By Ross Walker

Every year, approximately 3.3 million people worldwide die from 60 different alcohol related health issues. This brings up some very important questions. Is all alcohol harmful? Is there a safe dose? And, is anyparticular type of alcoholic beverage beneficial to our health?

Firstly, and most importantly, there is no dispute that consuming more than four drinks per day on a regular basis and also binge drinking which is defined as 5 or more drinks in one sitting, are related to significant alcohol related health issues and should be discouraged.

Secondly, around 1 in 20 people carry one of the genes for alcoholism and they should avoid all alcohol. But many people enjoy low dose to moderate consumption of alcohol and the evidence is conflicting as to whether this is harmless, harmful, or possibly may even confer some health benefits. 

A recent paper published in the journal Alcoholism: Clinical and experimental research, has explored three areas of alcohol research and its relationship to breast cancer.

Firstly, there is a clear relationship between alcohol directly affecting hormone levels - alcohol metabolites have been shown to be cancer causing. Alcohol also blocks the key metabolic pathway known as the 1-C metabolic pathway, which has strong immuno-protective mechanisms. 

Secondly, the evidence from 15 trials in the meta-analysis suggests that consuming regular, low dose alcohol – one daily for women and two daily for men (a standard drink being 125mls wine, 1 middy of beer and one 30ml nip of spirits) may be a concern in women. Consuming low dose alcohol is, in women, associated with an increased breast cancer risk. 

Finally, it is estimated that 144,000 breast cancer cases and 38,000 breast cancer deaths worldwide were directly due to the regular consumption of alcohol at any dose. 

Well, does this seal it? Should women avoid alcohol completely because of these well-established facts?

You may be surprised to hear that I don’t believe it is that straight forward. The clue is in the title of the journal, Alcoholism: Clinical and experimental research. Although I believe it is irresponsible for any doctor to encourage any person to drink, I also believe it is important to look at the entire body of evidence before publishing a blanket statement such as “low dose alcohol increases breast cancer risk”.

Let’s look at the well-established data that has not been considered in this article;

1. There is a clear link between obesity, type 2 diabetes and a number of cancers including breast cancer. Could it be obese and/or diabetic women who consume low dose alcohol have the increased risk, and not those with an acceptable BMI? This important concept was not mentioned. 

2. If you consider the data from the Mediterranean, there is, in fact, a 50% reduction in cardiovascular disease and cancer in consumers of low dose alcohol. So, it may even be the interaction between low dose alcohol and a poor western diet – with or without obesity – and diabetes that contributes to breast cancer risk.

3. Almost never spoken about in medical literature, or in the media, is the well-established, long-term data from the Nurses Health Study that showed in those women who took a daily high quality multi-vitamin for 15 years or more and consumed low dose alcohol, the breast cancer risk was negated.

4. Certainly, not considered as well, are the psycho-social factors that may be associated with breast cancer and/or the reasons certain people may consume alcohol.

5. Finally, many people who consume alcohol under report their intake, so, again it may be that higher doses are consumed despite the fact that women may claim they are only drinking one to two glasses per day.

It is my opinion, with the totality of evidence presented, that if women enjoy a low level of alcohol consumption, with a particular emphasis on red wine, a healthy Mediterranean style diet (avoiding western processed, packaged rubbish masquerading as food), take a daily multivitamin and also have a happy life with strong social support, then I can see no evidence for increased cancer risk.

It is my view that it is not the low dose (and I stress the phrase- low dose) alcohol that is the issue, but all of the other associated factors in totality that are increasing the risk for not only breast cancer, but any other alcohol related disease.