Can Alcohol Cause Breast Cancer A Board Certified Plastic Surgeon Weighs In
Breast cancer is the most commonly diagnosed cancer among American women. If youre a woman, you have a 1 in 8 chance of developing breast cancer in your lifetime. At our Fairfax practice, board certified plastic surgeon Dr. Hess has helped many women reconstruct their breasts following mastectomyan experience that has led him to explore the causes of breast cancer. In this months blog, Dr. Hess examines one such risk factor: alcohol.
Alcohol And Breast Density Marker
In addition to the carcinogenic role of its metabolites, alcohol has been shown to alter estrogen levels, which may lead to changes in breast density, affecting breast cancer risk . An intermediate marker of breast cancer risk that has also been linked with many hormonal breast cancer risk factors is mammographic density, a measure of epithelial and connective tissue in the breast. Higher density confers a 4-6 fold increase in breast cancer risk . Moreover, alcohol use has been shown to modify the mammographic density-breast cancer association in a dose-response way . Associations between alcohol use and intermediate markers such as breast density provide further evidence that alcohol is truly associated with breast cancer and that this association cannot be explained by bias alone.
Epidemiologic studies have used different measures to assess mammographic density with earlier studies using qualitative measures such as the Wolfe parenchymal patterns , and more recent studies using more quantitative methods that either use categories such as the Breast Imaging Reporting and Data System or use a continuous measure ranging from 0-100% based on computer threshold programs .
Consumption Of Alcohol Can Cause Breast Cancer
We have already discussed the link between breast cancer and alcohol. There is a definite of risk cancer and drinking alcohol every day. There is an even higher risk if we drink too much alcohol every day. Clearly we need to moderate our consumption of alcohol.
If you have tried to moderate your consumption of alcohol and failed, perhaps there is a better way? Maybe there is a reason to avoid alcohol completely.
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How Much Alcohol Increases The Risk
Even low levels of alcohol consumption can increase a womans risk of breast cancer.
What might be less well known is that the risk of breast cancer is greater among women who start drinking at an early age. Women who drink around two standard drinks a day through their teens and early twenties are three times more likely to develop breast cancer than those who do not drink.
Alcohol intake is linked to breast cancer risk, the more you drink the higher the risk.
Why Does Alcohol Use Raise Cancer Risk
When you drink alcohol, your body breaks it down into a chemical called acetaldehyde. Acetaldehyde damages your DNA and prevents your body from repairing the damage. DNA is the cells instruction manual that controls a cells normal growth and function. When DNA is damaged, a cell can begin growing out of control and create a cancer tumor.
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Considerations For Clinical Recommendations On Alcohol Consumption For Breast Cancer Prevention
Existing epidemiologic evidence, complemented further by studies of genetic and intermediate markers, strongly suggests that alcohol use may increase breast cancer risk. High alcohol consumption has also been associated with a number of other adverse health conditions including liver diseases such as alcoholic hepatitis and cirrhosis, cardiovascular diseases such as high blood pressure and cardiomyopathy, and other cancers such as that of mouth, pharynx, larynx, esophagus, and colon . Alcohol abuse also leads to violent crimes, automobile accidents, psychiatric problems, and for a pregnant woman, increases the risk of birth defects . However, modest alcohol consumption has been consistently associated with a decreased risk of coronary heart disease . In a recent meta-analysis, among women, current drinkers had a 29% reduced risk of CHD incidence and a 21% reduced risk of CHD mortality compared to non-current drinkers .
Prevalence of alcohol consumption among US women, by Race and Ethnicity
Prevalence of alcohol consumption among US women 20 years and older stratified by race-ethnicity and age group . Definitions: Non-current drinkers, ⤠12 drinks in the past 12 months Moderate drinkers, > 12 drinks but ⤠7 drinks/week in the past 12 months heavy drinkers, > 7 drinks/week in the past 12 months.
How Does The Combination Of Alcohol And Tobacco Affect Cancer Risk
Epidemiologic research shows that people who use both alcohol and tobacco have much greater risks of developing cancers of the oral cavity, pharynx , larynx, and esophagus than people who use either alcohol or tobacco alone. In fact, for oral and pharyngeal cancers, the risks associated with using both alcohol and tobacco are multiplicative that is, they are greater than would be expected from adding the individual risks associated with alcohol and tobacco together .
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Are There Any Health Benefits From Drinking Alcohol
You may have heard that drinking alcohol can be good for the heart. But the NHS alcohol guidelines say that the evidence is not clear and that there is no completely safe level of drinking. You should not drink alcohol for health benefits. The risk of cancer increases even drinking small amounts of alcohol.
For more information about alcohol and heart health visit the British Heart Foundations website.
How Alcohol Raises Breast Cancer Risk
Alcohol increases the risk of several medical illnesses , as well as many types of cancer .
According to the U.S Department of Health and Human Services, alcoholic beverages are considered to be carcinogens . In addition to causing cancer, alcohol facilitates cancer growth when cancer has already started.
Alcohol promotes the initiation and growth of cancer through several mechanisms, including:
- Liver disease: Alcohol often leads to liver failure. The liver is involved with many physiological functions, including maintaining healthy immunity. Because the immune system helps fight cancer, liver impairment can give cancer a greater chance of enlarging and spreading.
- Oxidative stress: Alcohol metabolism increases oxidative stress, a byproduct of normal metabolism that induces damage to DNA, which can initiate cancer.
- Breakdown of tissue: Alcohol consumption results in toxic byproducts that break down tissues throughout the body. If a person has cancer, the breakdown of epithelial tissue facilitates metastasis of cancer.
In addition to these general carcinogenic effects, alcohol raises the risk of breast cancer specifically by increasing estrogen levels, especially estradiol and estrone. Higher estrogen levels elevate the risk of breast cancer, and chronic or irregular exposure to elevated estrogen can have a lasting effect on breast cancer risk, increasing the chances of developing the disease years down the road.
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Effect On Absorption Of Folate Or Other Nutrients
Alcohol might affect the bodys ability to absorb some nutrients, such as folate. Folate is a vitamin that cells in the body need to stay healthy. Absorption of nutrients can be even worse in heavy drinkers, who often consume low levels of folate to begin with. Low folate levels may play a role in the risk of some cancers, such as breast and colorectal cancer.
Relationship Between Alcohol And Breast Cancer
Alcohol is a known carcinogen, which means it can adversely affect hormone levels and damage DNA within cells.
People with a specific gene, called the alcohol dehydrogenase 1C*1 allele , may be at an increased risk for getting breast cancer due to alcohol use.
The gene mutations most associated with a family history of breast cancer are BRCA1 and BRCA2. Even though alcohol consumption is an established risk factor for breast cancer, it hasnt been definitively shown to increase breast cancer risk among people who carry these particular gene mutations.
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How To Prevent Alcohol
Alcohol is classified as a Group 1 human carcinogen by IARC. It is causally linked to 7 types of cancer. Besides female breast cancer, it increases the risk of developing oral cavity , pharynx , oesophagus , liver, larynx and colorectum cancers.
There is no safe level of alcohol consumption. The risk of breast cancer increases with each unit of alcohol consumed per day. More than 10% of alcohol-attributable cancer cases in the Region arise from drinking just 1 bottle of beer or 2 small glasses of wine every day. For breast cancer, this is even higher: 1 in 4 alcohol-attributable breast cancer cases in the Region is caused by this amount.
Simply put, alcohol is toxic. It harms every organ while it passes through the body, says Dr Carina Ferreira-Borges, Acting Director for Noncommunicable Diseases and Programme Manager for Alcohol and Illicit Drugs at WHO/Europe. So, it makes perfect sense to limit the amount of consumed alcohol, to find ways to replace alcohol with other beverages and to adopt nationwide policies that help to reduce alcohol consumption.
How Does Alcohol Increase Your Risk Of Developing Breast Cancer
The ways in which alcohol increases the risk of developing breast cancer are not fully understood but probably include:
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The body breaks down alcohol into a substance called acetaldehyde which can cause changes in our DNA. This can trigger a response in the body which leads to cancerous cells developing.13,14
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Alcohol increases levels of the female hormone oestrogen high levels of oestrogen can cause vulnerable cells continually to excessively multiply and become cancerous.15
Breast cancer is the most common cancer in the UK and about 1 in 13 cases is estimated to be attributable to alcohol, yet only one-in-eight UK adults make the connection between alcohol and cancer.16
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Alcohol And Breast Cancer Risk: What To Know
Can as little as one alcoholic drink a day raise your breast cancerrisk? Our experts weigh in.
Can as little as one alcoholic drink a day raise your breast cancer risk?
Studies say yes. But does that mean you should steer clear of alcohol completely? And what about that glass of wine thats supposed to be good for you?
Alcoholic drinks come in three choices: beer, wine and liquor. A drink is defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor. If you choose to drink, exceeding the recommended limit of one alcoholic drink a day increases your breast cancer risk.
But that risk is very low, says Therese Bevers, medical director of MD Andersons Cancer Prevention Center. You need to be more concerned if it becomes a routine in which you drink more than one drink each day.
More than 100 studies have looked at the association between alcohol consumption and breast cancer risk in women. These studies, although observational meaning they draw on inferences from researchers – have consistently found an increased risk of breast cancer associated with alcohol intake.
We always question the validity of observational data, but with this were seeing it over and over again, Bevers says.
And while some studies show that one glass of wine a day can be good for your heart, you shouldnt have more if youre trying to stay healthy.
How does alcohol affect breast cancer risk?
So, why does alcohol intake increase breast cancer risk specifically?
Do I Have To Stop Drinking After A Breast Cancer Diagnosis
No. You dont have to do anything you dont want to do.
Some thoughts from the breast cancer trenches re: drink/dont drink:
- Life is short. Drink the wine.
- Life is precious. Live it up and enjoy it.
- I wont miss out on all the things I love.
- I want to enjoy life and that means drinking.
- It doesnt matter whether you drink or not. Some people never drink and get cancer. Some drink a lot and dont get it. I dont believe the studies.
People have strong opinions about their alcohol! And theyre entitled to them.
But please know this:
Alcohol is carcinogenic.
To reduce risk of an initial breast cancer diagnosis, there is no safe level of alcohol intake. Theres a risk relationship between alcohol and breast cancer, even at low levels of consumption.
The World Cancer Research Funds alcohol and cancer report indicates a confirmed link between alcohol consumption and pre- and postmenopausal breast cancer initial diagnosis.
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How Does Alcohol Cause Breast Cancer
The focus of many studies into risk factors of breast cancer has been able to disprove many common myths and rumours. At the same time, there are undeniable facts about the proven links between breast cancer and alcohol dont be confused by the false messages.
The biggest risk factor for breast cancer is the unavoidable fact of being a woman.
There are also some other factors that we cannot change, such as increased age, hereditary factors and the natural production of estrogen.
These are unavoidable. But there are many lifestyle factors that we can control
Alcohol: The Cause Of Nearly 40 000 New Breast Cancer Cases
The WHO European Region has the highest rate of new breast cancer diagnoses compared to any of the other WHO regions. According to estimates from the International Agency for Research on Cancer , in 2020 alcohol consumption was responsible for almost 40 000 new breast cancer cases in the Region.
The same data show that breast cancer has become the most common cancer globally. More than 2 million new cases were estimated in 2020, and about 100 000 of these were attributable to alcohol consumption.
Many people, including women, are not aware that breast cancer is the most common cancer caused by alcohol among women globally. People need to know that by reducing alcohol consumption they can reduce their risk of getting cancer. It doesnt matter what type, quality or price alcohol is, says Dr Marilys Corbex, Senior Technical Officer for Noncommunicable Diseases at WHO/Europe.
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Bringing It All Together
Other things that affect a womans breast cancer risk are less easy to control. As with most cancers, the risk of developing the disease increases with age. Having a family history of the disease can increase a womans risk, and breastfeeding can reduce it.
All the different things that can increase the risk of breast cancer are held together by a common thread: they all affect the hormones circulating around in the body in some way.
Hormones help control what happens inside our bodies by sending messages from one place to another including instructing cells when to stop and start multiplying.
If this system goes wrong, cells can get too many messages telling them to make more cells. And that can lead to cancer.
Overall the best advice is the same as at the start of the week: to keep active, keep a healthy weight throughout life, and limit alcohol.
Clare
Alcohol And Breast Cancer Risk
Drinking alcohol increases the risk of breast cancer in women and heavy drinking increases the risk in men.
The more alcohol a woman consumes the greater the risk, with no lower threshold.
Alcohol is metabolised into acetaldehyde, a cancer-causing compound. This occurs primarily in the liver but also in breast tissue.
Alcohol increases levels of circulating hormones including oestrogen, which increases breast cancer risk
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How You Can Help To Reduce Your Alcohol Intake
- Measure your current level of drinking using the drinks calculator on askaboutalcohol.ie
- Try keeping track of what youre drinking with a drinks diary note how much you drink, when, and how you felt afterwards.
- Stay within the weekly guidelines for low risk drinking
- If drinking at home, use a drinks measure to calculate how much you are pouring.
- Buy smaller wine glasses, as it will make it easier to drink less and keep track of how much youre drinking. A big wine glass can hold two standard drinks or more.
- Dont get involved in rounds. This means you can drink at your own pace and stay more in control when youre out.
- Do something else! Try and think of ways to spend time with friends that dont have to involve drinking.
What About Risk Of Alcohol And Breast Cancer Recurrence Or A Second Primary Breast Cancer
One systematic review looked at six databases and 16 studies, of which 11 assessed breast cancer recurrence.
About half of the 11 studies showed a modest, but significant association between alcohol consumption and increased risk of breast cancer recurrence. Two of the included studies suggested the association was stronger in postmenopausal women.
This same study observed that the association between alcohol and second primary breast cancer is less clear.
However, the WCRF report on diet, nutrition, physical activity and breast cancer survivorsdoes not at this time find evidence strong enough to make specific recommendations for survivors on alcohol and recurrence risk.
As a dietitian, Im trained to use research in making nutrition recommendations for others.
As a breast cancer survivor, I make personal nutrition and diet decisions based on my diagnosis AND the research. I believe alcohol may have contributed to my cancer. Of course I have no way of confirming that. But whos to say continuing to drink wouldnt negatively influence my recurrence risk?
I just couldnt discount the connection found in the review . And research is ongoing. Because the evidence isnt strong enough NOW, doesnt mean it wont be in the future.
I understand how findings like those in the WCRF report make it easy to dismiss the concerns around alcohol. And should you choose to? Theres nothing wrong with that.
Theres no judgment either way.
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Whats A Safe Amount Of Alcohol To Drink
Depending on which research you read, or from whom you get your information, youre likely to get conflicting and confusing messages on HOW MUCH alcohol is safe to drink after youve been diagnosed.
Because of the inconsistencies and variations in research, its difficult to draft concrete guidelines. Remember, the WCRF hasnt issued specific alcohol guidelines for breast cancer survivors.
This is where you must decide whats comfortable for you.
Some evidence suggests ANY alcohol consumption, even at levels as low as 6 grams per day moderately increases the risk of recurrence, particularly in postmenopausal women. Thats about 1.2 teaspoons of pure alcohol, or less than ½ of a standard drink.
If that information gives you pause, but youre not ready to give up drinking completely, think about what matters most to you.
- If enjoying a special, fine dining meal means drinking good wine.
- Consider drinking only at special meals .
There are guidelines specific to alcohol consumption re: reducing risk of an INITIAL breast cancer diagnosis , but please remember to not confuse those with guidelines for risk of recurrence.