On Alcohol and Breast Cancer, Guilt, Correlations, Fun, Moderation, Doctors’ Habits, Advice and Herbal Tea
Few BC news items irk some women I know more than those linking alcohol consumption to the Disease. Joy-draining results like those reported this week serve up a double-whammy of guilt: first – that you might have developed cancer because you drank a bit, or a lot, or however much defines more than you should have imbibed; and second – now that you’ve had BC, the results dictate, or suggest at least, it’s best not to drink alcohol.
The problem is this: If you’ve had BC and might enjoy a glass of wine, or a margarita or two at a party, or a glass of whiskey, straight, at a bar, or after work with colleagues, or when you’re alone with your cat, for example, you might end up feeling really bad about it – worse than if you had only to worry about the usual stuff like liver disease and brain damage, or if you could simply experience pleasure like others, as they choose.
The newly-published correlative data, in the Nov 2 issue of JAMA, are clear. The findings, an offshoot of the Nurses’ Health Study, involve over 105,000 women monitored from 1980 until 2008. The bottom line is that even low levels of alcohol consumption, the equivalent to 3-6 drinks per week, are associated with a statistically significant but slight increase in breast cancer incidence. And the more a woman drinks, the more likely she is to develop breast cancer.
All things considered, it might be true that alcohol is a breast carcinogen, as Dr. Steven Narod calls it in the editorial accompanying the research study. Still, there’s no proof of cause and effect: Other factors, like consuming lots of food or perhaps some yet-unidentified particularity about living in communities with abundant food and alcohol, are potential co-variables in this story. But what if it is true?
From the editorial:
These findings raise an important clinical question: should postmenopausal women stop drinking to reduce their risk of breast cancer? For some women the increase in risk of breast cancer may be considered substantial enough that cessation would seem prudent. However, there are no data to provide assurance that giving up alcohol will reduce breast cancer risk.
How I see it is this: Everything’s best in moderation, including enjoyment of one’s life. You work, you rest, you have some fun.
This evidence is not like the strong data linking cigarettes to smoking that officials sat on for a few decades under the influence of the tobacco industry. This is a plausible, mild, and at this point well-documented correlation.
I don’t deny the sometimes harmful effects of alcohol; no sane physician or educated person could. But if you have a glass of wine, or even a second, so long as you don’t drive a car or work while affected, I don’t see it as anyone’s business but your own. More generally, I worry about how much judging there is by people who behave imperfectly, and how that can make individuals who are good people in most ways feel like they don’t deserve to be happy or enjoy their lives.
Women, in my experience, are generally more vulnerable to the put-downs of others. And so my concern about the BC-alcohol link is that this will, somehow, be used, or have the effect of, making survivors or thrivers or women who haven’t even had breast cancer feel like they’re doing the wrong thing if they go to a party and have a drink. And then they’ll feel badly about themselves.
Really I’m not sure what more to say on this loaded topic, except that it points to the deeper and broader ethical dilemma of doctors who are not all perfect examples of moderation, expecting and asking other people to change their personal habits when they themselves like to go out and have fun, and drink, at parties, or have wine in the evenings over dinner in the privacy of their homes.
How shall I resolve this post?
Last night I sipped Sleepytime tea, manufactured by Celestial Seasonings, before reading a book. The stuff is said to be 100% natural, with “a soothing blend of chamomile, spearmint and lemongrass.” I tried it first a few weeks ago and, by a placebo effect or through real chemistry, it helps me sleep more soundly.
I’ve absolutely no idea what are the effects of “Sleepytime tea” on breast cancer. It might help, it might hurt, or it might do nothing at all.
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I didn’t hear this latest development as something women should feel guilty about or to beat themselves up with. I haven’t read the study or editorial yet, or any newspaper coverage, and I’ll want to look at all of them. Instead I heard the coverage of ABC-News and an interesting comment by Otis Brawley, MD., that the evidence about alcohol and breast cancer isn’t as compelling as its POSITIVE effect on heart health.
But what I heard was that even in moderate amounts alcohol exhibits an estrogenic activity. So does that mean alcohol consumption is only an issue for hormone-sensitive breast cancers? More of this information needs to be teased out. Does it mean that it increases the risk by 15% in and of itself? What about a woman, for example, who hasn’t had children, started menstruating early, and had some aunts with breast cancer — for someone with those existing risk factors does is even moderate drinking the factor that might tip the balance?
As it is right now, without perspective to all the other factors, I think it is simply more information. More evidence. But not as strong as a guideline. And yes, it is something more for women to consider, along with adding exercise and eliminating fat from the diet.
You know, it’s a good discussion. I’m glad you wrote about it. In the interim: moderation is everything.
Thanks for writing in. The story was covered extensively in the NYT, WashPo, LATimes, CNN…My sense is that some of the doctors interviewed mentioned the upside, in terms of heart disease, as a way of providing balance. That’s fair enough and a good interview strategy but, at some level, it may be a way of avoiding the issue or seeming judgmental.
The language in JAMA was strong, calling alcohol a carcinogen. The reason why this story may hold, unlike some others in the news about BC, is there are no contradictory data of which I’m aware, and this comes from the NHS, a well-organized, large database of women. And finding a dose-response makes the data more likely to be true.
I’ve seen friends of mine – wives and sisters of physicians, among others, who’ve been more or less reprimanded for drinking wine in the context of a personal or family BC history. This is why I raise the issue.
Interesting how this same, very sane, philosophy of encouraging moderation is not applied to tobacco use. In particular occasional cigar smoking, which has little or no association with negative health outcomes, gets painted with the same “tobacco is deadly” message that cigarette smoking has earned.