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Breast Cancer and Alcohol: How Much is Safe?

Nearly 5,000 breast cancer deaths a year may be attributable to just light drinking (up to one drink a day).

May 6, 2013 |
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Supplementary Info

Sources Cited

D. W. Lachenmeier, S. Gumbel-Mako, E.-M. Sohnius, A. Keck-Wilhelm, E. Kratz, G. Mildau. Salivary acetaldehyde increase due to alcohol-containing mouthwash use: A risk factor for oral cancer. Int. J. Cancer 2009 125(3):730 - 735

M. Gronbaek. The positive and negative health effects of alcohol- and the public health implications. J. Intern. Med. 2009 265(4):407 - 420

V. Bagnardi, M. Rota, E. Botteri, I. Tramacere, F. Islami, V. Fedirko, L. Scotti, M. Jenab, F. Turati, E. Pasquali, C. Pelucchi, R. Bellocco, E. Negri, G. Corrao, J. Rehm, P. Boffetta, C. La Vecchia. Light alcohol drinking and cancer: A meta-analysis. Ann. Oncol. 2012 24(2):301-308

H. K. Seitz. Alcohol and breast cancer. Breast 2012 21(4):426 - 427

H. K. Seitz, C. Pelucchi, V. Bagnardi, C. La Vecchia. Epidemiology and pathophysiology of alcohol and breast cancer: Update 2012. Alcohol Alcohol. 2012 47(3):204 - 212

K. Linderborg, M. Salaspuro, S. Väkeväinen. A single sip of a strong alcoholic beverage causes exposure to carcinogenic concentrations of acetaldehyde in the oral cavity. Food Chem. Toxicol. 2011 49(9):2103 - 2106

Friedenson B. Alcohol, acetaldehyde and breast cancer risk. Breast. 2012 Aug;21(4):612. Epub 2012 Apr 16.

Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011 Feb 22;342:d671. doi: 10.1136/bmj.d671.

H. K. Seitz, F. Stickel. Molecular mechanisms of alcohol-mediated carcinogenesis. Nat. Rev. Cancer 2007 7(8):599 - 612

Robert Baan, Kurt Straif, Yann Grosse, Béatrice Secretan, Fatiha El Ghissassi, Véronique Bouvard, Andrea Altieri, Vincent Cogliano. Carcinogenicity of alcoholic beverages. http://oncology.thelancet.com 2007 8(4):292 - 293.

W. Y. Chen, B. Rosner, S. E. Hankinson, G. A. Colditz, W. C. Willett. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA 2011 306(17):1884 - 1890

Acknowledgements

Images thanks to zyphichore

Transcript

Recently, the IARC, the International Agency for Research on Cancer, the official World Health Organization body that decides what is and what is not cancer-causing, concluded that alcoholic beverages--all alcoholic beverages are to be considered carcinogenic to humans.

Most recent research has focused on acetaldehyde, the first and most toxic alcohol metabolite, as a cancer-causing agent. Seems that bacteria in our mouths oxidize alcohol into this carcinogen called acetaldehyde, which we then swallow.

There's convincing evidence that alcohol consumption increases the risk of breast cancer, but most of the data derive from studies that focused on the effect of moderate or high alcohol intakes, while little was known about light alcohol drinking (up to 1 drink/day), hence this new meta-analysis of studies that compared light drinkers to non-drinkers, and found a moderate but significant association with breast cancer, based on the results of more than 100 studies.

They estimate that about 5,000 breast cancer deaths a year are attributable to light drinking, meaning nearly 5,000 women that died of breast cancer maybe wouldn't have if they had stayed away from alcohol completely, leading to an editorial in the medical journal Breast that concluded "women who consume alcohol chronically have an increased risk for breast cancer that is dose dependent but without threshold," meaning there's apparently no level of alcohol consumption that doesn't raise breast cancer risk at least a little. So, no safe threshold. Any level of alcohol consumption appears to increase the risk of developing an alcohol related cancer.

For example, the Harvard Nurses’ Study found that even consumption of less than a single drink per day may be associated with a modest increase in risk. Forget a single drink what about a single sip. A new study found that even holding a teaspoon of hard liquor in your mouth for 5 seconds—and then spitting it out results in Carcinogenic concentrations of acetaldehyde produced from the alcohol in the oral cavity instantly after a small sip of strong alcoholic beverage, and the exposure continues for at least 10 min after spitting it out.

Even alcohol-containing mouthwash can give you a carcinogenic spike. The researchers conclude, " All in all, there is a rather low margin of safety in the use of alcohol-containing mouthwash. Typical use will reach the concentration range above which adverse effects are to be expected. Until the establishment of a more solid scientific basis for a threshold level of acetaldehyde in saliva, prudent public health policy would recommend generally refraining from using alcohol in such products. 

So why isn't the same recommendation made for alcoholic beverages? Well, as the Harvard paper concludes "individuals will need to weigh the risks of light to moderate alcohol use on breast cancer development against the benefits for heart disease prevention to make the best personal choice regarding alcohol consumption. They're talking about the famous J shaped curve. While smoking is bad and more smoking is worse, and exercising is good and more exercise is better, for alcohol there appears to be this beneficial effect of small doses. A six-pack a day raises overall mortality, but so does teetotalling. 

The #1 killer of women isn't breast cancer, it's heart disease, and a drink a day reduces the risk of heart disease. Why just reduce the risk of heart disease, though, when you may nearly eliminate the risk of heart disease with a healthy diet? So a plant-based diet that excludes certain plant-based beverages may be the best for overall longevity.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by Jonathan Hodgson.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

Previously I've addressed the pros and cons in Alcohol Risks vs. Benefits. The other mouthwash video I referred to is Don’t Use Antiseptic Mouthwash, part of a video series on improving athletic performance with nitrate-containing vegetables (if interested, start here: Doping With Beet Juice).

As you can see in my volume 13 DVD listing, I've got another video coming up in a few weeks, Breast Cancer Risk: Red Wine vs. White Wine. Make sure you're subscribed (for free!) so you don't miss it.

How else might one reduce breast cancer risk? See, for example:

Or any of my 75 videos on breast cancer.

Also, be sure to check out my associated blog post for more context: Breast Cancer & Alcohol: How Much Is Safe? and Breast Cancer and Wine.

  • Gary Giovino

    Nice way to wrap it up Michael

  • Lynn

    Thanks for sharing what others refuse to share.

  • Mark Brend

    I wonder what the risk is if your use mouthwash like I do.
    Rinse with mouthwash, spit, light rinse with water, toothpaste, rinse and re-rinse until my mouth does not have any visible paste left. :{} ?

  • Fredrika Nordh

    What about alcohol based deodorants?

  • lyra

    What about social drinking? My heritage is French, Italian, and Spanish. Needless to say, we are wine drinkers. And for generations, the women in my family have lived well into their 80′s and 90′s. Most of us drink moderately, and not hard liquor either, but almost exclusively red wine. However, when we get together for family gatherings, we have been known to polish off a couple of bottles of wine. Does this social bonding help protect us against our ‘bad habit’.

    According to Dr. Dean Ornish, people with strong bonds — friends and family ties — enjoy a bolstered immunity which may protect them from coming down with maladies like cancer and heart disease, which affect the rest of the population eating the same diet (usually meat-based). Now, I am a vegan and I have a healthy life style overall, but I do enjoy an occasional glass of wine. And I don’t have any of the risk factors that are associated with developing cancer. What is wrong with women enjoying an occassional glass of wine?

    I have to say, I often wonder if some of these studies targeted at women aren’t motivated by a puritanical bias on the part of the researchers. I suppose we’ll hear next that men may still drink moderately, but if you’re a women, you’d better not take so much as a sip. Look, I know that many of these studies are not fool-proof. Researchers may be affected by unconscious biases towards certain groups (e.g. women drinkers). And the results may be skewed. So I have some questions. Did they take a healthy vegan lifestyle into consideration, or were they looking mainly at meat eaters? This is still a puritanical society when it comes to what women can or can’t do. Well, perhaps I’m just rationalizing. I do like my wine. All the same, I’d like to see more studies before I accept these results. I don’t see anything wrong with an occasional glass of wine enjoyed among friends.

    • Plantstrongdoc

      A lot of problems, which affect both genders, are associated with alcohol consumption – of course some of them dose dependent: Violence (probably mostly men), car accidents, hypertension, stroke, colorectalcancer, diabetes, osteoporosis, atrial fibrillation, heart failure etc. The true safe upper limit for both genders is probably low. That said, I drink wine every week, and I have no intention of stopping that. And you make a good point, you eat healthy, it is a part of social life, social bonding, eating well, it makes you relax, it tastes great – and hey its plant based! :-)

    • http://www.facebook.com/darryl.roy.752 Darryl Roy

      For perspective, breast cancer accounts for only 3.3 out of 100 deaths among American women. Cardiovascular diseases accounted for 10 fold the number of deaths. (http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf)

      I think these two papers are worth perusing:

      Sun, Qi, et al. “Alcohol consumption at midlife and successful ageing in women: a prospective cohort analysis in the nurses’ health study.” PLoS medicine 8.9 (2011): e1001090. http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001090

      Women who drank moderately (and even daily) had a better chance of living to 70 without a medical history of serious diseases (cancer, diabetes, cardiovascular disease and stroke, Parkinson’s, MS, etc.), loss of cognitive function, disability, or mental illness. This measure aggregates a whole range of potential health setbacks.

      And on the other side:

      Britton, A., M. G. Marmot, and M. Shipley. “Who benefits most from the cardioprotective properties of alcohol consumption—health freaks or couch potatoes?.” J EPIDEMIOL COMMUN H 62.10 (2008): 905-908. http://jech.bmj.com/content/62/10/905.short

      Physically active non-smoking women with healthy diets didn’t get the heart/stroke risk benefit from alcohol seen in the general population.

  • http://www.facebook.com/daniel.wagle.5 Daniel Wagle

    I have started to have some tooth problems and I started to swish with salt water instead of the alcohol based mouthwash. I find the salt water is far more soothing than the alcohol based mouthwash, which is very irritating. Is salt water the best thing to swish one’s mouth with? I do use sea salt and of course don’t drink the salt water.

    • Tania

      The best thing to swish is organic coconut oil

      • http://www.facebook.com/daniel.wagle.5 Daniel Wagle

        Thanks, and what I found on the Web about “oil pulling” which I think you are referring to is very interesting.

  • Toni

    Hello, what about kefir? when you leave it several days it generates a little of alcohol , may be less than 1% but it’s alcohol

  • Marge

    I heard Dr. Oz recommend a glass of beer per day as being beneficial.
    I think that was irresponsible. Some don’t want to stop at one glass. And with the information in this video, it would be best to avoid all alcohol and go plant-based.

  • Rahn Kim

    How about grape juice?

  • Melissa Hoffman

    I wonder if this casts a totally different light on the use of alcohol based herbal tinctures. What do you think?

  • Avi

    How bad it is if I am using Listerine day and night, every day?
    And is it possible that it effects the liver?

  • Margaret

    The teetotalers in the studies showing the J shaped curve may have been people who had a history of alcohol dependence. They also may have been abstaining because of other health problems such as liver disease. They need to re-do those studies, excluding those with a history of alcohol related diseases, and controlling adequately for other health-related behaviors.