Does Drinking Alcohol Increase Recurrence Risk?
Most people who’ve been diagnosed with breast cancer want to know if it’s OK to drink alcohol after treatment.
A study designed to provide answers has some drawbacks that limit the usefulness of the results, including relying on women to remember how much they drank in the six months before and after breast cancer diagnosis.
The research was published online on Aug. 9, 2023, by the journal Cancer. Read the abstract of “Alcohol consumption and prognosis and survival in breast cancer survivors: The Pathways Study.”
Alcohol and breast cancer
We know that drinking alcohol increases the risk of developing breast cancer, especially hormone receptor-positive breast cancer, as well as other types of cancer. The links between alcohol and cancer are so strong that in 2017, the American Society of Clinical Oncology (ASCO) published a position paper on alcohol and cancer.
Still, links between drinking alcohol after breast cancer treatment and the risk of recurrence are less clear. A few studies have looked at a possible link but have offered mixed results. And there are no specific guidelines on drinking alcohol for people with a history of cancer other than following cancer prevention guidelines to reduce the risk of developing a new, second cancer.
In this study, the researchers wanted to know if drinking alcohol before and after diagnosis affected recurrence risk.
About the study
This analysis used information from The Pathways Study, a study of more than 4,500 women with a history of breast cancer to look at how diet, exercise, supplements, and other factors affect survivorship.
The researchers looked at information from 3,659 women who were diagnosed with stage I to stage IV breast cancer from 2003 to 2015. When the women joined The Pathways Study, they filled out a questionnaire that asked about the foods and beverages they consumed during the previous six months, including alcohol. On average, the women filled out the questionnaire about two months after they were diagnosed.
Among the women, who had an average age of 59.68 and an average body mass index (BMI) of 28.46 when they were diagnosed:
68.1% were white
6.6% were Black
13% were Asian or Pacific Islander
10.3% were Hispanic
2.1% were American Indian or Alaska Native
71.1% were post-menopausal
54.9% were diagnosed with stage I breast cancer
34.2% were diagnosed with stage II breast cancer
9.5% were diagnosed with stage III breast cancer
1.5% were diagnosed with stage IV breast cancer
84.3% were diagnosed with hormone receptor-positive breast cancer
46.8% received chemotherapy
46.8% received radiation therapy
44.3% took hormonal therapy
59.5% had lumpectomy and 37.2% had mastectomy
38.5% were past smokers and 4.2% were current smokers
10.3% had other health conditions
1.1% had a history of alcohol dependence
68.6% met national guidelines for exercise
Most, but not all, of the women — 2,763 — filled out the same questionnaire six months later.
The researchers defined an alcoholic drink as:
a 6-ounce glass of wine
a 12-ounce can or bottle of beer
a 1.5-ounce shot of liquor
The researchers classified the women as:
nondrinkers
occasional drinkers (who had less than half a drink a day)
regular drinkers (who had one-half or more drinks a day)
Overall:
36.9% were nondrinkers
33% were occasional drinkers
29.95% were regular drinkers
The first questionnaire showed that in the six months before diagnosis average alcohol consumption was:
a little more than one drink a week for occasional drinkers
about 1.75 drinks a day for regular drinkers
The second questionnaire, filled out about six months later, showed the women were drinking less. Average alcohol consumption was:
about one drink a week for occasional drinkers
about 1.5 drinks a day for regular drinkers
It’s important to know that the study’s design relied on the women remembering and accurately reporting how much alcohol they’d drank in the previous six months each time they completed the questionnaire. It seems unlikely that all the women would have perfect recall of what they ate and drank six months earlier.
It’s also worth keeping in mind that some of the women might have been embarrassed or nervous about reporting how much they drank, and may have unconsciously or consciously reported drinking less than they did.
Occasional and regular drinkers were more likely than nondrinkers to:
be younger when diagnosed
be diagnosed with earlier stage, hormone receptor-positive disease
receive radiation therapy or hormonal therapy
be current or past smokers
be more physically active
be leaner
have fewer other health conditions unrelated to breast cancer when diagnosed
The women had follow-up interviews to assess their health at specific times after joining the study:
six months after joining
12 months after joining
two years after joining
four years after joining
six years after joining
eight years after joining
After eight years, the women had follow-up interviews every other year.
After an average of 11.2 years of follow-up:
there were 524 recurrences
a total of 834 women died: 369 women died of breast cancer, and 314 died of cardiovascular disease
The average time from diagnosis to recurrence was 4.9 years. The average time from diagnosis to death was 6.9 years.
When the researchers looked at the outcomes by drinking category, they found that drinking any amount of alcohol didn’t affect outcomes.
The researchers reported that the women’s weight seemed to cause alcohol to affect outcomes.
In the six months before diagnosis:
Drinking caused a slight increase in recurrence risk in women who weren’t considered obese and were occasional or regular drinkers; this increase wasn’t statistically significant, which means that it could have been due to chance and not because of the difference in alcohol consumption.
Drinking had no effect on recurrence risk in women who were considered obese.
In the six months after diagnosis, the researchers saw the same results: Women who were considered obese had a slight increase in recurrence risk but the increase wasn’t statistically significant, and drinking had no effect on recurrence risk in women considered obese.
What this means for you
Although this study suggests that drinking alcohol is OK after a breast cancer diagnosis, there are some important things to keep in mind before you start toasting to your health:
The women in the study had to remember how much they drank in the six months before and after they were diagnosed. How many of the women accurately remembered how much they drank? It’s hard to remember what you had for dinner two days ago, let alone how many drinks you had six months ago.
The study only looked at alcohol consumption in the six months before and after a breast cancer diagnosis. It’s possible that women who had a recurrence started drinking more alcohol seven or more months after diagnosis.
More than 84% of the women were diagnosed with estrogen receptor-positive breast cancer. A 2021 study found that estrogen receptor-positive breast cancer has a higher risk of recurring more than 10 years after diagnosis. The women in this study were followed for an average of 11 years, so it’s possible that recurrence rates could have been higher if there had been a longer follow-up period.
Although few other studies have looked at breast cancer recurrence and drinking, many, many large studies have linked alcohol and breast cancer risk and have suggested that drinking any amount of alcohol regularly seems to increase breast cancer risk.
Updated on December 4, 2023