Monday, April 14, 2008

Breast Cancer Risk & Alcohol: Isn’t Red Wine (in moderation) Good for You?

We’ve all read the articles in the newspaper. Moderate consumption of red wine is good for you. It lowers the risk of heart disease, and helps you live longer.

Doesn’t it?

A report from this week’s meeting of the American Association for Cancer Research questions that. Yesterday, Dr. Jasmine Lew presented the results of a study of 184,000 women in the US looking at the relationship between alcohol consumption and breast cancer. What they found may surprise you.

Dr. Lew’s group from the National Cancer Institute found that post-menopausal women who drank an average of 1-2 drinks a day were 32% more likely to develop hormone-sensitive breast cancer. Women who averaged 3 or more drinks a day were 51% more likely than nondrinkers to develop hormone-sensitive breast cancer.

So does that mean women should stop drinking? Not so fast…

An article written by Dr. James O’Keefe in the Journal of the American College of Cardiology last year reviewed the literature on health effects of alcohol. They reported on associations between alcohol consumption and a variety of conditions, including myocardial infarction (heart attack) in middle aged men, stroke, and the risk of type II diabetes. Their report shows that small amounts of daily alcohol consumption improves many health outcomes, while large intake makes them worse (see graph).

From O'Keefe et al., 2007.

In a related study published in The American Journal of Clinical Nutrition in 2007, Dr. Pamela Mink and her colleagues reported results from the Iowa Women’s Health Study. Study participants were 34,489 postmenopausal women who were free of cardiovascular disease. They found an inverse relationship between dietary flavonoids and coronary heart disease, cardiovascular disease, and total mortality. Flavonoids are chemicals found in fruits, vegetables, and red wine that act as antioxidants. Because flavonoids in the diet can come from several sources, these doctors looked at the relationship between consumption of various specific foods and health outcomes, and found that red wine specifically was associated with decreased mortality from coronary heart disease and cardiovascular disease.

A major weakness of all of these studies is that they are population-based comparisons, meaning that they show a correlation between wine consumption and a particular disease process, but cannot prove a causal relationship. So we assume that because red wine is correlated with decreased heart disease, the red wine causes the drinker to have less heart disease. But maybe it’s not the wine, maybe it’s alcohol. Maybe it’s the cheese that gets eaten with the wine. Maybe it’s truffles in the sauce on the red meat that goes so well with the cabernet sauvignon. Studies like these just can’t tell.

So what’s a woman to do? There is no easy answer. Like all medical decisions, the reality is more complex than the headlines. Maybe if you have a strong family history of breast cancer but have no relatives with heart disease, abstinence from wine would be beneficial. Maybe if you had your first heart attack at 35 and don’t know anyone with breast cancer, a glass of red wine a day might not be a bad idea. For most women, however, the answer is unclear. So if you drink moderately, I’m not sure the report from the AACR meeting is a valid reason to stop. However, if breast cancer runs in your family, it certainly should prompt you to discuss your alcohol consumption with your doctor.


Anonymous said...

Has any research been done on drinking alcohol when your cancer is in remission?

outre said...

I can't imagine how confusing all this stuff would be for a lay person... 'cause I get confused. I rarely deal with diet/nutrition stuff tho.

I'm in the thinking of eat whatever you want in moderation, be merry. Yum. There's syrah and truffle cheese at home I could indulge in. Though I have taste loss so I'm not even sure I'll be able to enjoy it. (I'll just sniff the cheese..)

Maybe we should just eat fermented berries/fruits (instead of man-made alcohols) like the birds that cleaned up my parents deck covered in fermented mulberries...

Doctor David said...

I'm not sure if anyone has looked at effects of alcohol during remission. Interesting question!

Outre... are you inviting me over? I'd LOVE some syrah tonight. And since I'm unlikely to get breast cancer.... :)

Anonymous said...

Studies certainly do only research pieces, don't they? I think organic wine is always a better choice. I really thinkg sulfites are harmful. It always boils down to the way the processing and additives, doesn't it seem?

Organic wines are tastier, honestly.

Anonymous said...

Wow, looks like I was drinking with that typo thinkg???

Well, I just might, since Dr. David is going to outre's and all.

Sudipta Das said...

Hello David
on this issue I am fully agree with you. but If we want to combat against a dreadful disease like

cancer we need a comprehensive knowledge of the

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that can lead to the

infliction of the disease which would help us to nullify

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Doctor David said...

Kathleen, once you sober up, you're welcome to join me at outre's party! ;)

Sudipta, thank you for the kind words.

outre said...

Yeah! Party at my house!

Anonymous said...

(Psst...FYI, she's still a medical student!)

Hyperchondriac said...

we are looking into survivorship. but that's a relatively new area of research since the increase in survivorship from cancer is recent as well. as such, cohort studies are rare and hard to come by. hopefully we'll get the data we need. soon.

Anonymous said...

Dang... admitting menopause is bad enough, now they want to take away my occasional glass of red wine?!

Doctor David said...

Ben, thanks for pointing out my mistake. I'm just anticipating her graduation. Of course, it points out how even in medical school, people can do fabulous research and make a real difference. She should be an inspiration to people who take the time to do research during med school.

Hyperchondriac... do I understand correctly that you are involved in gathering data on how alcohol consumption impacts the remission of women with treated breast cancer? That truly would be great data to have, and would answer the question raised by the anonymous commenter.

Anonymous said...

Alcohol consumption with an increased risk of breast cancer has been linked by researchers at the University at Buffalo to a process that causes genes that promote normal cell growth to produce proteins that precipitate unregulated cell growth, an action known as hypermethylation.Women who drank three or more alcoholic beverages a day increased their risk of breast cancer by 30 percent.
Alcohol Rehab

Unknown said...

It's that time again! The seventh Cancer Research Blog Carnival has been posted on Highlight HEALTH. There are some wonderful articles this time around, including discussions of the ethics of science, cancer genetics, and things that increase your risk for developing cancer (obesity and working the night shift, for example). All in all, a great group of articles that I'm sure you'll enjoy.


Alcoholism Information-Alcoholism Information

Anonymous said...

Excessive consumption of alcohol can lead to many diseases like cancer, lung problems, heart failure, and many more. That is why moderation in drinking alcohol should always be observed, in order to live a healthy life.

Prostate Cancer said...

I think as with everything else, there should be moderation. If you take it in small amounts then you lessen the risk while still being able to benefit from it. On the other hand, if you take too much, then you should really expect to get the harsh effects of alcohol.

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Unknown said...

You are absolutely right that women should stop drinking. Addicts are unable to know that How long does alcohol stay in your system if they will know that then will surely start avoiding it.

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