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Update on wine and breast cancer

With breast cancer awareness month upon us again, it’s fair to ask what we have learned about prevention and treatment, and for wine drinkers, it remains a confusing picture. It’s clear that heavy alcohol consumption increases risk, not so certain whether moderation – especially wine – is all that bad; it might even be good. On one hand, the message from the medical community is unambiguous: any level of drinking increases the odds of developing breast cancer. On the other hand, at moderate levels of drinking, cancer risk is extremely difficult to measure with confidence, even more so with wine. Here’s why I think a daily glass or two of red wine with dinner is still a healthy choice:
  •   A recent study from the University of California San Diego[1] looked at survival and recurrence after breast cancer treatment, finding that light drinking had no correlation. Moderate alcohol intake was “protective against all-cause mortality” in non-obese women.
  •   There appears to be no breast cancer risk of drinking in premenopausal women, according to a very large European study involving more than 66,000 women followed for 15 years.[2] In postmenopausal women, the risk became clear at more than 2 drinks per day, but as with other studies this was seen mostly in overweight subjects.


How red wine might protect against breast cancer

  •     In order to confirm a possible correlation between alcohol and breast cancer, a plausible cause-effect relationship needs to be demonstrated. The prevailing idea is that alcohol elevates estrogen levels via enzymes called aromatases. Aromatase inhibitors (AIs) are commonly prescribed for prevention of cancer recurrence, and interestingly red wine contains natural AIs. A clever study[3] from the Women’s Heart Center at Cedars Sinai in Los Angeles tested the idea that wine could be an anti-cancer agent by assigning women to have an 8-oz glass of either red or white wine daily for a month, while monitoring hormone levels. The two groups then switched from red to white or vice-versa. The researchers concluded that red wine is a natural AI in premenopausal women, providing an explanation for its possible protective effect. The strength of this particular study is that drinking was carefully measured and consistent, rather than reliance on self-reported questionnaires.


  •               This pattern of regular, moderate, exclusive consumption of red wine is unfortunately not typical in modern society, making it increasingly difficult to suss out from population studies whether their risk profile is distinct. The best evidence is still from a 2008 study in southern France, with a population of consistent wine drinkers.[4] There was a clear J-shaped curve, with an unequivocal benefit to moderate drinking. It was the nondrinkers most likely to get breast cancer.
   

Why we should make the pink ribbons red

We would do well to remember that despite all the fear and publicity around breast cancer, heart disease remains far and away the biggest threat to women’s health. Even if there was a risk of breast cancer from wine – a debatable supposition – it is almost certainly cancelled out from the benefits to heart health. Let’s make the pink ribbons red.



[1]Low to moderate alcohol intake is not associated with increased mortality after breast cancer.
Flatt SW1, Thomson CA, Gold EB, Natarajan L, Rock CL, Al-Delaimy WK, Patterson RE, Saquib N, Caan BJ, Pierce JP. Cancer Epidemiol Biomarkers Prev. 2010 Mar;19(3):681-8.
[2] Alcohol consumption and breast cancer risk subtypes in the E3N-EPIC cohort.
Fagherazzi G1, Vilier A, Boutron-Ruault MC, Mesrine S, Clavel-Chapelon F. Eur J Cancer Prev. 2015 May;24(3):209-14.
[3] Red versus white wine as a nutritional aromatase inhibitor in premenopausal women: a pilot study.
Shufelt C1, Merz CN, Yang Y, Kirschner J, Polk D, Stanczyk F, Paul-Labrador M, Braunstein GD. J Womens Health (Larchmt). 2012 Mar;21(3):281-4.
[4] Patterns of alcohol (especially wine) consumption and breast cancer risk: a case-control study among a population in Southern France.
Bessaoud F1, Daurès JP. Ann Epidemiol. 2008 Jun;18(6):467-75.
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