Stir together the unexpected stressors of the COVID-19 pandemic and the easy comfort that alcohol brings stressed-out people.
The resulting cocktail contains both heightened levels of breast cancer risk and additional challenges as medical professionals screen their breast cancer patients and develop treatment plans.
Whether you’re a cancer patient or not, the best way to help your doctor help you is by telling the truth — the whole truth — about your drinking habits.
“Patients will underreport how much alcohol they’re actually consuming,” said Evie Hobbs, a breast cancer doctor and assistant professor of hematology and oncology at Oregon Health & Science University in Portland. “It can be very difficult to get candid information.”
It’s not unusual for Hobbs’ patients to start out saying they stop at one glass of wine per evening when the truth is several glasses or even a whole bottle, Hobbs said. Wine — not beer or liquor — has long been women’s drink of choice, she said, and they turned to wine in a big way during those earliest, scariest, loneliest days of the coronavirus lockdown.
Hobbs said she aims to develop trust and pin down what her patients’ drinking habits really are.
“I ask a lot of questions: Are you concerned about how much you are drinking? What times of day, how much? How is it affecting your life?” she said. “I always try to frame it as, I’m here to help you and this is something that involves your safety.”
The more you consume
There’s an unfortunately simple, direct and well-proven correlation between the amount you drink and your risk for breast cancer.
The American Cancer Society’s “Alcohol Use and Cancer” webpage lays it on the line: “Drinking even small amounts of alcohol is linked with an increased risk of breast cancer in women.” No amount of alcohol is completely safe, the ACA concludes. The best amount is none at all.
Reams of research back this up. A pooled analysis of data from 53 different studies found an approximate 7 percent greater risk of breast cancer with each alcoholic drink consumed in a day, according to breast cancer advocacy organization Susan G. Komen. Women who had two to three drinks per day had a 20 percent higher risk than those who drank no alcohol, according to Komen.
Another pooled analysis by the National Cancer Institute that included 118 studies found that light drinkers have a “slightly increased” risk of breast cancer compared with nondrinkers. The risk goes up for moderate drinkers and sharply up for heavy drinkers.
Scientists are still exploring the various ways alcohol intake influences the development of different types of cancers. For example, it’s been well established that alcohol can damage body tissues (especially in the mouth and throat) and DNA, ease the absorption of carcinogens from cigarettes and other sources, inhibit the absorption of nutrients and suppress the immune system.
When it comes to breast cancer, the most concerning culprit is probably the way alcohol interacts with estrogen, the female sex hormone.
“Alcohol has a direct effect on the liver, where estrogen is produced,” Hobbs said. “Patients who have moderate to high alcohol consumption have higher levels of estrogen in their bodies.”
Too much estrogen production has been definitively linked to a widespread form of breast cancer. Hobbs said approximately 70 percent of breast cancer patients have what’s called estrogen-receptor-positive breast cancer, meaning their cancer cells feature chemical receptors that allow them to use estrogen to grow.
Alcohol may raise other breast cancer risk factors in ways that aren’t fully understood, Hobbs added.
“Alcohol use can cause a state of chronic inflammation in the body,” she said. “We know that inflammation can generally cause a greater risk of developing cancer — especially colon cancer, but also breast cancer.”
An efficient, effective immune system is your body’s best way of defeating cancer before it begins and your best ally in responding to treatment, Hobbs said. But chronic inflammation tends to suppress or weaken the immune system, she said.
Breast cancer risk factors often associated with alcohol intake are a sedentary lifestyle and obesity, Hobbs added. People who drink heavily tend not to exercise, nor actively manage their health or get regular mammograms, she said.
That multiplies cancer risk factors substantially, she said.
After a breast cancer diagnosis, continued alcohol consumption can complicate therapies and worsen side effects, so it’s very important that patients tell their doctors about their drinking habits, Hobbs said.
“It can be dangerous if we don’t know,” she said. “Many chemotherapies can cause damage to the liver.”
Honesty with your doctor about how much alcohol you’re consuming is paramount, whether to maintain your health or to develop an effective and safe approach to cancer treatment, Hobbs said.
“Sometimes (patients) know they’re drinking more than they should, so there’s that fear of being judged,” she said.
Judging is not what your health care team aims to do, Hobbs stressed.
“We may bring in things like, ‘Why are you using alcohol to cope? How can we overcome using alcohol as a crutch?’ There are different therapeutic options,” Hobbs said. “Your primary care doctor and your oncologist and your team … all align to support the patient. I’m here to help. We’re all here to help.”