A few weeks ago I filmed a series of videos on how alcohol increases the risk of breast cancer. As many forgo drinking for Dry January, I thought it would be a good time to do it.
And in addition to being a breast cancer surgeon – now retired – I’ve had breast cancer twice, so it’s a subject close to my heart.
In my clips on social media, I state a simple fact: If you want to reduce your risk of getting breast cancer or the chance of a previous breast cancer coming back, reduce how much alcohol you drink.
When alcohol breaks down in the body, it releases a carcinogenic chemical called acetaldehyde. Normally this is broken down into more harmless substances, but continuous, regular consumption means that acetaldehyde can build up in the body – which can cause damage to cells. These damaged cells can become cancerous.
Dr. Liz O’Riordan, who is in her 20s, believes alcohol may have increased her risk of developing breast cancer in her 40s.
Dr O’Riordan, pictured, was diagnosed with the disease in 2015 aged 40.
Drinking alcohol increases the levels of certain hormones, including estrogen, which drives some breast cancers. Just one glass of wine or one pint each day – roughly two to three units of alcohol – increases a woman’s risk of developing the disease, increasing the risk by 15 percent.
For each additional daily drink, the risk increases another ten percent.
If you have breast cancer and you drank alcohol in the past, it doesn’t mean you developed the disease. For most of them we cannot know the exact reason. The three biggest reasons are breastfeeding, old age and old bad luck. But there is strong evidence that alcohol consumption contributes significantly.
A 15 percent increased risk does not mean you have a 15 percent chance of developing breast cancer. This means your own risk of developing breast cancer – depending on your age and whether you have a history of the disease or have it in your family – increases by 15 percent.
Having followed similar accounts on Twitter and Instagram, I know this is a difficult topic to talk about. Some people get angry, calling it ‘victim-blaming’ – as if you’re implying that if a woman who drinks (let’s face it, there are a lot of us) gets breast cancer, it’s their fault.
I feel like blaming the victim, really, I do. After my diagnosis, a friend might mention that they read that working night shifts or stress are ’causes’ of breast cancer. Around that time, there was one big thing that suggested using deodorant was a trigger.
I know there is no good evidence for these things so I can fly off the handle. I felt like people were saying that all the pain I was going through was somehow self-inflicted. And that hurt even more.
Today, having undergone multiple surgeries, chemotherapy and radiotherapy, I am currently cancer free. The treatment ended my career as a surgeon, because it affected how I could move my arm.
But now I write, teach and use social media to raise awareness and share public health messages.
I think it’s important for women to know their breast cancer risk, no matter how uncomfortable they feel.
I often wondered if my own heavy drinking at age 40 might have played a part in my diagnosis as a junior doctor.
I drank like a fish – and after being told that alcohol increases the risk of cancer (also involved in colon, mouth, throat and liver cancer) I didn’t go in.
Maybe I was naive or deliberately looking the other way. I’m ashamed to admit it, but when I was in my early 20s I was so drunk I could barely remember the night before. I was the first student in the year to be hospitalized for alcohol poisoning – and I was proud of it. I went from a narcissist to a drinking narcissist.
Like many young women, I think alcohol gave me self-confidence when I was insecure about trying to establish a career as a surgeon – one characterized by male dominance.
As I got older, I stopped being carefree, but drinking remained a part of everyday life. birthday? Let’s drink. Just unwinding after work? let’s drink…
When my video posts about the link between alcohol and cancer came out, the comments were very positive. People were grateful when they were presented with evidence. But of course some are upset. I’ve been accused of being ‘shocking’ – someone said if they showed my video to a friend who had breast cancer, it would ‘just freak her out’.
He said that I should correct what I said to suggest that the only other risk factor was ‘excessive’ alcohol consumption.
But in reality, there is no safe level of alcohol. Even one portion a day – one shot of spirits or half a glass of wine – increases the risk of breast cancer by five percent.
Others said they were going to unfollow me on social media: ‘I don’t need to hear that the odd glass of wine, after I’ve passed, can cause breast cancer to come back. Farewell is from me,’ one wrote.
There is no safe level of alcohol. Even one portion a day – one shot of spirits or half a glass of wine – increases the risk of breast cancer by five percent
I followed up my article on alcohol with a series of videos on a more provocative topic: how obesity increases the risk and recurrence of breast cancer, especially in postmenopausal women.
Fat cells – also known as adipose cells – produce an enzyme called aromatase, which converts testosterone (yes, women produce it too) into estrogen. And estrogen, as I mentioned, drives certain types of breast cancer.
The more adipose cells you have, the higher your estrogen levels and the higher your risk of breast cancer. This seems to happen especially after menopause, when estrogen levels should naturally be low. Obese postmenopausal women are approximately 30 times more likely to develop breast cancer than non-obese women.
Or to look at it another way, in a group of 100 women in a healthy weight range, nearly nine will develop breast cancer by age 50 or older. In a group of 100 obese women, 11 or 12 will probably develop breast cancer.
Being overweight is also associated with a 40 percent increased risk of breast cancer recurrence.
Again, to state this, it does not mean that an obese woman has a 40 percent greater chance of dying from breast cancer, but that her individual risk of recurrence and death increases by 40 percent.
About 9 out of 100 women in a healthy weight range will develop breast cancer by age 50 or older. In a group of 100 obese women, 11 or 12 will probably develop breast cancer.
Let’s say you have an 80 percent chance of being alive ten years after diagnosis. That means a 20 percent chance of dying from breast cancer in the next decade. If you are overweight, this increases from 20 percent to 28 percent. The higher your risk of relapse, the greater the impact of being overweight.
A recent meta-analysis, which included more than 200,000 patients in 82 studies, found that obese patients with estrogen-driven – or ER+ – breast cancer had a lower survival rate than women of a healthy weight. This includes women who were overweight before diagnosis and those who gained weight afterwards.
When I explained this, critics pointed out that there is no evidence of weight loss after a breast cancer diagnosis. This is true even though the research is still ongoing.
It should be emphasized that not every overweight woman will develop breast cancer or relapse. You can lose weight – not easy as we all know – and the cancer can still come back.
Here’s the thing about breast cancer risk: You can tell the odds based on good data, but you can’t predict the future.
But it is known that being overweight increases the risk, so it makes sense to try to achieve a healthy weight and maintain it, especially after diagnosis.
Could my 25-year-old son listen to a middle-aged doctor and cancer survivor talk about the dangers of alcohol? Probably not, to be honest. But that’s no reason not to put the information out there.
What’s more, hormone blockers used to treat breast cancer can cause women to gain weight. And during chemo there is a tendency to snack a lot, to relieve nausea and discomfort. It happened to me – I put on a stone – but knowing what I knew about danger, I worked hard to lose it.
Again, there was a lot of love for my posts about weight and its relationship to breast cancer. ‘If I had known this ages ago, I would have done things differently. Thank you,’ one commented pleasantly. Another said: ‘It’s hard to hear, but I’ve got the vibe I need!’
But, inevitably, there was also a fair amount of backlash. My posts have been labeled ‘ugly’ and ‘provocative’. One woman wrote: ‘Why do you post things [breast cancer survivors] Do I feel worse?’
My intention was not to preach or make women feel bad about themselves. I know how damaging these things are to patient and doctor relationships – for example, obese women are less likely to visit their GP when they get a lump or something, because they worry their weight will be judged. This doesn’t help anyone.
But I stand by what I said. Facts are facts.
It’s scary how many cancers are caused by alcohol and obesity. We need to get better at having these difficult conversations – blaming ourselves for what we did in the past, when we didn’t have this information, but now, if we want to, we can use it to change our lifestyle and educate our children.
Could my 25-year-old son listen to a middle-aged doctor and cancer survivor talk about the dangers of alcohol? Probably not, to be honest. But that’s no reason not to put the information out there.
Today, I’m not teetotal but I don’t drink much and I’m in the best shape of my life. Getting here was a stick.
I’ve found other things that fill my confidence, besides drinking. I like to exercise and lift weights. And I know that being active can reduce the risk of breast cancer recurrence by up to 50 percent, so I feel like I’m doing something active, because a lot of times, when you have cancer, you can feel very helpless.
I love my job. I make my own clothes. I am a dog owner. I volunteer at the Hedgehog Sanctuary. I found outdoor swimming and a community of women who support and encourage each other.
Yes, it’s hard to hear that you may not be living as healthy as you could and to take a hard look at your lifestyle choices. But I want women – especially young women – to sit up and take note.