Hi, in another post a couple of people wanted to know what meta study my son had read when he advised me that because of my weight,age,and other factors I might as well carry on drinking. I cannot find that thread, so i have started a new one
today he told me it was an original report published in THE JOURNAL OF CLINICAL ONCOLOGY VOLUME 28, NUMBER 29, OCTOBER 10 2010
‘Alcohol Consumption and Breast Cancer Recurrence and
Survival Among Women With Early-Stage Breast Cancer:
The Life After Cancer Epidemiology Study
Marilyn L. Kwan, Lawrence H. Kushi, Erin Weltzien, Emily K. Tam, Adrienne Castillo, Carol Sweeney, and Bette J. Caan’
He went through all the tables and figures with a fine toothcombe took a view on what the finding meant for me. He is a probabalist working in cancer research. Obviously the findings are different for women in different age groups, habits, etc. And everyone has to make their own decision, but I thought i would post this answer to those that had said they were unable to find a meta study on alcohol and re-occurance
I am surprised at your son’s conclusion given that post menopausal were at greater risk of recurrance (as well as overweight/obese women). However, I can’t access the full article only the abstract.
What was interesting to me was that as little as 3 or 4 alcoholic drinks per week increased risk. I’m no good at stats so if anyone can say how much risk is involved I’d be interested.
Elinda x
that is only the abstract, and even then it only says MAY increase risk, not will, and it touches on what he told me. amongst post menopausal, normal size women in the sample, more non drinkers died of heart problems and other illnesses than drinkers, and this cancellout the cancer re-occurance.
he also said the risk of reocurrance in my group was very very small wether you drank or not, so the percentages might look significant, but they are percentages of very small numbers, which are therefore very small.
However I can see that some people would say no risk, no matter how small is worth taking. I did not post this to change anyones mind, just to answer the question, where did he get his data.
He looked at the full report not the extract. The British Medical Journal did a study comparing a selection of extracts on results on drug research (not cancer, all drugs) used by GP’s when they have not time to read the full report. I cannot remember what percenage were innacurate, but it was surprisingly high and quite shocking.
It was me that queried whether there was a meta analysis on alcohol and recurrence - meta analysis in stats is commonly understood to mean an analysis combining several studies to form some sort of average conclusion. The results are often plotted on a graph to determine if any of the studies are outliers. In actual fact, this is the same study I referred to in our discussion! With Elinda, I’m a little surprised at your son’s conclusion. It finds that just 3 drinks a week raises the risk for recurrence by 35% and mortality by 51%. This study may well be an outlier (5% chance of this being the case), but those stats are pretty stark.
It may well be that the internal analysis shows that your weight reduces your risk from 35% - but does it also analyse much higher levels of consumption?
Elinda - re the stats - when it says HR 1.35 it means the Hazard Ratio is 1.35, ie the risk is raised by 35%. So if the risk of recurrence for non-drinkers is, for instance 50% (it isn’t - that is just to make the calculations easier for me to do in my head), the rate for drinkers would be 50% x 1.35 = 67.5%. The CI figure is the Confidence Interval, which is a measure of the accuracy of the findings. The standard for good research is 95%, as it is in this case - it means essentially if you repeated the research 100 times, you would replicate the results 95 times.
I wouldn’t focus too much on the word “may” - all research is couched in similarly cautious terms - you won’t find any reputable research that says “will”. It’s researchspeak!
Elinda - sorry, forgot to give you the other stats. The increased risk for post-menopausal women is 51% and overweight women 60% - I don’t know what it means if you are both! What I can’t get from the abstract is the baseline this is measured against, which is very frustrating.
Hi oldandlumpy,
Thanks for this and for getting back to us on your sons findings re alcohol and re-occurance of cancer,its so interesting to get an independant view from someone who works in cancer research and is qualified in interpretating the different studies.
Its a shame we are not able to get access to the full text but i noticed a footnote at the end of the abstract which i found very interesting too,not sure if this is what your son was refering to?
“Their decision is the same as that facing women without breast cancer; the answer is not a clear-cut yes or no. Moderate consumption of alcohol is likely to increase a woman’s risk of dying as a result of breast cancer while decreasing her risk of dying as a result of heart disease. Whether to consume alcohol is an individual decision and is dependent on each woman’s evaluation of and comfort level with those risks.”
As ive always been tee-total any Alcohol link and reocurrence doesnt realy apply to me,but because of this does this mean i will now have an increased risk of dying as a result of heart disease?,looks like we cant win either way!
Linda x
Does this mean that overweight women have a 60% chance of recurrence?Surely not-if so why did my onc give me an 85% chance of 10 year survival-I was[not now]very overweight,definitely post menopausal and had tnbc.I was told that older women had better all round survival figures than younger ones.
No Horace, it’s relative risk. It means all other things being equal an overweight woman that drinks 3 or more units a week will have a 60% higher risk of recurrence than a non-drinker. So if the risk for a non-drinker is 10%, the risk for a drinker will be 16%.
Linda - small amounts of alcohol consumption, particularly red wine, have a protective effect against heart disease. So light drinkers do better than non-drinkers, who both do waaayy better than heavy drinkers. Hope that helps.
well i dont think he was refering to the comment, but that he drew similar conclusions from the tables. he also commented on how they got the figures for how much people drank–thay asked them to remember what they had drunk during the previous years, they did make some comment in the report of the validity of this.
I cannot remember exactly what he said, but he said something like the risk of either dying of breast cancer, heart desease or other deseases (i am sure he said bowel cancer) once you have had primary breat cancer is quite small. The increase risk wether you drink or not of this happening dependant on drinking looks to be a high percentage, but its a percentage of a small figure.
So yes I think you are right, even though the increase risk is tiny the fact that you are TT means you have a higher risk of dying of heart desease according to this study.
My son commented that our family and friends social life centres around alcohol. If i had not been a drinker i would probably have not married my husband, had the same kids, become a drummer. wether or not i then got breast cancer is a debatable point. So he asked–if you could have gone back and done it again would you have been a drinker.
At the end of the day none of us know what caused/contributed to our cancers,the only reason i dont drink is because i dont realy like the taste (not boreing realy lol)but if i wanted to drink i would.
Its all about “Risk” not causation , if i get in a car i have a risk of dying in a car accident,if i walk accross the road i have a risk of being hit by a bus,(it happens) if i transport myself off to a dessert island and wrap myself up in a cocoon and live my life beautifully i have a risk of dying a lonely old woman with NO LIFE!
Life is for living so i never have any past regrets, and i certainly wouldnt have changed a single thing ,after BC i just intend to enjoy every single minute.
Hi Everyone
OAL – thanks for getting your son to go over this for us and without reading the whole paper it is not really possible for us to second guess his conclusions.
Having said that, and without trying to be controversial, some things that have occurred to me are:
The women in this study were diagnosed with cancer between 1997 – 2000, 11 years ago. What was their original diagnosis and treatment? Cancer Research UK states that treatment and survival rates for newly diagnosed bc ladies is much improved with post meno ladies between 50-69 with the most improved chances of survival – therefore are these figures still accurate?
Alcohol is believed to raise oestrogen levels (which feeds the cancer) and on the other thread were this was originally raised there was another link to research (sorry can’t find it now) that suggested only ER+ lobular cancers were statistically affected by alcohol. Did all the women who subsequently died have ER+ lobular cancer? If you did not have lobular cancer do these figures apply?
It does not appear that any other risk factors were taken into account. Assuming that all the women were ER+, did they adjust their diets or lifestyle in any other way post bc to reduce oestrogen levels? If not, how can we be sure that it was not these other factors that caused the recurrence or at least played a part?
There are several types of breast cancer and one of the things I have a problem with is that all the research seems to lump everything together. They do make the distinction with diagnosis and treatment but until they do the same with the stats it seems to me that what might be relevant for one person may not be for another.
I think it is a case of all things in moderation and well being is important too - if having a drink with friends and family is what makes you happy then go for it none of us knows what is round the corner. My faher was told in his late forties that if he didn’t give up smoking and drinking he would die within five years. His answer was I would rather die enjoying myself. He gave up neither and lived for another 35 years. It is just risk factors and each individual has to weigh up what it means to them and make an informed decision.
Hi Old and Lumpy
Thanks very much for this info
I am 1 week out of my second mastectomy for a new primary, in just over 2 years.
I must admit drinking is one thing I have not worried about more the 5 cigarettes I smoke daily !
One thing I will say is last time the year of treatment I had sent me to the darkest place and I spent the whole time dying!!
I can’t believe how different I feel this time and sod cancer I have got too much living to do, to worry about the why’s and wherefores and I now have come to the conclusion what will be will be.
I get up each morning have a quick rekkie, think it’s ok I’m still here and get up and go for it, maybe not so much this week with this drain LOL
AND I’ll drink too that!!!
Have a nice day
Mandy x
The women taking part had early stage bc with a very good prognosis anyway - but bear in mind low grade cancers can recur much later than the 7 years that this study covers. In terms of the currentness of the findings - given that most research uses as its endpoint ten year survival statistics, so the newest research would have recruited in 2001, this is pretty current. It doesn’t mention hormone status - although in general if research is limited to one type of cancer only, it would specify that in the abstract. As a large scale study, this is likely to include all hormone status variants, although it is disappointing not to get the breakdown. The article I linked to above makes it clear alcohol is a risk factor for all types of bc, but to a varying degree.
There are of course, many other variables that will affect the outcome - they broke down the results by menopausal status and weight. There are of course other confounding variables but it would take a huge and complicated study to analyse those.
oal made an interesting point about balancing the benefit of moderate drinking in protecting against heart disease, against the raised risk of bc recurrence. Unfortunately this analysis concludes that the optimal consumption that balances these competing risks is only 0.5 - 1.5 drinks per week!
Anyway - we all make different decisions but it’s useful sometimes to know if they are well-informed.
Thanks Finty, I always end up with more questions than answers when looking at the research. As you say, in the end it comes down to personal choice and good that we have access to the research to help us on our way.
I’m still struggling a bit with interpreting this research. The o.5 to 1.5 drinks per day - exactly how much is this? I’m trying to see how this compares with say the maximum recommended limits for women. Anyone have any idea? Elinda x