How big a risk factor Is alcohol for breast cancer?
For years, a seemingly endless march of studies has pronounced that moderate consumption of alcohol could be beneficial for heart health. If you like a glass of wine with dinner, you've probably welcomed this news. But if you have other risk factors for breast cancer, you might want to scale back on your alcohol consumption.
Alcohol and the Heart
Therefore, some researchers and doctors have offered that drinking in moderation could be good for you. The American Heart Association defines drinking in moderation as one to two drinks per day for men and one drink per day for women. A drink is measured as about 10 grams of alcohol, which translates to one 12-ounce beer, four ounces of wine, 1.5 ounces of 80-proof spirits or 1 ounce of 100-proof spirits.
However, despite the fanfare surrounding some studies, the data on potential health benefits of alcohol is still mixed. The American Heart Association "does not recommend drinking wine or any other form of alcohol to gain these potential benefits, " but it does recommend lowering your cholesterol and high blood pressure, getting plenty of physical activity, eating a healthy diet and controlling your weight.
Alcohol and Breast Cancer Risk
These health guidelines are similar to those offered by the American Cancer Society for helping to reduce your risk of cancer, which says limiting alcohol intake lowers the risk of developing breast cancer. "Even a few drinks a week is linked with an increased risk of breast cancer in women," the ACS reports. "This risk may be especially high in women who do not get enough folate (a B vitamin) in their diet or through supplements. Alcohol can also raise estrogen levels in the body, which may explain some of the increased risk. Cutting back on alcohol may be an important way for many women to lower their risk of breast cancer."
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Dr. Melissa Pilewskie, a breast surgeon oncologist at Memorial Sloan Kettering Cancer Center in New York City, says "what we know from the data is that there is a low to moderate risk association with alcohol consumption and breast cancer risk." She says women who drink one or more alcoholic drinks per day have a greater risk of developing breast cancer than women who don't drink or drink just one drink per day. "Basically," Pilewskie says, "women who don't drink or have an occasional drink, there doesn't seem to be an increased risk. But for those who drink more than, on average, one drink per day, we do see an increase in breast cancer risk."
The size of this risk is similar to other "small risk factors, such as having a family member with breast cancer, obesity and things like that," Pilewskie says. A 2017 report produced by the World Cancer Research Fund and the American Institute for Cancer Research pooled data from 16 studies looking at the connection between alcohol and premenopausal breast cancer and another 15 studies that examined the connection between alcohol and postmenopausal breast cancer. The report states that women who drank one alcoholic drink per day had a 5 percent increased risk of developing premenopausal breast cancer while postmenopausal women who drank one alcoholic drink per day had a 9 percent increased risk of developing breast cancer.
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It seems clear that there's a link between alcohol consumption and breast cancer. But what's different about the risk associated with alcohol intake versus other risk factors, Pilewskie says, is that "this is something that we have control over. We don't have control over our sex or our family history," but we can decide to not drink. "I counsel women that if they're concerned or have other risk factors for breast cancer that they should limit their alcohol consumption to one drink per day or less," she says.
Unlike with some of the heart health findings, there does not seem to be any variation in risk associated with different types of alcoholic drinks. And as Hollie Zammit, an outpatient oncology dietitian at UF Health Cancer Center, Orlando Health, notes, ethanol – the alcohol that's in all our drinks regardless of whether it's beer, wine or liquor – "is a group 1 carcinogen, and it can increase our risk for several cancers." The International Agency for Research on Cancer maintains the list of carcinogens and defines group 1 carcinogens as substances that are known to cause cancer in humans. This group also includes asbestos, plutonium, radon and talc, among more than 100 other substances and compounds.
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Although we know there's a connection between alcoholic beverages and breast cancer, the causal mechanism is still being studied. "We don't really understand where the association comes from. Is it alcohol itself or other changes in the body that occur in women who drink?" Pilewskie says. "We also don't really know if having one drink per day is the same as not drinking every day and then having seven drinks in a day. That is another gray zone. Whether it's consumption at one time or cumulative consumption is also an unknown," she says.
Pilewskie says awareness and education about the potential risk surrounding alcohol is the key. "It's something to be aware of and something that, from a physician standpoint, I think is often not communicated." She says a study she was involved in found that "about 20 percent of our high-risk patients drank more than one drink per day, so that's a population where we can have impact in providing education on this. I think it's important for women to know, but also for physicians to talk about this as a risk factor."
Zammit agrees, saying "for my patients who don't drink, I tell them, 'don't start.' For my patients who have a couple glasses of wine, we encourage them to cut back or cut it out if they can."
Dr. Raquel Reinbolt, assistant professor of internal medicine at The Ohio State University Wexner Medical Center, also recommends moderation and common sense when it comes to alcohol consumption. "From a common-sense point of view, we know that for anyone, a lot of alcohol is not a good thing." In addition to the potential for increased risk from the alcohol itself, alcoholic drinks are high in calories with no nutritive value. As such, it's easy to pack on the pounds when you're drinking too much. This is a problem because patients who are overweight are at a higher risk of developing breast cancer. So be mindful of how much you drink and as much as possible opt for a low-sugar soft drink or water instead of an alcoholic beverage. "In a practical sense, moderation is appropriate. If I were an internal medicine doctor, I would be telling patients the same thing – the data is interesting, and we should caution patients to be moderate and use common-sense " in regard to deciding whether and how much to drink.
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