Drinking wine after bilateral mastectomy

There is a risk associated with use of alcohol, but I will point out, my mom is an alcoholic and abused alcohol and smoked cigarettes for many years, and has never had cancer of any kind. I never smoked, rarely drank as I was afraid of becoming like her, led a very healthy lifestyle, and I am the one who is diagnosed.  I may have had breast cancer, but I refuse to allow it to control my life.  Quality of life is important to me, so I no longer deprive myself of everything.  I enjoy a few glasses when I want, not everyday, but that is more out of financial and weight concerns.  There needs to be balance.  Wine may not be the best for my breast cancer, but red wine is good for my heart.  I just do not let breast cancer define me.  Enjoy life!

Alcohol consumption is at most a weak contributory factor in breast cancer recurrence.  If I recall correctly, the most recent study indicated that moderate alcohol consumption increased recurrence risk by about 30%.  After a bilateral mastectomy for DCIS, your risk of recurrence is in the range of 1% - 2%; this means that alcohol consumption might put your risk into the range of 1.3% - 2.6%.   

More importantly (to me, anyway), is the fact that alcohol consumption has been shown to have no impact on mortality.  This is because alcohol actually has health benefits.  Here is a video of Professor Michele Holmes, from Harvard, discussing the most recent study.  Her conclusion is that given the expected long term survival of women with early stage BC, the benefits from moderate alcohol consumption, in terms of heart health, balance out the negatives with regard to increased BC recurrence risk.  http://www.ecancermedicalscience.com/tv/video-by-category.asp?play=364&cid=5&scid=0&q

Ha!  I had DCIS and had a recurrence after having a BMX.  Now it's IDC with some DCIS.  My former BS told me I could wait a while before making decisions, possibly years.  Well, I'm glad I acted quickly, but I still got it again!

AH!!!!!   I hate the scare tactics on alcohol!  Let's get the facts straight rather than shout out scare tactics.

Yes, studies have shown that alcohol consumption may increase BC risk by up to 30%.  This means that alcohol is considered to be a low risk factor for breast cancer.  There's no argument about that. The 30% increase in risk is exactly the number that I used in my previous post.  What it means is that someone who had a mastectomy for DCIS, who has a 1% - 2% risk of recurrence, may increase their risk of recurrence to 1.3% - 2.6% if they consume moderate amounts of alcohol.  Recurrence risk is spread over many years - some recurrences don't happen for 10 years or even longer, but most recurrences will happen within the first five years after an initial diagnosis.  So this means that for those of us who had mastectomies for DCIS, consuming alcohol may increase our recurrence risk by approx. 0.1% per year.  Wow!!!  That's sure going to keep me from enjoying a glass of wine.  Uh, no!!

What about those who had a lumpectomy?  If someone has a post-treatment (surgery, possibly radiation, possibly Tamoxifen) recurrence risk of 6%, a 30% increase means that moderate consumption of alcohol will increase this recurrence risk to 7.8%.  Again, this risk is spread over many years, but most of the risk will occur within the first five years.  So in this example, for each of these first 5 years, recurrence risk may be increased by 0.35%.  Whether this is enough of a risk increase to eliminate alcohol consumption from your lifestyle is a personal decision. 

To put the BC risk from alcohol consumption into perspective, take a look at this risk chart from the Komen Foundation:  http://ww5.komen.org/BreastCancer/BreastCancerRiskFactorsTable.html  Most of our BC risk is driven by factors that we can't control.  We freak out about alcohol because it is one of the few risk factors that we can control, but the fact is that it is a low risk factor and the amount that most of us will be able to impact our overall risk by reducing/eliminating alcohol consumption is very small.

Something else to keep in mind is that the leading cause of death of women in North America is heart disease.  Cancer - all cancers combined, including lung cancer which kills more women than breast cancer - is second.  Moderate alcohol consumption has been shown to help reduce the risk of heart disease (note however that heavy alcohol consumption has the oppositve effect).  This is why study after study has shown that while moderate alcohol consumption may lead to a slightly higher risk of BC or BC recurrence, there is no impact on mortality.  This is because today, thankfully most women survive breast cancer and go on to live long lives.  But as we age, heart disease becomes a much greater concern.  So in making our choices, we need to consider all our health risks - and when it comes to alcohol consumption, there is a bit of a "balancing act" (to use the words of Dr. Holmes).

Yes, there are thousands of articles that talk about BC risk and alcohol consumption. It's a favorite topic of journalists reporting on health news. Many of those articles just regurgitate the same info from the same study, but even at that, it's a fact that there have been quite a few studies that have shown a link between alcohol and BC.  But rather that read newspaper writers' interpretations of BC and alcohol studies, I find more credibility in the opinions of doctors who specialize in breast cancer and who look at all of the studies and draw overall conclusions: 

• From Dr. Susan Love:  "If wine makes your dinners more pleasurable, you don't have to abandon it altogether. However, you may want to forgo the second glass. Four or five glasses a week shouldn't have a measurable effect on your risk of recurrence.   Another thing to consider: Recent research indicates that alcohol appears to only increase breast cancer risk in women who have low folate levels. Folate is a B vitamin that is found in a variety of foods; it is also added to many vitamin and mineral supplements. In its synthetic form it is referred to as folic acid. So if you are someone who enjoys a glass of wine with dinner, you may want to consider taking a folate supplement or a multivitamin that includes folate. "  http://www.dslrf.org/breastcancer/content.asp?CATID=60&L2=1&L3=6&L4=0&PID=&cid=596&sid=132
• From Dr. Michele Holmes (who specializes in lifestyle factors and BC - see the video link in my above post): "Kwan et al showed what we've always suspected: There's an increase in recurrence and breast cancer death associated with alcohol, mostly in postmenopausal women, and the impact may be worse in obese women. They did not find an increase total deaths, which pulls together some of the previous literature. Our message about alcohol to women with breast cancer may have to be as nuanced as our message to women who don't have breast cancer. Yes, alcohol may indeed increase the risk for recurrence and death from breast cancer. However, with the very high survival rates of women with early-stage breast cancer, many patients live long enough to get heart disease. Alcohol may not increase risk for total death because it is preventing women of dying from heart disease."   http://www.hemonctoday.com/article.aspx?rid=51335

I'm not suggesting that heavy alcohol consumption is good for us - there have been dozens of studies that have shown that it's not.  I'm not advocating that those who don't consume alcohol now start drinking - of course not.  I'm not saying that those who choose to eliminate alcohol from their diets are making a bad choice - not at all.  I'm also not suggesting that there is no link between breast cancer risk and alcohol - alcohol does slightly increase BC risk.  But I'm fed up with all the scare tactics that lead women with BC to believe that they can never enjoy a drink again.  We need to have perspective and look at alcohol in the context of the total picture of our BC risk, our overall health and our lifestyle/enjoyment of life.  And in that context, for those of us who enjoy an occasional glass of wine with dinner, the science suggests that there is nothing wrong with that and for most of us, the negative health impact will be minimal, if there is any impact at all.

Daisy, I did the math on the 30% recurrence risk.  Women can decide for themselves if this is a  minimal increase in risk, based on their on risk level and their own risk tolerance.  For me, having had a mastectomy, a 0.1% increase in risk per year is minimal.  If you think that's too much of an increase in risk for you, then make your own choice.  I'm not trying to make this decision for other women - like you, I'm trying to present the facts so that they can make the decision for themselves.  For me, that means presenting what I believe to be credible sources of data, including the conclusions of respected specialists who have reviewed all the research.  Yes, there are over 600,000 articles on the internet that women can search through themselves, but how many are written by experts who understand this issue, have read all the research studies and know how to analyse a piece of research? How many are thorough reviews of the research, rather than topline summaries? How do you figure out what is a good article vs. one that is only presenting a part of the study (the part that is most likely to get headlines, rather than the "ifs" and "buts" that go along with most every research study).   Dr. Holmes is Professor at Dana-Farber/Harvard and Brigham and Young.  Her specific area of study is how diet/lifestyle factors affect survival for those diagnosed with breast cancer and prostate cancer. Your dietian may have attended ASCO; Dr. Holmes presented at ASCO.  To me, she's a credible source.

Or how about Dr. Jeffrey Peppercorn, who is a researcher/breast cancer specialist from Duke?  Here's his analysis on the most recent study that showed the 30% increase in risk:  "...The new results could be consistent with counseling breast cancer patients that "one glass of wine may be okay, but keep it at that," Peppercorn said, though he cautioned against overinterpreting the observational data. Peppercorn additionally warned about the barely significant overall hazard ratios and the limitations of self-reporting alcohol intake."

What's important to note is that we are not disagreeing on the research or the results.  We are actually quoting the exact same study.  What we are disagreeing on is the interpretation and implications of this study and for this I am relying on the opinions of experts.  By the way, it's not me who says that a 30% increase in risk is considered "low risk".  Komen say that.  And here's how the American Cancer Society talk about alcohol and breast cancer risk:  "Compared with non-drinkers, women who consume 1 alcoholic drink a day have a very small increase in risk. "  ACS :: What Are the Risk Factors for Breast Cancer?   And from the Annals of Surgery/NCI:  "Risk factors that have received a great deal of publicity (hormone use, alcohol consumption, obesity, nulliparity) present a relatively modest relative risk for breast cancer (<2). ....the documented effect of alcohol consumption on the incidence of breast cancer appears to be modest. Numerous studies have reported that consumption of one drink per day or less (approximately 12 g alcohol) does not significantly affect the risk of breast cancer."  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1514477/  So my comment about alcohol being a "low risk factor" is based on the medical/scientific standpoint assessment of risk; it's not my opinion.

I agree completely that everyone can and should make their own decision about whether or not to consume alcohol and I encourage everyone to read up on the BC & Alcohol studies.  It's important to not rely on the opinions of laypersons - including myself.  My only advice is to be careful in your choice of information sources - all articles on Google are not equal.  Read the respected medical journals if you can, read the original reports on the studies or the interpretations from experts in the field.  Then make a decision that's right for you, for your health and for your lifestyle.

By the way, I find that one of the best things I do to reduce my blood pressure is relaxing with a glass of wine!  Since there are those who believe that stress may lead to breast cancer, and since stress has certainly be proven to cause a multitude of other health problems, I consider that to be one of the good things that I do for my health! 

In all my posts on this topic I've stressed that I am referring to "moderate" consumption.

Given what the BC & Alcohol studies actually show, and given the questions about how many of these studies are done (self reporting is a big issue; when self-reporting, do women underestimate the amount of wine that they drink? Quite possibly, don't you think?) I think it's wrong to scare women into thinking that alcohol consumption is bad.  A question such as the one that started this thread stems from those types of scare tactics, whether in the press or on this board.  Honestly, should someone who had a bilateral mastectomy for non-invasive breast cancer really be worried about whether drinking a glass or two of wine will increase her BC recurrence risk?  I understand why the question was asked - I'm not criticizing that at all - but to me the answer should be pretty simple:  If you've had a bilateral mastectomy for DCIS, your risk is so low that any possible minor increase in risk from alcohol consumption isn't something that you should be worried about, if you want to enjoy the occasional glass of wine. The stress of worrying about it will be worse for you than the occasional glass of wine. For the question asked, that's the simple and factual answer.  And many did answer that way.  Unfortunately it wasn't left at that and instead a discussion was started about how alcohol has a high impact on recurrence risk.  This is factually incorrect; alcohol has a low impact on recurrence risk.  And given the question that was asked to start this thread, this subsequent discussion seems to serve no purpose but to counter the earlier responses and create fear and questioning about whether any alcohol is okay.     

Most studies on BC and alcohol consider a glass of wine to be 5oz.  None of the studies (to my knowledge) have shown any increase in risk for those who consume up to 3 glasses of wine a week.  Most of the studies have shown that consuming 4-6 glasses of wine a week may increase BC risk anywhere from 10% - 30% (but with no increase in overall mortality).  Those are the facts.  Everyone can decide from there what they choose to do about that. 

There are many women who make an educated decision about alcohol consumption and choose to consume moderately. I am one of those women.  I think it's shameful the way that so many (in the press, some doctors, some women here) try to make us feel guilty or bad or stressed about our choice.  The facts - about moderate alcohol consumption - simply don't support that. 

Everyone can - and should  - make their own decision about this.  Daisy, both you and I have presented different points of view and supporting documentations.  I'm happy to leave it at that.

With regard to how a 30% increase in recurrence risk can equate to a 0.1% increase in risk per year, here's how the math works on that. What's necessary is to convert the relative increase (30%) into an absolute increase.  Here's how that's done:

• It is generally agreed that for those who have a mastectomy for DCIS, recurrence risk falls in the range of 1% - 2%.  This has been confirmed by many studies.  Note that this is lifetime recurrence risk (i.e. this risk is spread out over all the years of the rest of your life).
• 30% of 1% is 0.3%; 0.3% is the absolute risk increase.  This means that a 30% increase of a base risk of 1% equals 1.3%.
• 30% of 2% is 0.6%; 0.6% is the absolute risk increase.  This means that a 30% increase of a base risk of 2% equals 2.6%.
• Therefore, for those who choose to consume alcohol moderately, their lifetime recurrence risk after a mastectomy for DCIS may increase from a range of 1% - 2% to a range of 1.3% - 2.6%. 
• As I explained in one of my earlier posts, while a recurrence can occur at any time, even 10 or 20 years later, most recurrences happen within the first 5 years.  This also means that most of the risk increase from consuming alcohol will affect us during those first 5 years.  So let's assume that 80% of recurrences happen within the first 5 years.  That means that the amount of risk increase that will impact us over these first 5 years will range from 0.24% to 0.48% (80% of the 0.3% and 0.6% absolute risk increases).  To determine the annual increase in risk, divide these numbers by 5.  This means that the annual risk increase for those who have a mastectomy for DCIS and who choose to consume alcohol moderately is in the range of 0.05% to 0.1% (I've rounded the numbers up).

Edited for typos only.

how did you even find out you had a recurrence?  I had DCIS in 1 breast, had them both removed and did immediate reconstruction with lat flap procedure.  was under the impression after the pathology came back negative for invasive cancer and the node was negative that would be it.... no more mammography etc.... how did you discover 8 months later of a recurrence?

Daisy-

I can appreciate what you are saying, however, they know NOTHING about what is causing cancer so avoiding certain things is the equivalent of shadow boxing.   We don't know who/what the ghosts are or what the problem is.   All alcohols do not have the same properties etc.. so I just find it to be a bunch of :malarkey.   Again, this is a byproduct of "we-don't-know-what-the-hell-is-going-on-let's-pin-the-tail-on-the-cause!" 

To each their own but before you stress out over a few drinks or whatever remember if liquor was the devil 95% of the population would have bc.  I still quote Axel Rose from Guns N' Roses and their profound lyrics of "they blame it on the cigarette but I can't see, tell me who you are going to believe."  Enough said!

Liz

I come from a long line of drinkers. While I enjoyed alcohol in my twenties, by my 30s I was strictly a "social drinker" and after I had my daughter I just about gave up alcohol.  For the past 20 years, I did a lot of the "right things"-  walked 5 miles daily, ate organic, gave up butter and most fats,etc.  I have 6 older siblings and two parents still alive in their late 80s-- At 43, I was the first(and for their sakes, I hope the last)  in my family to get cancer-- and I was the one who was always teased for "looking" so fit. But I also live in a world in which people put pesticides on their lawns (and my generation, women in their 40s, have all been exposed to pesticides since our childhood-- who ever regulated DEET when we were kids or the pesticides sprayed from airplanes?), the FDA and EPA refuse to properly regulate our air and water (my filter system is good but cannot remove pharmaceuticals or weed killer).  Every time I see my oncologist, I ask, what did I do wrong? should I eat more broccoli? will not eating tumeric daily  bring back my cancer? what I want is to regain control of my life, but it's gone forever  Her area of research is on diet and exercise and their relationship to breast cancer-- but she  just shakes her head when I ask, "do I need to give up sugar completely?" (My God, what is left for me to enjoy?). I will not give up chocolate and I finally enjoy butter (ironically, my cholesterol is always perfect now that I restored fats to my diet).  So like so many of you have said, we have to just live our lives-- probably we'll always worry (I know I do), but we can't blame ourselves for causing our cancer. As my doctors all concur, "it's just bad luck."    - -- Julie.

I can't recall what the BS told me.. I think she said to recuperate and then we would have a follow up appointment sometime.  I was just curious how they found IBC on someone after a bi-lateral mastectomy ... I guess there is no guarantee all the tissue is removed but I feel like I had it.. now it's gone.... and I was told no more mammography after this.... I guess I have more questions for the docs!

I thought I'd bump this topic in case anyone has new information....?

I love this site.. I find almost every issue. I was worried about drinking wine after bilateral mastectomy also. I figured it wasn't too harmful to have a glass or two. So much information and misinformation and confusing statistics. I've got over 150 bottles of wine in my cellar and I'm not dumping them out or giving them away. Too bad we can't all meet and have a wine party!!

Cheers

From what I read online alcohol abuse definitely contributes to breast ductal hyperplasia (which in some cases is a precursor of bc) and they define abuse as the consumption of more than 7 portions of alcohol weekly (1 portion equals one beer or one glass of wine or one shot of liquor e.tc.).  I used to be a heavy drinker for 40 years before I was diagnosed with adenosis and ductal hyperplasia but I anyway had to quit altogether few months prior to my diagnosis due to alcoholic fatty liver issues.  I found it easy to accomplish through the occasional use of beers without alcohol and of course there are non alcoholic wines too (at least in Europe) but I didn't want to just replace a bad habit with a substitute that will resemble so closely to my initial addiction and compromise my effort so I never tried these non alcoholic wines.  In social occasions I might or might not self indulge in a real beer but even if I do so I just sip this one drink for hours! lol  I'm very scared of all the repercussions of alcohol use or abuse cause I've been there, done that and it actually didn't turn out favorably for me... Cheers! lol