Women who consumed moderate levels of alcohol, either before or after diagnosis, had better cardiovascular health and overall survival than nondrinkers. When overall survival of breast cancer survivors is considered, as in this study, the findings include deaths from other cancers and chronic conditions including cardiovascular disease.
“Cardiovascular disease is increasingly recognized as an important contributor to mortality among breast cancer survivors,” wrote the study authors. Some breast cancer treatments have cardiotoxic and metabolic effects, which may be related to deaths from cardiovascular causes among breast cancer survivors.
A MIX OF CAVEATS AND BENEFITS
An editorial by Wendy Demark-Wahnefried, PhD, RD, of the University of Alabama at Birmingham Comprehensive Cancer Center, and Pamela J. Goodwin, MD, of the Samuel Lunenfeld Research Institute at the University of Toronto, accompanied the published study report.5 The commentary explained that the data “reinforce that women who choose to consume modest amounts of alcohol after their breast cancer diagnosis may not be adversely affected; in fact, they may benefit from such a decision.”5
However, the authors raised several important caveats. The first is that, while moderate alcohol consumption is associated with cardiovascular benefit, other known associations include accidental and violent death, chronic health conditions, and psychosocial problems. Moderate alcohol consumption is defined as up to one drink per day for women and up to two drinks daily for men. The authors also stated, however, that nondrinkers should not be encouraged to drink.
The second caveat is that, while several studies now show no adverse impact on disease-specific survival or overall survival from modest consumption of alcohol after breast cancer diagnosis, other associations may apply to some subsets of patients with breast cancer.1,6,7
Demark-Wahnefried and Goodwin explained that the American Cancer Society has published recommendations regarding alcohol consumption for cancer survivors.8 The guidelines state that survivors who drink alcoholic beverages should limit their consumption, with no more than one drink per day for women and no more than two per day for men. The recommendations are controversial in that alcohol consumption increases the risk for several cancers yet decreases the risk of cardiovascular disease, for which cancer survivors have greater risk.
COUNSELING PATIENTS ON ALCOHOL INTAKE
“The results of this study should be reassuring to women with a breast cancer diagnosis. It is unlikely that their alcohol consumption before diagnosis will influence their longevity after diagnosis, and the limited data suggests that if they chose to drink, in moderation, their breast cancer survival will not be adversely impacted. These findings are based upon this one recent large study. Also, a major cause of mortality in women with breast cancer is cardiovascular disease, and this study shows a benefit for moderate alcohol intake,” said Newcomb. She added, “There is also information that maintaining physical activity and avoiding becoming overweight will add to overall health, including enhancing longevity after breast cancer.