New Study Links Alchohol to BC Recurrance

http://www.reutershealth.com/archive/2009/12/10/eline/links/20091210elin018.html

This seems to be latest study...I'm also trying to cut out all the alcohol, which is hard this time of the year but there is more and more evidence of how dangerous it is for bc survivors so...

The study is pre AI's which lower the amount of estrogen in post-menopausal women. Since they feel alcohol increases the circulation of estrogen in the body, I wonder if it's a trade off when you take an AI? Now they'll have to do a study of women who are on AI's and drink.

I'm not Triple Negative but I saw the headline of this thread and thought that I would add some information that might be helpful.  There may be a benefit to quitting alcohol, and there certainly is nothing wrong with doing that, for those who want to do quit.  But many of us don't want to stop enjoying our wine (or other beverages) and as I read it, this study is not quite as definitive as the headlines make it seem and in my opinion, it's not a reason to over-react, particularly if you are not in the high risk groups (as determined by this study).  

Here is a link to another thread with a discussion about this research study:

http://community.breastcancer.org/forum/86/topic/745233?page=1#post_1633831

And if the link doesn't work (as so often happens with links within BC.org; all other links seem to work fine!), here is a copy of what I just posted in that other thread, after spending a few hours on the internet researching and reading about this study:

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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  

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I heard/read something (somewhere, damn chemo fog!) that this may not be accurate for those who have had bi-lat mx?  Did anyone hear that as well?

I had also read about folate.  I try to eat lots of green leafy veggies or broccoli before drinking.  I'll bet my breath smells great.  HAHAHA

Beesie, thanks for taking the time to research and organize the findings. 

- I had no idea about the folate, very interesting. 

Barbe - 

I guess you didn't see the news yesterday . . . evidently BEER is good for prostrate cancer.  God knows Men have it easy!!

Laura 

azdiva, I read the comment that this study doesn't apply to women who've had bilaterals in the other thread on this topic but from what I've read about the study, this is not entirely true.  The study defines "recurrence" as "local, regional, and distant disease, new contralateral breast cancers, and breast cancer death if no previous recurrence was recorded."  Women who've had bilaterals still do have a very small risk of either a local recurrence or a new contralateral breast cancer.  And certainly any woman who's had a bilateral for invasive cancer (this study only looked at those who had invasive cancer, not DCIS) still has a risk of regional and distant disease.  So that would suggest that at least a portion of the risk does still apply to women who've had bilaterals.

PS73, you're welcome!  With regard to folate, I take a multivitamin that includes folic acid and if I'm drinking more than just a glass of wine, I sometimes supplement with 1/2 a folic acid pill (to keep my daily intake below 1000mg).  Most of the news about folate is good; it has a variety of benefits, health-wise, however a recent study suggests that too much folate might actually cause cancer, but it's mostly lung cancer (for which I'm low risk - never smoked in my life and grew up in a non-smoking household) and the increase is quite small. A general overview: http://dietary-supplements.info.nih.gov/factsheets/folate.asp  An article about the recent study: http://www.theglobeandmail.com/life/health/folic-acid-may-increase-cancer-risk-study-shows/article1367188/

Barbe, some believe that chocolate might be good for us.  Chocolate is a flavonoid, and there is some evidence that flavonoids reduce breast cancer risk.  http://www.ncbi.nlm.nih.gov/pubmed/17158855    There is an inconsistency in this information, however, since red wine is also a flavonoid.   While the study in the first article suggests that all flavonoids protect against BC risk, the following study seems to suggest that it is primarily leafy veg flavones that benefit us: http://www.nature.com/bjc/journal/v89/n7/full/6601271a.html  Still, I'm taking the first study to the bank, and I'm continuing to consume chocolate and red wine.  Who knows, it might turn out that these are the right flavonoids after all and maybe I'm significantly reducing my BC risk!

Meggy, I wanted to respond to some of the comments since my last post but I do apologize for taking the thread off track again from the Triple Negative discussion.  Hopefully the discussion focuses back on Triple Negs from this point on.  And if I ever do get hold of the detailed tables and there is anything specific about Triple Negatives, I'll come back and let you know.

Beesie: You're the best! As soon as I saw that study I wanted to delve into it more, and found precious little.  Very frustrating.  I must admit I left it at that because being on day 5 post-AC, I was feeling rather fatigued. Thank you so much for digging up what you did.

Back to the trip neg angle, my understanding is that alcohol may be much less of a risk for us than for ER+ women, because our tumours don't feed on circulating estrogen which is how they think alcohol acts on the body.      

I hate these studies...there are so many other variable...a co-worker of mine is a 6 year out TN..never drank...I drink and I'm a TN...I know several women who have had breast cancer and did not drink..before, during and after..I know women that drank before, during, and after...my oncs have never told me to quit drinking...ever...

I have a group that I hang out with..we ALL drink...2 of us got breast cancer..we all drink about the same...

I just think that if every women that drank got breast cancer.every one we know would have breast cancer...and then how do they explain the women who dont drink that get breast cancer?  Hmmm...I know that this is about recurrence..but whatever....

22 year triple neg. survivor here. Must say I never gave up my 2 glasses of wine a day. One while preparing dinner and one with dinner, that makes 14 glasses a week. I'M STILL STANDING AND LOVE MY WINE. I'm 63 years old, Italian and feel great. We Italians love our wine, you know that Mediteranian diet that contributes to longevity. We can drive ourselves crazy if we listen to every study that's out there. Remember everything in moderation. My grandmother, born in Italy, lived to be 103 and tells us as little children they were forced to drink wine because it was good for the blood and years later that was another theory that was proven to be true. Guess I'm just waiting for the next study that will show wine to be good for women with breast cancer. Most important thing is live your life and be happy. How much better is that glass of wine at night if it is going to give you a little comfort, sure sounds better then stressing over more of those dam studies and statistics....

nonijones-

Thank you for your post.  I don't drink all that much.  Probably a couple of glasses a couple of times a week.  But I tell you, although at 5 years out, my hair is all back, breast cancer took my hair, my hormones and therefore my sex life, decadent food because of low fat diet, not to mention peace of mind.....it really makes me mad to think I can't have a @#*! glass of wine!!!!!!!

Thanks, Shannon

I truly want to do what I can to keep the cancer from coming back. That said, I have cut down on fat intake, exercise daily, increased certain vitamins and cut back on my wine intake. But I can't seem to cut it out all together. I have a very small glass, 1/4 cup about 4 nights a week. I have maybe one beer a week. Then I feel weak. 
My onc. said to cut it out completely, but if I must, keep it at one a day or less. That I can do, but cut it out completel would be very hard for me. Like the previous post, Chemo, thru me into menopause and I've suffered from anxiety since my DX. My minds a wreck and my body looks like I've been in a Ninja sword fight. Until they study this a little more, I'm gonna have to continue to be weak and attempt to enjoy my singular Merlot at night.  

My wife used to have hardly a drink per two months. The cancer came back within a year.