For Women, the Wineglass Is Half Full

[Guest guest]

By Sally Squires

WASHINGTON POST

Tuesday, April 22, 2008; Page HE01

Raising a glass of wine and wishing " Salud! " -- Health! -- is one of life's

many pleasures.

But for women, this well-meaning cheer rings hollow: There's mounting

evidence that drinking wine and other alcoholic beverages increases the risk

of breast cancer.

That's not the image that many people have about sipping wine, beer or other

alcoholic beverages in moderation. A recent Harvard study of 878 people

found that nearly two-thirds of drinkers and about a third of teetotalers

considered such imbibing to be safe and healthful. So healthful that about

30 percent of those surveyed said the purported health benefits of alcohol

are one reason they drink.

The link between alcohol and breast cancer is something that " almost nobody

in the study had heard about, " says the survey's lead author,

Mukamal, an internist at Beth Israel Deaconess Hospital in Boston. Only 10

percent correctly identified breast cancer as a possible risk of moderate

drinking, the researchers reported in the journal Family Medicine.

Since the survey ended, Mukamal continues to informally poll people at

cocktail parties. " I've spoken with other colleagues and friends who I would

have considered to be fairly sophisticated consumers, " he says. " And most

have no idea about this, either. "

Yet just this month, Danish researchers added to a substantial base of

evidence linking alcohol consumption to an increased risk of breast cancer

in women. These results offer a cautionary note for younger women and

underscore that it's never too early to go easy on alcohol. The researchers

tracked nearly 10,000 women for 27 years. They found that the amount of

alcohol the women consumed when the study began, rather than after

menopause, correlated best with their breast cancer risk nearly three

decades later.

If women do drink, there's widespread agreement that they should avoid

having more than one drink per day. (A drink is 5 ounces of wine, 12 ounces

of beer or 1.5 ounces of distilled spirits such as whiskey, tequila or

vodka.) Just that amount of alcohol translates to " about a 10 percent

increased risk of breast cancer, " says Rimm, an associate professor of

epidemiology and nutrition at the Harvard School of Public Health.

More alcohol equals more risk. How much more? " Some studies suggest that two

or more drinks per day are associated with about a 30 to 40 percent increase

in the risk of breast cancer, " says JoAnn E. Manson, chief of preventive

medicine at Harvard's Brigham and Women's Hospital and a professor of

medicine at Harvard Medical School. For women who have other risk factors --

a mother or sister with breast cancer, for example -- " that can be a

substantial risk, " Manson notes.

Just how alcohol raises breast cancer risk is something that researchers are

still trying to understand. Alcohol is known to boost estrogen and other

hormones, which are linked to breast cancer. In animals, alcohol has also

produced some abnormalities of the mammary gland.

Mixing alcohol with hormone replacement therapy can be particularly risky,

since alcohol and estrogen seem to augment each other. " That combination is

something to avoid, " Manson says.

But there may be ways to help cut the risk from drinking alcohol. One

nutrient under investigation is the B vitamin, folic acid. Also known as

folate, this vitamin gets its name from the Latin word for leaf, because it

occurs in green, leafy vegetables, such as spinach, turnip greens and Swiss

chard. Citrus fruits and dried beans are also rich in folate. Research

suggests that women who eat a lot of fruit and vegetables have a lower risk

of breast cancer.

Since 1998, the Food and Drug Administration has mandated folate

fortification in grain products, such as bread and pasta, to help prevent

spina bifida and other neural-tube birth defects. Folate is also a common

ingredient of multivitamins and of prenatal vitamins.

Alcohol blocks folate absorption from food. So researchers have wondered

whether diets high in folate might offer protection against breast cancer

among women who drink. A 1998 study published in the Journal of the American

Medical Association studied nearly 3,500 women with breast cancer and found

no link between folate intake and overall breast cancer risk. But when

researchers looked at women who had at least one drink of alcohol per day,

they found that breast cancer risk was greatest among those with the lowest

folate intake. " Our findings suggest that the excess risk of breast cancer

associated with alcohol consumption may be reduced by adequate folate

intake, " the team reported.

In March, Manson and her colleagues published a report of a 10-year study of

multivitamin use and breast cancer risk in nearly 40,000 women. Taking a

multivitamin did not protect against breast cancer, except in women who

consumed at least one drink daily. Those results " suggest that multivitamin

use might help to counteract the elevated risk of breast cancer for women

consuming alcohol, " Manson says.

But experts say that doesn't mean that it's okay to imbibe and then pop a

multivitamin or eat a lot of spinach to compensate. " There's no conclusive

evidence that any vitamin or nutrient can cancel out the adverse effects of

alcohol on breast cancer, " Manson says. " Studies to date have been

inconsistent. "

Nor is there any evidence that one type of alcohol is better -- or worse --

than any other in terms of breast cancer risk. Red wine is often touted for

health benefits. But there's " no clear evidence that beer or liquor is more

or less likely to increase breast cancer risk than wine, " Manson says.

What counts is how much you drink. Simply put, the more alcohol a woman

drinks, the greater her risk of breast cancer. Or to put it another way,

everything in moderation.