Alcohol and recurrence.

I am interested by the further publicity about alcohol, and its link to breast cancer on the BBC news today. It talks about alcohol consumption, past as well as current. The logical implication being, ‘what is done, is done.’ The report also encourages people to reduce their consumption. When I spoke to my onc nurse about this issue recently, and whether it was best to avoid alcohol all together, she said she thought it was ‘shutting the door after the horse has bolted.’ My bc nurse was similarly unconcerned.

What does everyone else feel? Does anyone have any specialist knowledge?


first, have to say I’m no expert.

I find this reaction from the nurses quite extraordinary really. What about the other breast if only one was affected, what about recurrance and what about the risk of other cancers (not just breast cancer). True it is lifetime risk but on the whole, it’s never too late to improve lifestyle particularly for those drinking too excess.

This is a section from the pdf on alcohol and breast cancer from Breakthrough Breast Cancer:

‘We are still not entirely sure how alcohol increases the risk of breast cancer. Drinking alcohol changes the levels of hormones that you have in your body, including the female sex hormone oestrogen’

The full link is here and the pdf at the bottom of the page:

Given that most breast cancers are ER+, it would seem to make sense not to have alcohol or keep it very limited.

The increased risk seems to be quite low, in terms of stats they say that:

‘drinking one unit of alcohol per day probably causes an extra one woman out of 100 to get breast cancer’.

For all of us its a weigh up between our quality of lives (if alcohol is something we enjoy) and reducing risk as much as possible.

I used to love my red wine, not to excess but on a regular basis. I decided to give that up. I’m now 2 years down the line and I don’t miss it in the slightest. If I did want the occasional glass of something I’d have it. Others will feel differently and it’s down to personal choice.

Don’t know if that helps at all. Elinda x

intresting subject

I blame my BC on too much alcohol consumption and not eating until I had consumed half a bottle of red when I was working full time. I still drink red wine but only 1 or 2 units and with my evening meal. is this still too much? I really don’t know but enjoy a glass of decent red. my onc nurse was happy with it.
don’t know if we should believe everything in the press but perhaps we should.

Carol, your last sentence needs a reply - DON’T BELIEVE EVERYTHING YOU READ IN THE PRESS.

As for the underlying research, we’ve seen plenty of instances where what’s reported on the news (anything that includes statistics) is at best unclear and at worst a total fairy story when compared with the ACTUAL research, so before making any other comment I’m going to see if I can find the research itself.

Only to say that the Radio 4 discussion got me out of bed to turn it off. I had planned an 8.30am start…a very late and rare lie in for me.
Stage 4, teetotal, never took to the taste of alcohol.
Still lovely day and I’m off to sort out the garden.

Oh yes, I forgot to say we can now expect to have accusing looks if anyone happens to spot you in the pub with anything stronger than a lemonade, just as when the “your lifestyle causes cancer” report a month or so ago had people asking what I’d done to cause my cancer.

OH CM I thought this too. :slight_smile: Listening to the radio this morning, half asleep it has to be said, I was reminded of all those experts behind the putting newborns on their fronts to sleep campaign a few years ago. My newborn would not sleep on her front so, to my midwife’s disapproval I let her sleep on her back…and now of course the advice has turned full circle with the back to back campaign, advice. Sorry rambling now…x

I don’t think there’s any doubt this isn’t acadmic research. It was published in the British Medical Journal today:

This is an article from the Telegraph on the research above:

If it can save lives surely that’s got to be a good thing. There’ll always be those people who are judgemental about people with cancer but mostly I think that’s fear. They’re hoping that if they can see we’ve done something that might have caused our cancer it lets them off the hook.

Four very interesting words start the RESULTS section:


The Telegraph report also states that consuming more than the recommended upper limit causes 2,500 cases of breast cancer.

SO WHAT ABOUT THE OTHER 44,000 CASES? I can only assume they WEREN’T caused by alcohol.

I see what you’re saying but the numbers are quite compelling. I suppose it depends if you want to wait for other evidence that clearly shows cause and effect or not. Think that might be a very difficult thing to prove. Be interested to read the full study at some point as it might make their findings and assumptions clearer. Elinda x

I’m trying to put a different slant on it, elinda, rather than denying the numbers. Yes, there is an increased risk, but the portrayal in the mass media so often is IT’S ALL YOUR OWN FAULT AND YOU DESERVE WHAT YOU’VE GOT, which is not at all helpful and can be very distressing, particularly when you’ve recently been diagnosed and feel that people are looking at you and blaming you for your cancer.

I think I am right in saying it is only er+ cancers that they are talking about? At least that is what I was able to glean from the last report, a couple of months ago. If so, and if you are taking tamoxifen, what impact does that have??

Also, what other factors are there? Excessive alcohol consumption is often linked to other ‘undesirable’ lifestyle choices. And what about environmental factors? Have these been discounted? How do they isolate people to find out what is causal, and what is not? I am probably being a bit dense! I don’t understand it really.

Hello all, I’ve always been interested in the links between lifestyle, diet and illness, and am mostly a healthy-eating veggie with the odd fish sneaking in, but I also love cakes, biscuits, cheese straws, kettle chips and wine. At one stage in my 20s I was drinking way too much, but I managed to get it under control and I was having maybe 3-4 glasses of wine a week till my surgery, occasionally more. I’m about to go off on my high horse here, probably too much info but what the hell!
I can wholly understand that those of us who have cancer might want to control all the controllable aspects of their lifestyles, and I do try to do that to an extent. However, there is also an element of greyness with the whole issue in that one thing - e.g. red wine - is thought to be beneficial for some aspects of health, while being a negative for others, especially if drunk to excess. I’ve had a total of 3 glasses of wine in the last month since my surgery, and I’m happy with that. I’m hoping that my 3 glasses will reduce my risk of cardio-vascular disease, while not encouraging my cancer to return (luckily it’s not active).
There are so many risk factors that affect us all, some outside our control. The lifestyle problem is particularly difficult to wade through because there are so many vested interests issuing claims and counter-claims (big pharma, supermarkets, politicians some of whom own supermarkets etc.) Alcohol abuse is one area in which I have a lot of experience as I constantly see the results of it as a part of my work.
I do think that as a society we’re refusing to deal with the issue, primarily because alcohol is big business. We also pay for it in other ways big time! Because we allow vested interests to sell cut-price alcohol, and make it easy for kids to get hold of it, we have an obvious cultural problem which makes any backlash all the more aggressive. And of course, those vested interests will always try to pretend that the issue is one of personal responsibility rather than their faults for continuing to use any means, fair or foul, to sell more and more alcohol to people so that they can give their shareholders big dividends at our expense.
I know that some types of alcohol are especially dangerous, in particular the super-strong types which often contain the more nasty fractions of alcohol, distilled out of the expensive alcohol and bought by manufacturers of cheap stuff to add strength to their cocktails of chemicals - white cider and super-strong lager is especially dangerous in terms of physiological damage and addictiveness (I see 25 year olds with end-stage alcoholic organ disease). And we let our kids drink this crap, by allowing it to be sold in corner shops and supermarkets for under £2 for 3 litres of 8-9% alcohol. That’s where I wish certain politicians and journalists would stop bleating about the nanny state and making the middle classes pay for a few ‘weak’ alcoholics, and actually come and see what’s going on. Cancer is only one small part of the problem, and peoples’ reactions to research linking alcohol with disease are very often clouded by the constant obfuscation on the whole issue.
So to sum up, we’re blamed by some people for having cancer because it suits the argument that there’s no need to try to curtail the massive market in alcohol that encourages people to drink at dangerous levels in the cause of big profits, it’s all down to personal responsibility. And all valid research is clouded by other research released by those with vested interests to cloud the issue and obscure any attempts at reaching the truth.
My personal view is that I’m going to try to stay as healthy as I can by exercising as much as possible and eating mostly healthily (with the occasional cake!) and I’m going to have a glass of wine now and then. I think of it as stacking the odds in my favour as much as I can, whilst still having the odd treat which might actually help me in another way.
Off the high horse now! Lynne xx


Following on from what Elinda says, this is in BMJ and it is large scale and finds an increased risk of bc in those consuming above limit levels of alcohol BUT and it is a big “but” the article in BMJ is only a summary of the actual workings and makes a key statement (bear with me on being pedantic, I’m an academic and statistician…). It says “if we assume causality…” and this is a big assumption.

I used to use an example to my students which we called “brown bread and sun spots” (the increase in the number of people getting suspicious moles checked went up in the 1970s in line with an increase in people consuming brown bread but in fact the missing variable was that people also started going on foreign holidays which was the causal factor, not the brown bread).

I don’t smoke, am not overweight, active, eat healthily and rarely drink alcohol these days. When I was a student I used to go out for some really wild nights. I once dropped a plank on the area where I got bc (my granny swore bc was caused by “getting a knock”) and my mother got bc at 41 but was my only female relative with bc. I ran all of these “risk” factors by my surgeon in a “why me” phase and he said that I had missed out pollution, mobile phone signals, living next to nuclear power stations and all kinds of other things that might have given me bc, or that it could just be chance…

It looks as though many of the other factors which may play a role have been stripped out here and it could well be a “brown bread and sun spots” or false causality. We know that there is a link but there are links to many other factors also.

We will all believe what we believe and change our lifestyles if we feel that this will reduce our risks of recurrence. My ex swears I should “alkilise” my body, but biochemists I work with dismiss this as nonesense.

The long rambling is to say this is not a simple equation. It is certainly not a “do this and you get bc” or don’t do it and you won’t. We will all make choices. I am happy to drink (probably moderately)and occasionally even push to boat out without feeling that I am doing myself terrible damage.

The reporting of the paper incidentally is rubbish. The Daily Mail headline writer contradicts the paper entirely saying that what you do from now will make no difference because the damage is done. Its rubbish. Monkeys with typewriters and all that… Will hunt out the full paper and have a proper read of it later. Happy to pm any stats which do say anything useful to anyone who is interested in changing their diet as a preventative measure. Each to their own xx

Hi TSR - in answer to your question about how the stats are compiled, it is usually quite straight forward to normalise for what statisticians call “confounding factors” - particularly if the cohort is large enough and enough good quality data is collected. So for instance in the case of alcohol and exercise you would compare those that are active and high alcohol consumers, with those that exhibit only one of those behaviours - a simple regression analysis. Proving causality is different and more complicated. You would expect any decent quality bc research to either specify that the results only apply to a certain group (by hormone status, age, bmi, stage or whatever), or to have normalised for those factors so that the results they report are independent of those issues - although where health is concerned, few issues are entirely unrelated.

Bubbletrouble - completely agree. I think we are heading for an alcohol induced health catastrophe in 20 years time, when the current generation of young heavy drinkers hits middle age. I also think there is a large element of class myopia - a belief that the middle classes at home drinking nice wine are somehow immune from the effects of alcohol, whilst tut tutting at the drinking culture amongst the young that is evident in any town centre on a Friday night. And I say that as someone who used to feel that way myself - I don’t any more.

finty x

That’s interesting MG. I am a bit sceptical too, but probably only to justify the odd glass of wine! Let me know if you glean anything more of interest - would love to see it.

Bubble and Finty, completely agree - the general attitude we have towards alcohol in this country is scary. It seems the ‘norm’ to drink, and get (very) drunk. It is a big problem, and set to get bigger. I think I am probably guilty of being one people, who with a nice wine, drunk out of a nice wine glass, in my comfy middle class environment, probably did not relate it to myself. Thank you also for your explanation of ‘confounding’ factors, I just do not understand, how they can isolate one factor, to the exclusion of all others though. And also, if there is any mention of alcohol consumption and recurrence, especially how it might be affected by tamoxifen, and other hormone therapies,

Hi Finty,

There are two questions:

Is this single variate or multivariate analysis. We know it is a multivariate set of factors which cause bc but only a alcohol, age and gender are mentioned and they may not be studied in a multivariate way.

Two, even if there is a relationship we don’t have causality unless we have ruled out other factors using randomised control variables. I have been told off by the econometricians for this a few times.

The authors might well have done both of these to the most sophisticated level but it is not clear that they necessarily have. All I am saying is that I suspend judgement until I am clear what they found and how they found it.

Beginning with “assuming causality” isn’t the best of starting points… It can be tested and if big claims are being made it should be.

Academic research studies problems from many different angles and papers frequently contradict and critique other papers. Just getting something published doesn’t make it gospel but I suspect it fits with a broader social health agenda hence its publicity today.

Most of the newspaper reports are guilty of something which Winston Churchill described as “using statistics as a drunk uses a lamp post, for support rather than illumination.” I prefer illumination. I’m not drinking at all at the moment, just dont fancy any other toxins on top of those I can’t choose but have, but I won’t necessarily stick to that depending on my final understanding of what I’m dealing with and the various risks x

MG I completely agree - I don’t think they have published any internals, so no way of knowing in this case - but with a huge cohort I would expect a multivariate analysis (but I’ve been disappointed before!). My reply to TSR was just to explain in extremely general terms that it can be done. But with diet and lifestyle issues I much prefer intervention studies to large scale observation studies or case controlled studies.

Most reporting of research in the non-specialist media is execrable - the only exception I would make is The Independent, who can sometimes do a pretty good job.

I still have the odd glass of wine - but rarely more than 2 or 3 a week, and have found it much easier than expected to give up. And I always have at the back of my mind the possibility of my mets popping up in the liver (more probable than not) and I want it to be in as good a condition as possible for that eventuality.

finty x