Should survivor become teetotaler?

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.

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.