Alcohol & Breast Cancer
I have a history of breast cancer. I’ve heard it’s OK to drink up to one glass of wine per day. Recently, I read that women concerned about breast cancer should have no more than two drinks per week. My doctor just told me to eliminate it entirely. Who’s right?
The conflicting information on alcohol arises from the fact that alcohol can be protective against some health conditions, but has been linked with increasing risk of other diseases. For example, up to one drink per day for women, or two per day for men, may lower the risk of heart disease. When it comes to breast cancer, however, the relationship between alcohol consumption and risk isn't totally clear.
Drinking alcohol increases estrogen levels in the body. Some health experts believe that through this pathway, alcohol may increase the risk of estrogen sensitive cancers. This includes estrogen receptor positive (ER-positive) breast cancer, the most common type of breast cancer. Beyond the estrogen connection, alcohol itself is believed to be carcinogenic, or cancer-causing."
This applies to wine, beer, and hard liquor. It is the alcohol that matters, not the form of alcohol you drink.
For breast cancer survivors, some early studies suggested, at least for ER positive breast cancer, risk of recurrence may increase when a woman has more than one or two drinks per week. This is far below the standard health recommendation that women consume no more than one drink per day.
Also, keep in mind that one drink may be smaller than most people realize. A single drink is five ounces of wine, 12 ounces of beer, or 1½ ounces of hard liquor. A typical large glass of wine often contains eight, or even 10 ounces, which is two servings.
Before you decide you should give up alcohol, it is useful to note that some recent research has suggested moderate alcohol consumption actually improves survival after a breast cancer diagnosis. Considering this along with the earlier studies, we end up with a somewhat confusing picture. This is because all of these studies are what we call "observational," which means none of them can, by themselves, prove cause and effect. However, it can be helpful to consider all of the studies together. When we do this, we don't see a strong pattern one way or the other. That is, some studies show alcohol slightly increases risk of breast cancer recurrence, while others show it decreases risk. This suggests that if there is an effect of alcohol, it is probably very small, regardless of whether it is protective or harmful. And if alcohol does turn out to increase risk of recurrence after breast cancer, the studies suggest the effect is likely to be strongest for overweight and obese women.
If you have a history of breast cancer, are at high risk of developing breast cancer due to genetic or other factors, or you are significantly overweight, you might consider saving alcohol for special occasions, or enjoying it once per week with a nice dinner. If completely avoiding alcohol is not difficult for you, you may decide it's easiest to simply avoid it. And whatever you decide, be sure to discuss it with your doctor or dietitian if you have additional questions or concerns
But don’t focus only on alcohol. Regular exercise combined with eating at least five servings of vegetables and fruit per day have been shown to lower breast cancer recurrence risk. Health care providers rarely tell a woman that she’s increasing her risk of recurrence by not exercising or not eating enough vegetables and fruit, but they don’t hesitate to tell a woman alcohol is off-limits. I think it’s important to keep this in perspective.
Submitted by Suzanne Dixon, MPH, MS, RD, on behalf of the ON DPG
- Newcomb PA, Kampman E, Trentham-Dietz A, Egan KM, Titus LJ, Baron JA, Hampton JM, Passarelli MN, Willett WC. Alcohol consumption before and after breast cancer diagnosis: associations with survival from breast cancer, cardiovascular disease, and other causes. J Clin Oncol. 2013;31(16):1939-46.
- Weaver AM, McCann SE, Nie J, Edge SB, Nochajski TH, Russell M, Trevisan M, Freudenheim JL. Alcohol intake over the life course and breast cancer survival in Western New York exposures and breast cancer (WEB) study: quantity and intensity of intake. Breast Cancer Res Treat. 2013;139(1):245-53.
- Kwan ML, Chen WY, Flatt SW, Weltzien EK, Nechuta SJ, Poole EM, Holmes MD, Patterson RE, Shu XO, Pierce JP, Caan BJ. Postdiagnosis alcohol consumption and breast cancer prognosis in the after breast cancer pooling project. Cancer Epidemiol Biomarkers Prev. 2013;22(1):32-41.
- Harris HR, Bergkvist L, Wolk A. Alcohol intake and mortality among women with invasive breast cancer. Br J Cancer. 2012;106(3):592-5.
- Kwan ML, Kushi LH, Weltzien E, Tam EK, Castillo A, Sweeney C, Caan BJ. Alcohol consumption and breast cancer recurrence and survival among women with early-stage breast cancer: the life after cancer epidemiology study. J Clin Oncol. 2010;28(29):4410-6.
- Horn-Ross PL, Canchola AJ, West DW, Stewart SL, Bernstein L, Deapen D, Pinder R, Ross RK, Anton-Culver H, Peel D, Ziogas A, Reynolds P, Wright W. Patterns of alcohol consumption and breast cancer risk in the California Teachers Study cohort. Cancer Epidemiol Biomarkers Prev. 2004;13(3):405-11.
Page Updated: July 2013