Want to meet me for a drink? Grab a glass of wine and discuss the day and life in general?
In my pre-breast cancer days, I loved my red wine. Whether catching up with a friend or sharing a meal with my husband, a glass (or two) of a robust red was de rigueur. Occasionally I’d sip dry Chardonnay, but those peppery, heavy Zin’s stole my heart.
On two separate trips to Europe, wine figured prominently in the itinerary. Visiting Burgundy, France and the Tuscan region of Italy, how could it not?
One glorious afternoon in Italy, my husband and I toured an obscure winery.
We tasted a variety of wines with a group of folks we’d met at a cooking class earlier that day. Someone suggested this hidden gem, and we eagerly tagged along. We all knew each other only from the few hours we’d cooked pasta together. It’s a memory I’ll treasure forever.
In this precious life there are so many simple pleasures to enjoy. A glass of really good wine is one.
Now?
I no longer drink.
It’s not that I’ve developed an aversion to my beloved red wine. Rather, I’ve developed a violent aversion to breast cancer.
Anything I can do to reduce my risk of recurrence, I’m in.
Lest you think I’m some kind of alcohol saint, I assure you, I’m not. I continued to drink wine even after my diagnosis. I drank wine during radiation. I drank wine after I finished all my treatment.
My “pours” were minimal, and not every day. But I didn’t quit.
I never did quit outright. Didn’t declare an “I quit drinking” day. My wine drinking simply faded away. As did my tolerance level, which was when I began to randomly feel crappy after a single glass of wine.
That’s so unfair! But between sub-optimal post-menopausal alcohol metabolism and a dwindling tolerance to booze, it happens. (1)
I hated not knowing if I’d wake up clear or foggy. My days are too precious to spend in a haze, waiting desperately to feel better. I have people to help, for heaven’s sake!
Around the time my tolerance began to tank, I took a closer look at research on the link between alcohol and breast cancer. And that sealed the no-more-drinking deal for me. I deemed it too risky. I wondered if there was a link between red wine and breast cancer, but I found there is a link between all types of alcohol and breast cancer. Even beer and breast cancer!
What The Research Says About The Link between Alcohol and Breast Cancer
Besides maybe soy, I don’t think any food or beverage causes more controversy or confusion than alcohol.
Here’s the bottom line:
There’s strong evidence that alcohol consumption increases the risk of an initial diagnosis for both pre- and post-menopausal breast cancer. (1)
But you and I, my dear reader, have already been diagnosed, treated and “recovered” from breast cancer. We’re classified as survivors, eh?
What about us?
What’s the bottom line on the link between alcohol and risk of recurrence?
With mass volumes of research on this topic (current as well as ongoing), I couldn’t possibly cover it all here. To reign this topic in, I answer the six most common questions I get regarding alcohol and breast cancer recurrence.
1. Do I have to stop drinking after a breast cancer diagnosis?
No. You don’t have to do anything you don’t want to do.
Some thoughts from the breast cancer trenches re: drink/don’t drink:
- “Life is short. Drink the wine.”
- “Life is precious. Live it up and enjoy it.”
- “I won’t miss out on all the things I love.”
- “I want to enjoy life and that means drinking.”
- “It doesn’t matter whether you drink or not. Some people never drink and get cancer. Some drink a lot and don’t get it. I don’t believe the studies.”
People have strong opinions about their alcohol! And they’re entitled to them.
But please know this:
Alcohol is carcinogenic. (1)
To reduce risk of an initial breast cancer diagnosis, there is no “safe” level of alcohol intake. There’s a risk relationship between alcohol and breast cancer, even at low levels of consumption. (1)
The World Cancer Research Fund’s (WCRF) alcohol and cancer report (a gold standard reference) indicates a confirmed link between alcohol consumption and pre- and postmenopausal breast cancer initial diagnosis. (3)
2. What about risk of alcohol and breast cancer recurrence? Or a second primary breast cancer?
One systematic review looked at six databases and 16 studies, of which 11 assessed breast cancer recurrence.
About half of the 11 studies showed a modest, but significant association between alcohol consumption and increased risk of breast cancer recurrence. Two of the included studies suggested the association was stronger in postmenopausal women. (5)
This same study observed that the association between alcohol and second primary breast cancer is less clear.
However, the WCRF report on diet, nutrition, physical activity and breast cancer survivors does not at this time find evidence strong enough to make specific recommendations for survivors on alcohol and recurrence risk. (6)
As a dietitian, I’m trained to use research in making nutrition recommendations for others.
As a breast cancer survivor, I make personal nutrition and diet decisions based on my diagnosis AND the research. I believe alcohol may have contributed to my cancer. Of course I have no way of confirming that. But who’s to say continuing to drink wouldn’t negatively influence my recurrence risk? (See question two below for more about this.)
I just couldn’t discount the connection found in the review (as well as other studies and professional articles). And research is ongoing. Because the evidence isn’t strong enough NOW, doesn’t mean it won’t be in the future.
I understand how findings like those in the WCRF report make it easy to dismiss the concerns around alcohol. And should you choose to? There’s nothing wrong with that.
You get to decide where you stand on the issue. You get to decide whether or not you want to take that risk, or even whether or not to choose to believe the studies.
As evidenced above, without alcohol, some people don’t consider life worth living, can’t imagine living life to the fullest. Other people live fulfilling, wildly satisfying lives without touching a drop.
There’s no judgment either way.
If you’re conflicted, consider experimenting with not drinking and see how that feels. If it doesn’t work for you? Pour yourself a glass of something and enjoy it guilt free.
3. Does alcohol raise estrogen levels?
Yes.
Drinking alcohol increases the serum level of endogenous estrogens. Serum is the clear liquid that can be separated from clotted blood. “Endogenous” means produced or grown in the body.
Even drinking small amounts of alcohol, say 1.25 to 2.5 standard drinks per day raises the level of estrogen.
Why is estrogen a problem? In estrogen receptor (ER)-positive human breast cancer cells, alcohol increases ER-dependent gene expression. This results in cells being reproduced quickly and at high speed. (2)
If you had ER-positive breast cancer, the goal now is to keep estrogen levels low. You’re likely taking medication to do that. Since alcohol raises estrogen levels, drinking can be counterproductive to that effort.
4. Does the TYPE of alcohol matter?
No.
It doesn’t matter your drink of choice. A juicy red wine, icy cold beer or fancy cosmopolitan all deliver alcohol to your system.
Wine, beer and spirits contain ETHANOL, which appears to cause the damage. (3)
Ethanol is a clear, colorless liquid found in ALL types of alcohol, and the main active ingredient in ALL alcoholic beverages. (7)
5. What’s a SAFE amount of alcohol to drink?
Depending on which research you read, or from whom you get your information, you’re likely to get conflicting and confusing messages on HOW MUCH alcohol is safe to drink after you’ve been diagnosed. (8)
Because of the inconsistencies and variations in research, it’s difficult to draft concrete guidelines. Remember, the WCRF hasn’t issued specific alcohol guidelines for breast cancer survivors.
This is where you must decide what’s comfortable for you.
Some evidence suggests ANY alcohol consumption, even at levels as low as 6 grams per day moderately increases the risk of recurrence, particularly in postmenopausal women. (3) That’s about 1.2 teaspoons of pure alcohol, or less than ½ of a standard drink. (4)
If that information gives you pause, but you’re not ready to give up drinking completely, think about what matters most to you.
- If enjoying a special, fine dining meal means drinking good wine.
- Consider drinking only at special meals .
- If holidays aren’t the same without your traditional fancy drink.
- Continue to enjoy alcohol on those annual occasions.
- If the best part of your monthly book club is wine with friends.
- Treat yourself to a glass once per month.
There are guidelines specific to alcohol consumption re: reducing risk of an INITIAL breast cancer diagnosis (1 for women per day), but please remember to not confuse those with guidelines for risk of recurrence. (9)
6. Why do I feel guilty when I drink?
I’m not sure.
Guilt comes from a different place for everyone, and it’s a common theme for survivors. While there’s no “data” to support my response, I’ll share what I know from my graduate studies in health psychology and personal experience.
Guilt is a negative emotion. You can feel guilty for something you DID do. You can feel guilty for something you DIDN’T do.
Those of us who’ve been diagnosed want to live the healthiest life we can, for as long as we can.
Regarding alcohol, we know what the research says. We know what our doctors suggest. And yet, at the end of the day, sometimes we just want to ignore all of that. Ignore the fact that we were diagnosed in the first place. Have a glass of wine and forget.
But that can feel like we’re inviting the cancer back. And if it returns?
This time we’ll know it’s our fault because we CAUSED it. And that can cause feelings of guilt.
Please remember:
Just like no one food causes cancer, neither can one alcoholic drink. Guilt is an energy sucker. Let. It. Go.
Wrapping It All Up
To drink or not to drink. That is the question after diagnosis. I hope I’ve cleared up some of the confusion and given you guidance on making the decision that best serves you.
If you’ve changed your mind about drinking alcohol after reading my blog, please tell me how so, in the comments below!
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This information is for educational purposes only and is not intended as medical advice. Please consult your dietitian or doctor for guidance specific to your needs.
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Read my other articles about foods related to breast cancer recurrence:
- Foods to avoid to reduce breast cancer recurrence risk
- Plant-based diet to reduce the risk or recurrence
- How breast cancer prehabilitation may reduce recurrence risk
- How tea affects recurrence risk
SOURCES
- Differences in alcohol tolerance as we age
- Alcohol Use and Breast Cancer: A Critical Review
- Alcoholic drinks and the risk of cancer
- Standard alcoholic drink
- To what extent is alcohol consumption associated with breast cancer recurrence and second primary breast cancer?: A systematic review
- Diet, nutrition, physical activity and breast cancer survivors.
- Ethanol (Ethyl Alcohol)
- Alcohol & Breast Cancer
- AICR Food Facts: Alcohol
Except for special occasions, I have given up drinking. I drank on my trip to Spain but never a whole drink. I will have a few oz of wine in my birthday but otherwise, I’m fighting the good fight.
As long as your decision makes you happy and comfortable – you make the right one! I’m sure Spain was amazing. You’ll have to tell me all about it when I see you next.
I cant stop drinking wine since my diagnosis thoroughly radiation treatments and after, I confided in my Dr. and they keep prescribing me more antidepressants and it’s not helping.
Sorry for delay in response. That doesn’t sound like it would be very helpful (the antidepressants). If you’ve not seen a therapist, perhaps consider working with someone? Your local cancer center should be able to give you a good referral. Good luck!
Thank you for your informative article. After months of no alcohol consumption due to treatment for a recurrence of breast cancer, I am now enjoying clean-crafted wines. Your article makes me wonder if that is still harmful.
Hi Sheri! Because I’ve not heard the term “clean-crafted”, I did a quick search. Seems there’s one particular company who has trademarked the term “Clean-Crafted Commitment”. It’s a marketing term meant to assure you there are no pesticides and chemical additives, and that sulfites are at a minimum. I’m not an expert in wine-making, and I don’t know what’s involved in processing in order to reduce sulfites. I also don’t know if it’s even possible to grow and produce grapes on this scale without SOME level of pesticide use. In case you’re unaware, the term “organic” doesn’t mean pesticide or chemical-free. Some states are still allowed to use a wide variety of chemical sprays and powders on their crops. Here’s info on use of the term organic from UC Berkley: “. . .pesticides, if used, must be derived from natural sources, not synthetically manufactured. Also, these pesticides must be applied using equipment that has not been used to apply any synthetic materials for the past three years, and the land being planted cannot have been treated with synthetic materials for that period either.” That said, the term “Clean-Crafted” is also what we call a “health halo”, indicating to consumers that THIS wine is better and healthier than others. To reduce your consumption of pesticides and chemicals, this may be a good option. But they’re not alcohol-free. As I wrote in the piece, ETHANOL is the carcinogenic component in ANY FORM OF ALCOHOL, and the component linked to potentially increasing risk of recurrence. Even with the research supporting the resveratrol in red wine as potentially heart-healthy, the fact remains that alcohol is not a health food and is 100% empty calories (no nutritional value.) Does that mean you should never drink it? The choice is yours. Make the decision armed with facts and then do what’s best for you! Hope that helps, and thanks for your comment and for reading my blog.
I am finding it hard not to drink as I am a social butterfly, and meet a lot of people in the pub! But since my diagnosis in April I have not touched a drop. I am doing everything I can to not get a recurrence, as hard as it is! I bought myself to some non alcoholic gin and enjoy that with ice a couple of times a week at home, and nurse my apple juice when I go out now.
Christine – thanks for your comment! I’m curious. Can being a social butterfly and meeting people (at the pub or anywhere, really!) happen without alcohol? Yes, of course! It’s entirely possible to be a social butterfly without consuming any alcohol whatsoever (ahem, I speak from experience) – there’s no “law” that states you must drink in order to be a social butterfly ;). Thoughts?
since my diagnosis and completed treatment… I have cut back on my drinking limiting 4 – 7 drinks a week, but I keep it about 4. I don’t drink during the week and I save my wine until the weekends and again about 4 drinks over 3 days. Since July, I had three events which I did drink a little more then my 4 drinks. Next week, I will be going on vacation and I would like to have a few drinks without freaking out that if I do my BC will come back. So, if I do have a few drinks during my vacation, would that increase the risk? I am considered low risk for recurrance and I am on anatrozole..
Hi Kathy, thanks for your comment. Please review bullet point #5 in the post – gives good guidelines for making the decision whether or not to drink. It comes down to the fact that it’s an individual choice – I provide information and science to help people make the best decision that serves them. Have fun on your vacation!
It’s been a huge dilemma for me. I’m constantly weighing up the associated risk factors of alcohol and recorrance of BC. I love wine and find it hard to foresee a fun filled life without having a drink but as you’ve talked about in your article – there’s a constant worry every time I have a drink – so it’s taking the fun factor out of drinking anyway!. My problem is stopping once I have started and my habit pre BC diagnosis was to drink quite considerably over the safe guidelines. You’re article has actually helped me a lot (I’ve read so much – just hoping to be convinced that carrying on drinking will be ok) Clearly all the medical advice points towards drastically limiting or cutting out completely – so I never get the green light I’m hoping for. Now having read your point of view I have made a decision to stop drinking on a weekly basis and just have a drink or two on special occasions. I think for me this will bridge the gap between having a life not worth living if I can’t kick back every now and then with a glass of wine with friends and the worry/guilt of over indulging on a regular basis. Thanks for writing this – it helps to hear the point of view of another woman who has had BC and understands the turmoil involved with the “to drink or not to drink” debate. No one can understand if they haven’t been through it personally.
Karen, thank you! What a thoughtful response you’ve shared to my article. Sounds like you’ve come to a decision you’re comfortable with. If I can be of further help, don’t hesitate to reach out; find me here: cathy@cathyleman.com Take care!
I start radiation for her2 breast cancer stage 1. I’m was hoping to have a beer after each session is that ok
Hello Barbara! Thanks for your question. Unfortunately, I’m unable to make specific recommendations or provide individual guidance here. Please use the information in the blog post to guide you in making the best decision for your situation. Best of luck as you journey through this milestone!
I am post menopausal and quit drinking (previous 1 drink per day) after my BC diagnosis. I am also a type 2 diabetic so we know what that means (limiting the foods I actually like). At this point I am just hugely annoyed (maybe it is part hormone blockers) at all the don’t eat that, don’t drink that and exercise constantly guidance. I have decided birthdays and Christmas 1 drink with friends MIGHT be safe although, at this point, it feels like nothing is safe. Yup-it is unfair. If I had advance notice of the world ending, or just my world, I would buy a gallon of ice cream and chase it with a bottle of Merlot. I now drink only sugar free mock tails.
Beth, thanks for that comment! It can be challenging to balance all the changes to our lifestyle after treatment. . .sounds like you’re doing a good job! Hang in there.
Hi Cathy! I just had breast cancer surgery last week. It was ductal stage 0-1. I’m so glad I found it early! Hardly no pain at all! I used to absolutely love to drink beer and vodka and smoke and listen to all my oldies on my cds! But I gave up smoking 7 years ago and now I’ll give up drinking too!!! I never want to risk the cancer coming back!!! It’s too surreal and depressing!!!! Thank you sooo very much for your wonderful blog!!!! It helped me immensely!!! I will have my last glass of wine with my bff, niece, and 2 daughters for Thanksgiving and that’s it!!!! God bless you!!🙏🙏
Hi Debbie! Thank you so much for your comment. I’m glad you had such a good surgery outcome. You’re most welcome – glad the blog helps. Btw, I hope you haven’t given up your “oldies” on those CD’s. 😉 Music is one thing we should never, ever give up, right? Take good care, I appreciate you!
Hello! After reading your article I have decided to totally give up wine. I was diagnosed with Breast Cancer in 2017. I drank occasionally before, during and after. Drinking wine I feel will be easy for me to give up because I probably only drank a average of 2 glasses per week anyway. We always have alcohol, beer, & various wines in the house mainly for guest & family members who visit. Thanks for your article. I will not discuss this with anyone in my family because I assure you someone will talk me into drinking. I will continue to be my social self. I will continue to be the place for friends & family to gather for great food & drinks & fun & games. I will continue to be myself… Alcohol free!
Thanks for your comment and your kind words about the post! Wow, that’s a big decision and I’m glad it’s one you feel good about. . .that’s most important. Btw, no one can “talk you into” doing anything 😉 In the end, we are always 100% responsible for our decisions and actions. xx