As a breast cancer surgeon, my job is to treat breast cancer; but as a healthcare leader, my job is to prevent it. For healthy women, prevention means they never get the disease. For survivors, prevention means it does not come back. The following article meets both objectives.
Alcohol and Estrogen Compete
Alcohol and estrogen are both metabolized in the liver using similar biochemical pathways. So if the liver is busy clearing alcohol from the bloodstream, estrogen levels will rise as they wait their turn through the liver.
Therefore, women who drink regularly, like every day, will have chronically elevated levels of estrogen circulating in their bloodstream. And since estrogen is the equivalent of light, sweet crude for the breast cancer engine, it’s easy to see why regular alcohol consumption is directly linked to an increased risk for breast cancer. In fact, there does not appear to be any “safe” level of alcohol use: even 1/2 glass of wine per day increases the risk for breast cancer. As a red wine and single-malt scotch lover, this was sad news for me when I learned of it several years ago.
Avoid alcohol if you want to avoid breast cancer.
The preponderance of data confirm that drinking alcohol on a regular basis increases the risk for breast cancer by approximately 40%. Therefore, my advice is to drink only occasionally and in moderation. The good news is that by drinking only on special occasions, indulging in expensive wine will be relatively affordable!
Estrogen-positive breast cancer and alcohol are like fire and gasoline.
The link between alcohol and breast cancer is old news, really. But there is more recent news about alcohol and breast cancer, per se, that ought to set off an alarm down every corridor of preventive medicine: alcohol dramatically increases the risk of breast cancer recurrence in women with estrogen-positive tumors.
Here’s the story:
Dr. Li of the Fred Hutchinson Cancer Research Center studied 365 women between 40-79 who were first diagnosed with estrogen-positive breast cancer and who were then diagnosed with a second cancer in the opposite breast. He compared these women to 726 similar patients who had not had tumor recurrence. Li was looking for differences between the two groups that might explain why one group suffered new cancers in the opposite breast, while the other group remained disease-free.
One thing stood out: having one drink per day increased the risk of a second cancer by 90%.
Another unexpected finding: the majority of patients with estrogen-positive tumors did not take or complete anti-estrogen therapy (tamoxifen, anastrozole, femara etc.)
In studying both groups of women, Li made a totally unexpected discovery, not related to alcohol, but that should be viewed as a cautionary revelation nonetheless. Only 39% of patients with tumor recurrence ever used anti-estrogen therapy – although all such women are eligible for this treatment which reduces breast cancer recurrence by 50% – and of the 39% who did use anti-estrogen therapy, only 14.5% completed five years of treatment.
In the 726 women who were used as controls (the patients without tumor recurrence), only 30% ever used anti-estrogen therapy, and of these only 18.5% completed five years of treatment.
Li’s study was not designed to understand why, when 100% of the women enrolled in the study were eligible for anti-estrogen therapy, so few ever used it, and even fewer completed five years of therapy. But for all women in Li’s study, one thing was abundantly clear: drinking alcohol was a very bad idea.
Alcohol increases the risk for breast cancer, specifically estrogen-positive breast cancer. Furthermore, in women with estrogen-positive breast cancer, drinking alcohol increases the risk of a new cancer in the opposite breast a jaw-dropping 90%.
TAKE HOME LESSON
Avoid alcohol – save it for special occasions.
If you have estrogen-positive breast cancer, avoid it like the plague.
And, please, take and stay the course with your anti-estrogen medication (tamoxigen, anastrozole etc.)
C Li, Relationship between potentially modifiable lifestyle factors and risk of second primary contralateral breast cancer among women diagnosed with estrogen receptor positive invasive breast cancer. Journal Clinical Oncology, Nov 10, 2009 (27) 32: 5312-5318
Alcohol, Postmenopausal Hormone Therapy, and Breast Cancer Ann Intern Med November 19, 2002 137:I-43