Study: Moderate drinking ups risk of breast cancer return

cp418

http://www.cnn.com/2009/HEALTH/12/10/drinking.breast.cancer.recurrence/

wallycat

I pulled that complete study at work yesterday and that is not the whole picture...

The whole study as I read it indicated that women who drink have a higher risk of contralateral breast cancer.  Many of us have bilateral mastectomy.  Overall, women who drank had better survival and less distant recurrence.

I know it is important to note all the options because many women opt to keep their healthy breast, but not all.

JanDun1

So you are saying the whole study states the opposite?

I read this article and several others that also agree that alcohol consumption ups your risk of recurrence. The decision should be simple...don't drink. I am interested in this because I really love to have a glass or two/three of wine on weekends. Having some wine is my only guilty pleasure. 

kmf

I like my glass of wine in the evening -- but I will say that since I've been diagnosed I am nursing a small one all night, and not every night.  How did you pull up the whole study?  I've also seen studies that say that one glass of red wine can help during radiation treatment.  Karenanne

pj12

My oncologist said "daily consumption of alcohol increased the risk for recurrence but a couple glasses of wine once or twice a week showed no increased risk.  I liked that.  Also the red wine during radiation study (done in Italy suggested women who indulged had an easier time with radiation therapy.   Do they mean, like less stress? Well, duh!  

pam 

Beesie

I'm a wine drinker too; Jan, like you, it's my only guilty pleasure.  The way I see it, breast cancer has had enough of an impact on my life so I'm not about to let it take away this pleasure.  But of course any news about alcohol consumption and breast cancer risk always interests me.

I have been trying to find the full tables from this study so that I can dig through them to find out what the study really says. I have a research background and often find that there is more subtlety to the results when you go through the details vs. what is reported in the press or even in the authors' text.  But so far, I haven't been able to find anything.  I did find some tables from the original broader-based study that this study was drawn from but there was not much detail on alcohol consumption in those tables. So I suspect that the more detailed tables associated with this report will be available at some time in the future but probably haven't been released yet. I did notice in one report that I read that this study has not yet been peer-reviewed which means that this is all very preliminary.

In any case, I did find two better summaries of the study, which do provide a bit more information:

http://www.medpagetoday.com/MeetingCoverage/SABCS/17444

http://www.medscape.com/viewarticle/713692

• Here are a few highlights, first from the medpage article:

Women whose alcohol consumption was defined as moderate-to-heavy (at least 6 g of alcohol a day, or at least three to four drinks per week) were at elevated risk of both breast cancer recurrence (HR 1.34, 95% CI 1.00 to 1.82) and death from breast cancer (HR 1.51, 95% CI 1.00 to 2.28) compared with those who drank no more than 0.5 g per day.

The increased risk of recurrence was highest for women who drank two or more glasses of wine a day, while there was no significant risk increase among those who consumed less than three drinks overall per week.

Postmenopausal breast cancer survivors were particularly at risk from moderate to heavy drinking (HR 1.51 versus 1.24 for premenopausal, P=0.03 for trend), as were overweight and obese women (HR 1.58 versus 1.09 for normal weight, P=0.03 for trend).

The researchers cautioned that further prospective studies are needed to confirm the findings.

...The new results could be consistent with counseling breast cancer patients that "one glass of wine may be okay, but keep it at that," Peppercorn said, though he cautioned against overinterpreting the observational data. (Note: Dr. Peppercorn was not involved with the study)

Peppercorn additionally warned about the barely significant overall hazard ratios and the limitations of self-reporting alcohol intake.

The study could not determine causality, and false associations due to confounding from other factors were possible, he noted.

• And second, from the medscape article:

Clinicians need to provide a "nuanced message" about alcohol consumption to women with early-stage breast cancer, said a presenter here at the 32nd Annual San Antonio Breast Cancer Symposium.

The message needs to be nuanced because, as a new study presented here showed, light consumption (fewer than 3 drinks per week) did not increase the risk for breast cancer recurrence in early-stage disease.

However, moderate to heavy consumption of alcoholic beverages (3 or 4 drinks per week, or more) was associated with a 1.3-fold increased risk for breast cancer recurrence and a 1.5-fold increase in breast cancer deaths, according to the study.

These results must be weighed against past research that shows that "moderate alcohol consumption" decreases the risk for cardiovascular disease, said epidemiologist Michelle D. Holmes, MD, DrPH, from Harvard University in Boston.

"Many women live a long time with early breast cancer, and alcohol consumption may decrease the risk of heart disease [during that time]," said Dr. Holmes, who acted as a discussant of the study on alcohol use and breast cancer disease recurrence.

Dr. Holmes also noted that the new study did not show that alcohol consumption was associated with a higher risk for death from all causes.

Among the group that drank 3 or 4 drinks per week, or more, the increased risk for recurrence was pronounced in postmenopausal (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.20 - 2.54) and overweight/obese (HR, 1.58; 95% CI, 1.07 - 2.35) women.

Dr. Kwan said that, on the basis of these findings, "women previously diagnosed with breast cancer should consider limiting their consumption of alcohol to less than 3 drinks per week, especially women who are postmenopausal and overweight or obese."

Dr. Holmes agreed that obese women with breast cancer should be careful about drinking alcohol and that they might have "particularly bad" survival outcomes if they do.

So,it appears that:

• Low levels of alcohol consumption do not increase risk.
• Those most affected are post-menopausal and overweight or obese.
• While the death rate from breast cancer increased for those who consumed more alcohol, the death rate overall did not, suggesting perhaps that for those most at risk, the positive benefits from alcohol related to cardiovascular health cancelled out the increased breast cancer risk. 
• The study was based on self-reporting, which can be suspect.  And the hazard ratios (i.e. the difference in results between the groups) were low, again raising caution.

One aspect that interests me a lot, and which wasn't commented on in any of the articles that I've read about the study, is the question of whether or not increased folate intake reduces the breast cancer risk associated with alcohol consumption.  Previous studies have shown that folate intake reduces or completely eliminates this risk; I noticed in one of the articles that I read that folate intake was one of the items tracked in this study but nothing was published about the possible effects (if any) of increased folate intake.  So I'm very interested to see the detailed tables to investigate this further.  Here is information on an earlier study which suggested that "An adequate dietary intake of folate might protect against the increased risk of breast cancer associated with alcohol consumption".  http://www.bmj.com/cgi/content/full/331/7520/807  

cp418

http://abcnews.go.com/Health/OnCallPlusBreastCancerNews/moderate-drinking-linked-breast-cancer-recurrence/story?id=9306082

sushanna1

Thank you Beesie.  Please keep us posted (pun intended.)

 Sue 

wallycat

This is the abstract.  I'm at home right now so don't have access to the full text database.

This is why I assumed it was strictly contralateral and not "any recurrence."

I have pulled other studies that show drinking after being diagnosed actually provided a more favorable outcome.  We all have to do what we are comfortable with.  I enjoy wine so have decided since I can't predict my outcome, I won't give it up.  It may be what ends up killing me....but that will be hindsight.

 J Clin Oncol. 2009 Nov 10;27(32):5312-8. Epub 2009 Sep 8.
Relationship between potentially modifiable lifestyle factors and risk of second primary contralateral breast cancer among women diagnosed with estrogen receptor-positive invasive breast cancer.

Li CI, Daling JR, Porter PL, Tang MT, Malone KE.

Divisions of Public Health Sciences and Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. cili@fhcrc.org

Comment in:

* J Clin Oncol. 2009 Nov 10;27(32):5301-2.

PURPOSE: An outcome of considerable concern among breast cancer survivors is the development of second primary breast cancer. However, evidence regarding how potentially modifiable lifestyle factors modulate second breast cancer risk is limited. We evaluated the relationships between obesity, alcohol consumption, and smoking on risk of second primary invasive contralateral breast cancer among breast cancer survivors. METHODS: Utilizing a population-based nested case-control study design, we enrolled 365 patients diagnosed with an estrogen receptor-positive (ER+) first primary invasive breast cancer and a second primary contralateral invasive breast cancer, and 726 matched controls diagnosed with only an ER+ first primary invasive breast cancer. Obesity, alcohol use, and smoking data were ascertained from medical record reviews and participant interviews. Using conditional logistic regression we evaluated associations between these three exposures and second primary contralateral breast cancer risk. RESULTS: Obesity, consumption of >or= 7 alcoholic beverages per week, and current smoking were all positively related to risk of contralateral breast cancer (odds ratio [OR], 1.4; 95% CI, 1.0 to 2.1; OR, 1.9; 95% CI, 1.1 to 3.2; and OR, 2.2; 95% CI, 1.2 to 4.0, respectively). Compared with women who consumed fewer than seven alcoholic beverages per week and were never or former smokers, women who consumed >or= 7 drinks per week and were current smokers had a 7.2-fold (95% CI, 1.9 to 26.5) elevated risk of contralateral breast cancer. CONCLUSION: Our population-based study adds to the limited available literature and suggests that obesity, smoking, and alcohol consumption influence contralateral breast cancer risk, affording breast cancer survivors three means of potentially reducing this risk.

PMID: 19738113 [PubMed - in process]

Beesie

wallycat, the abstract you pulled is for a different study than the one that cp418 referenced at the start of this thread.  The study you pulled was released in November; this other study was just released last week.  Actually, I'm not sure that it's even been released yet however the findings were presented at the San Antonio BC Symposium last week. The info I pulled relates to this second study.

I always sensed that there seems to be a new study released about alcohol & BC every month.  This proves it!  Why are medical researchers so fixated on this?   With all the research that's done on this, you would think that alcohol alone is the cause of 90% of breast cancers and recurrences!    Yes, alcohol consumption does appear to be a risk factor for breast cancer but all the studies to-date suggest that it is a weak risk factor. While a 34% increase in risk sounds large, in the scheme of things, when compared to other risk factors, it's actually not. Of course, it depends on what other risk factors you have and what your recurrence risk is to begin with.  For example, if someone has a 12% risk of recurrence, a 34% increase will take the risk up to 16%. 

This chart from the Komen site is handy for comparing the relative significance of risk factors:  http://ww5.komen.org/BreastCancer/BreastCancerRiskFactorsTable.html  

And Komen have one of the more practical explanations I've found about the risks associated with alcohol consumption: http://ww5.komen.org/BreastCancer/DrinkingAlcohol.html 

Rather than do yet another study on breast cancer and alcohol, I really wish that the doctors, scientists and medical researchers out there would put as much effort into researching some of the many other very important things that we don't yet know about breast cancer!

ktym

Bessie, I'm so with you, why the fixation on alcohol?  I think the whole exercise, get skinny, don't drink anything but green tea blah blah blah thing runs the risk of back lash.  Control for family risk, reproductive history, and the stress and quality of food related to weight gain etc. how much do some of these modifiable things really change what will happen to us?  Do we know or will the sound bites get repeated, many women made to feel guilty (chemo fatigue--you should have exercised more, hot flashes--you need to exercise more,  lymphedema--you need to weight lift, recurrence--you should have exercised more) and the most important studies never done because we assume we already know the answer. 

wallycat

Thanks...

I'll recheck my work database and see what i can find.

Yes, so many conflicting things.

Ha, funny that exercising daily, having a BMI of 19, being vegetarian/low fat eater, and having no cancer in my family didn't stack my odds for anything

dee1961

Cheers to more beer!

fairy49

one alcoholic drink, increases your circulating estrogen by 400%, which isn't good for ER+ BC.

Kate0574

Well, I happen to think think most of these studies are crap..... if the studies show that there is an increased risk of breast cancer if you drink then why dont they just say that drinking is maybe why I got cancer? I think everyone hears everything, dont drink, dont eat meat, dont do this dont do that... the facts that I have found is that all the women and men in my chemo group in 2007 were all of good weight, healthy, no family history. moderate drinkers.. a glass of wine here or there.  People weigh too much into the studies... like we need anymore stress, just live life to the fullest each day... and have a few.... if it were that bad none of us would be even questioning this and just not drinking......

Thanks for letting me vent....Kate

Gayleebug

Thanks, fairy49.  I still can't find what it means, though, if you are estrogen NEGATIVE like me.  And I love beer.  They can keep the wine or the hard stuff, as far as I'm concerned ....

Gayle

wallycat

Here's another version of this:

http://www.medscape.com/viewarticle/713692 

 I can't find this in pubmed yet...will do some digging at work tomorrow.  I'm curious if they were to look at grade, if that made any difference.

 I've also found a few (done on men of course) that shows there is EMT or some such piece of the puzzle inside cells that alcohol affects, so this could be how alcohol is implicated in cancer rate increase.  I'm curious if this applies to women, and then maybe there are genetic expressions that come into play....

SKIMMINGTHELAKE, I did find a study that shows alcohol also increased recurrence in hormone negative cancers...I'll see if i can post the link tomorrow.

Honestly, I just want to be an ostrich and put my head in the sand about all of this.  Sigh....

fairy49

Estrogen dominance and hormone imbalance, in my opinion is a huge factor in BC, the fact that alcohol increases circulating estrogen dramatically, its definately something to think about.  I totally agree with living life to the fullest and not worrying about every single thing, stress can do more damage in my opinion.  I have been sober for over 10 years, and for me personally, I do believe that my drinking was a big factor in my BC, again just my opinion.

L

ox

Gayleebug

wallycat -- thanks so much ... would appreciate that.  I think I saw one that talked to hormone neg, but they implied negative on the estrogen PLUS overweight/obese led to higher risk with alcohol.  I'm not overweight -- OK, 5-10 lbs? -- so I wasn't sure if those study results would apply to me.

wallycat

Here's a 2008 article that says drinking actually benefits survival ....

http://cebp.aacrjournals.org/content/17/8/1988.full

I'll try to find the negative receptor article again.....

wallycat

Here is a powerpoint/pdf from Kaiser that compares ER+/PR+, ER+/PR- and ER- and alcohol.

One slide discusss how many studies reflect this and which way the trend goes:

www.cbcrp.org/symposium/previous/2005/presentations/Enger.pdf
 

ck55

I am curious if taking Femara which basically eliminates estrogen in your body, would make any difference since it sounds like alcohol's main effect is increasing the circulating estrogen?

Were these studies done before Femara was a common treatment for ER+ cancers?

I like my wine and I am hoping the Femara and taking extra Folate may negate some of the effects of my drinking? 

Cyndi

Beesie

WOOHOO! 

Wallycat, thanks for that presentation. I'm ER+/PR-, postmenopausal and not quite in the 55-64 age category, but close (I'm 53).  So according to the chart on page 20, the best thing for me to do to reduce my BC risk is to have about a 1/2 drink a day (it's better for ER+/PR- than abstaining) and if I want to drink more, I'm better off having 2+ drinks per day rather than just having 1-2.  According to the chart, having 2+ drinks for someone who is ER+/PR- is almost as good as abstaining.  I love it!  I don't care what any other studies say, I'm taking this one to the bank!!  (I'll just ignore the fact that none of those results are statistically significant.)

wallycat

Beesie, LOL!!

I think as a researcher, you know how many studies can be skewed to present your point of view.

In your previous post you made some excellent points, which I am taking to heart.

If there were GLARING proof on any of this, I would not be as flip about including wine with my dinner, but there are no GLARING verdicts...and as I used to tell my patients "if you do something, and years later they figure out it did nothing for you, would be be angry?"...if the answer is yes, don't do it because there are no guarantees.

ktym

Ha ha.  Bessie I'm ER+/PR- too.  Pretty strong conclusions in that study compared to what the charts on 20 and 21 show.  Wally thanks for passing that on. 

Anonymous

I don't drink, but I think I'm going to start.    Anyway, I'm so tired of hearing how "good" we're supposed to be.  Damn...and then die and have NO fun...LOL

Harley44

....Shirley, you are too funny! !  

Erica3681

I've just read through this thread, looking for something that will tell me it's still okay to have a glass of wine with dinner. The recent big study wasn't reassuring. Some of the studies posted here are more hopeful, especially the one about better survival among pre-menopausal women who drank before diagnosis (not that it specifically applies to me). Like Wallycat says, it's pretty easy to skew my reading of the studies in the direction I want them to go.

Before my first diagnosis at age 54 (six years ago, a second primary diagnosed three years ago), I seem to have done everything "wrong"--HRT (estrogen only) after a hysterectomy, 4-5 drinks per week, no folate supplementation. But who knows what effect it had? My doc said (due to the slow-growing nature of my tumor) that the cancer had probably started growing at least a decade earlier, when I hardly drank at all. My mother and grandmother had bc, so even without alcohol, it was in my genes (I'm not BRCA+, though). My two sisters are fine so far. One doesn't drink at all, one hardly ever drinks. My mom and grandmother hardly ever drank and they got bc in their seventies, while I was diagnosed in my fifties. Was it because I had my one drink four or five times a week during the few years prior to my diagnosis? I know you can't make a study out of a sample of one. But you sure can drive yourself crazy!

Blundin2005

Well, I'm 61 y.o.  That means I lived over a span of life styles driven by our socio/economic existence in a small part of the globe.  I refuse to beat myself up for the influences that came my way or the choices that I made.  Perfection is a goal of the human condition, never reached.  

The "breaking news" is helpful but not the be all, end all to life.  I whole heartedly agree that over indulgence in anything is not in our best interests.  I've worked hard my whole life.  Nothing was handed to me on a platter.  That fact alone limited my indulgences in relaxation efforts.  It wasn't possible to work and study with a less than optimum brain.  But when I could, I sought relief like most humans.  That road led me to sports, dancing, reading, writing, laughing, drinking, smoking and searching for a better life in general.  Now I am the sum of all of those decisions and I don't regret one of them.   

Going forward, we've learned through our reading how to treat our bodies well and we do.  We continue to exercise, enjoy nature, read, write, laugh....we quite smoking years ago....we still have wine with our meals but cut out the after dinner drinks on the weekends, and water is always on the table....we eat the same healthy foods that we did all along...we take similar supplements adjusted for inflation (of age)....and we love.

I am so grateful for everyone's posts here to learn from the various perspectives....admittedly my bias is in Beesie's line of thought on many subjects.  One of my favorite tee shirts from years ago that I bought on a business trip to San Francisco was "Life is too short to drink bad wine".  I still adhere to that philosophy.  

My particular cancer profile leads me to believe that the HRT I took to remain functional in my career (that required frequent participation in a board room populated mostly with men--thus stress) was what activated my cancer.  I stopped when I was diagnosed and accepted my aging.  I fully expect that the cumulative affects of my decisions (+/-), over the course of my life will take me to a respectable age when I make my decision to leave this world.  

Actually, I can't think of a single disease that can not be traced to life style...our ancestors or our own.  I really deplore the "health care industry" holding patients accountable (via insurance premiums) in a society that "sells" cigarettes, beer, sex, fear, war, fantasy and every other human condition that can be manipulated by advertising....then demand that we "forget" their participation in our "conditioning" and pay them to punish us.  

Do we need to quit smoking?  Without a doubt.  Do we need to drink less?  Without question.  Do we need to eat healthy?  Obesity kills.  Do we need to better education?  Unequivocally.   Can we do this in a vacuum?  No....just one step at a time.

I'm all over the place on this post....just had to chime in on the topic.  

Best wishes to all as always,

Marilyn 

edited to add this link:  http://www.thedailyshow.com/full-episodes/mon-january-4-2010-michael-pollan 

Sierra

Hi Marilyn:

I am chiming in here as well

being ER-PR- still have red wine

not a lot but with dinner

So far, am 10 years out and very blessed indeed

I also had my share when residing in San Francisco

they have some fine wines out there

HRT, I believe is a contributing factor to BCA

Best to all

Hugs, Sierra

Blundin2005

Ciao Bella Sierra!  

The next glass of red wine I drink I salute you!

I thought I noticed a San Fran accent in your writing!

Hugs back at ya....

Marilyn