that I am not talking about women who have a alcohol problem. I am talking about women who enjoy a glass of wine in the evening, a lifestyle choice, if you will. A few have decided to stop drinking, a few have decided to ignore this one study for some or all of the reasons above, and most have decided to pay more attention to their wine. As one woman said to me yesterday, "I think each time whether I am really going to enjoy this glass of wine or whether it is habit. At a work cocktail reception, for example, I decided that a glass of seltzer would do just fine."
Here is a summary of the study from breastcancer.org:
SABCS: Moderate Drinking Boosts Breast Cancer Recurrence
The study reviewed here suggests that drinking even a few glasses of alcohol per week increases the risk of breast cancer coming back (recurrence) in women who've been diagnosed with early-stage disease.
These results were reported at the 2009 San Antonio Breast Cancer Symposium.
The results are similar to other studies suggesting that recurrence risk goes up if a woman drinks alcohol.
Other research also has shown that the risk of being diagnosed with breast cancer is higher in women who drink alcohol.
Over a period of 8 years, researchers looked at the medical and alcohol consumption records of nearly 2,000 women diagnosed with early-stage breast cancer. About 350 women had a breast cancer recurrence and 332 women died during the 8 years. Not all the deaths were related to breast cancer.
Half of the women were characterized as moderate-to-heavy drinkers, meaning they had at least 3 or more drinks per week. Wine was the most popular alcoholic beverage, followed by liquor and beer.
The researchers looked at both the risk of recurrence and the risk of dying from breast cancer in women who were moderate-to-heavy drinkers compared to women who didn't drink alcohol.
Women who drank 3 or more alcoholic drinks per week were 34% more likely to have a recurrence and 51% more likely to die from beast cancer compared to women who didn't drink.
Post-menopausal women who drank alcohol had the largest increase in recurrence risk. Among moderate-to-heavy drinkers, recurrence risk was 51% higher in post-menopausal women and 24% higher in pre-menopausal women.
Women who drank less than 3 alcoholic beverages per week had the same recurrence risk as women who didn't drink. The type of alcohol didn't seem to affect the amount of increase in recurrence risk among moderate to-heavy drinkers. The risk of dying from causes other than breast cancer wasn't affected by how much alcohol the
women drank.
Researchers don't completely understand why alcohol seems to increase the risk of breast cancer recurrence. Other studies have shown that hormone-receptor-positive breast cancer seems to be most affected by alcohol. Estrogen can cause hormone-receptor-positive breast cancer to grow and alcohol can increase the amount of estrogen in a woman's body. This increase in estrogen may be why there seems to be a link between drinking alcohol and breast cancer recurrence risk.
The bottom line is that we really don't know how much alcohol is safe for breast cancer survivors. If you've been diagnosed with early-stage breast cancer and want to do everything you can to lower your risk of recurrence, limiting how much alcohol you drink seems to make sense. You may even choose to stop drinking alcohol completely. It's also very important not to mix alcohol with some of the medicines you might be taking, such as pain medications.
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