The news constantly bombards us with headlines announcing yet another thing that may increase cancer risk. From pesticides to cigarettes, burnt toast to nitrates, the list goes on and on.
Yet one carcinogen is rarely spoken of, and this carcinogen is far more potent than charred food. The carcinogen in question is alcohol. Research suggests that 15% of breast cancer deaths in the United States are attributable to alcohol consumption.1 The exact mechanism of oncogenesis is still unknown,2 but the data speaks for itself. For Breast Cancer Awareness Month, take a moment to learn about one of the deadliest risk factors of all.
Compared to women who do not drink, women who have three alcoholic drinks a week have a 15% higher risk of getting breast cancer. Studies have shown that that for each additional daily drink, a woman’s risk of breast cancer goes up another 10%.3 The risk applies to youth as well. For girls ages 9 to 15, consuming three to five drinks a week triples their risk of developing benign breast lumps. Although these lumps are benign, they are not innocuous. Certain kinds of benign breast lumps increase a young woman’s chance of breast cancer later in life.4 Tellingly, breast cancer rates are extraordinarily low in Utah,5 where alcohol consumption is much lower than the American average.6
There is little research on alcohol and breast cancer recurrence, but the research that does exist paints a grim picture. Even consuming as few as 3-4 drinks a week increases the chances of breast cancer recurrence in women who were diagnosed with early-stage breast cancer.7
So as a practitioner, what is to be done? Conversations with patients are essential. Most healthcare providers wouldn’t hesitate to ask a patient about cigarette smoking, or counsel them on the risks of smoking. The same philosophy should apply to alcohol usage. Ask your patients about alcohol, and remember, no age is too early to begin the conversation. Don’t write off a patient’s alcohol use as harmless “social drinking”— a lot of unhealthy habits can fit under the umbrella of “social drinking.”
For women concerned about their breast cancer risk, make sure they understand exactly what is at stake. Consider the BRCA1 and BRCA2 mutations, which are well known to raise a woman's risk of breast cancer. Collectively, 5-10% of breast cancer diagnoses are linked to a
BRCA mutation.8 Now compare that to data on alcohol. Remember, 15% of breast cancer deaths are attributable to alcohol. If your patient is curious about her breast cancer risk, alcohol needs to be as much a part of the conversation as BRCA.
Of course, in today’s world, complete abstinence from alcohol may seem like a huge undertaking. But every drink not poured helps. Harm reduction is key here. Data suggests women should limit alcohol use to two drinks a week.9 Make sure your patients are aware of this. Remind patients who drink socially that they can still have a good time and see family and friends without alcohol. Suggest that patients make delicious virgin cocktails, or learn to appreciate the many non-alcoholic beer, wine, and champagne products on the market.
The silver lining on this dark cloud is that unlike many factors that increase a woman’s risk of breast cancer, her alcohol consumption is entirely within her control. Your patient cannot choose whether she has inherited a BRCA mutation, whether she began menstruating before the age of 12, or whether she started menopause after the age of 55. She cannot alter the level of dense connective tissue in her breasts, or prevent herself from aging.10 But she can make choices around her use of alcohol. For a woman worried about breast cancer, this is wonderful news.