Monday, December 5, 2011

Alcohol: Wine Not? Part Deux




You may want to rethink that extra glass of Pinot Noir tonight.  This study just in from Boston in the November 2011 issue of JAMA (that’s the Journal of the American Medical Association in case you didn’t know).  I hate to be the bearer of bad news.  I am certainly not a Debbie Downer- you know, the guy who brings to everyone’s attention in a loud voice at the birthday party that the potato wedge drenched in butter your Aunt Molly is consuming is slowly contributing to her clogged coronary arteries, which will likely ultimately lead to a heart attack.  Waaaaaa Waaaaaaaaaaaaa.  I actually cannot stand that guy.  But that aside, this is relevant, evidence based scientific research and it’s hot off the press.  Also, when I shared my previous entry, “Alcohol: Wine Not?” where I discuss the potential health benefits as well as the negative effects of alcohol, this study had not yet been published, so I feel it is my responsibility to bring this topic to your attention.  I will be brief.

The researchers in this study basically set out to determine the association between moderate alcohol consumption, patterns of drinking and the risk of breast cancer.  This was a prospective observational study meaning that information is collected from a group of people who are followed over several years.  And in this case it was over 100,000 women from 1980 to 2008 with an early alcohol assessment and 8 follow-ups. 
The results of this study demonstrated that the risk of breast cancer was modestly increased among women who consumed alcohol.  And these results had statistical significance even at levels as low as 3 to 6 drinks per week.  Prior studies have shown increases in breast cancer risk related to alcohol consumption.  What makes this study different and stronger is the large number of subjects involved.   It is interesting to note that frequency of consumption was not found to be a key factor in the association of breast cancer risk as it relates to alcohol consumption.  The intake of alcohol both early and late in adult life was independently associated with breast cancer risk. 


Bottom line: alcohol consumption in low levels was associated with a small increase in risk of breast cancer AND the most consistent measure was cumulative alcohol intake during adult life.   


The study is not all bad news- sorry Debbie Downer; there is light at the end of the tunnel!  According to the study, by drinking less in a consistent manner over time, women can decrease their risk of breast cancer at any point in their lives.     
Thought I would just briefly state that alcohol can potentially lead to increased breast cancer risk by both increasing estrogen levels and by its’ deleterious hepatic effects leading to the liver’s compromised ability to rid the body of carcinogens (cancer-causing agents). 
However, alcohol undoubtedly has potential positive effects as I previously discussed.  Most important of which is the association between moderate alcohol consumption and decreased risk of cardiovascular disease.
And, let’s not forget to take into account the other important factors that play a critical role in breast cancer risk such as gender, age, genetics, family history, race, menstrual periods, previous chest radiation, diet, physical activity, tobacco use, and the list continues.  When assessing the relation between alcohol consumption and breast cancer risk, all of these factors and more need to be taken into consideration.
So, what to do?  On the one hand, you are being told small to moderate amounts of alcohol intake are protective against heart disease.  I haven’t even talked about the research that shows its’ protective effect against dementia and diabetes.  On the other hand, you are being told the same small to moderate amounts of alcohol intake that can be so beneficial can also slightly increase breast cancer risk. 
Not an easy predicament.  Everyone is markedly different with respect to how they metabolize alcohol, genetic make up, family and personal history, environment etc. etc. etc.  What may be best for you may not be best for your friend or relative.  The advice I would give to my patient with a strong family history of breast cancer and a history of chest radiation for Hodgkin's lymphoma is very different from the advice I would give to my patient with high blood pressure and cholesterol who suffered a heart attack a few years ago.  The best thing you can do is to empower yourself with the knowledge these researchers provide to make the most educated and thoughtful personal decision (with the help of your health care provider of course) about how much alcohol you should consume.  


PS- Here is a direct link to the original article from JAMA

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