Page last updated: Wednesday, November 19, 2008
Commentary on alcohol and breast cancer
by R.Curtis Ellison MD
The recent paper from the UK (Br J of Cancer 2002;87:1234-1245) is a very well done analysis, and confirms the results we reported in 2001 (Ellison RC, Zhang Y, McLennan C, Rothman KJ. Exploring the relation of alcohol consumption to risk of breast cancer. Am J Epidemiol 2001;154:740-747). In other words, there is probably a very small increase in the risk of breast cancer associated with moderate drinking.

The best estimate in our analyses (based on more recent prospective studies in the US) was that women averaging one typical drink per day (estimated to contain 12 grams of alcohol) had a risk ratio by comparison with non drinkers of 1.06; this means the risk of breast cancer was only 6% higher than that of non-drinkers. In the recent UK study, it appears that women consuming the equivalent on one drink (5-14 grams) per day had a risk of 1.01 (in comparison with a risk of 1.00 for a never drinker) if a "never-smoker," 1.05 if an "ever-smoker," and 1.03 overall. Thus, they estimate an overall increase in risk of only 3% from one drink per day (using the definition of a drink as 5-14 grams/day, which is actually up to almost two drinks by British standards). While this degree of increase is beyond the limits of epidemiologic studies to be very sure about (in that it could still be confounding, and not truly the cause of the increased risk), it has been found so consistently by studies around the world that I think that it is true that there is a very small increase in risk for women who consume even as little as one drink per day.

It is unfortunate that the authors of the UK paper decided in the abstract to ignore the fact that one drink per day hadminimal effect on breast cancer risk and to refer only to the 32% increase in breast cancer risk for women drinking 35-44 g of alcohol per day and the 46% increase for women drinking more. This is much more than anyone recommends, and applies only to a very small percentage of the population. Further,it has been shown that adequate intake of thevitamin folate, protects women against any increase in breast cancer risk from moderate drinking (Zhang S, Hunter DJ, Hankinson SE, Giovannucci EL, Rosner BA, Colditz GA, Speizer FE, Willett WC. A prospective study of folate intake and the risk of breast cancer. JAMA 1999;281:1632-1637).

As I have stated (Ellison RC. Balancing the risks and benefits of moderate drinking. Ann N Y Acad Sci 2002;957:1-7) - as have others, women should remember that the protective effects of alcohol on cardiovascular disease (heart attack and stroke) are very large, and that cardiovascular disease is associated with ten times the number of deaths among women as breast cancer, because ofsuch protection, women who are light-to-moderate drinkers tend to live longer than non-drinkers.

R. Curtis Ellison, MD Professor of Medicine & Public Health Boston University School of Medicine 715 Albany Street, Room B-612 Boston, MA 02118 Tel. (617) 638-8080; Fax. (617) 638-8076

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