Dr. Roach: Should breast cancer survivor become a teetotaler?

Keith Roach
To Your Health

Dear Dr. Roach: I have been reading and hearing that alcohol is now suspect in causing breast cancer. As a stage 1 survivor (lumpectomy and tamoxifen), should I completely give up all alcoholic beverages? I may have between one and three drinks per week. All of my medical team say that is fine. Daily heavy consumption is the problem. What are your thoughts on this?

— J.H.

Dear J.H.: The increased risk for breast cancer among women who drink alcohol depends on how much they drink. Moderate and heavy daily consumption has a clear increase in risk, as does binge drinking, where a woman does not drink daily but drinks four or more alcoholic drinks in one day. I recommend strongly against that kind of drinking for anyone, with or without breast cancer.

For women who drink less alcohol, there is a smaller increase in risk. In an analysis of all published studies, women who drank less than one drink per day had about a 5% increased risk of breast cancer. With the lifetime risk of breast cancer being about 12% in women, these data would suggest the risk is about 12.6% in women who drink small amounts of alcohol. Put another way, among 160 women who drink less than a drink a day, one additional woman will get breast cancer. For a woman drinking on the low end of that group, like the one to three drinks per week you do, the increase in risk would be even smaller. However, since you already have had breast cancer, your attributable risk due to alcohol would likely be somewhat higher.

Drinking small amounts of alcohol has a measurable but small increase in breast cancer risk, and you need to balance the risks against the enjoyment you get from this very modest drinking. Because the increase in risk is so small, it’s worth it for many women.

Dear Dr. Roach: My mother recently had to decide between low probability surgery and more chemo, or hospice care. With her oncologist’s support, she chose hospice.

Mom was fully aware for several weeks while her metastasized endometrial cancer ended her life. The hospice house allowed Mom to live her few remaining days comfortably, pain-free and with dignity.

Please let your readers know that hospice is not giving up, it is accepting the inevitable with care and comfort.

— H.C.

Dear H.C.: I appreciate your writing about a difficult subject. I have referred many of my patients into hospice care, and the overwhelming majority of those patients and their families have reported a good experience, as you and your mom did. I have also seen some of my own friends and family in hospice care and have found that hospice workers are remarkable people. Their wisdom and experience have made a big difference. I have learned over time to refer to hospice early -- doing so in a person’s last few days is too late for to most benefit. It is often the case that people in hospice care live their remaining time not only with more comfort and dignity than many people have at the end of their lives in a hospital under standard care, but also it may extend that remaining time.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.