Medicine: Should Women Drink Less?

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Of all malignancies, breast cancer is perhaps the one most feared by women, and with good reason. For one thing, it is the most common form of cancer found in women: about one in ten will eventually be stricken, and the American Cancer Society estimates that 130,000 new cases will be diagnosed this year alone. For another, it will cause approximately 41,000 deaths among females in 1987, second only to a projected total of 44,000 for the less prevalent but deadlier lung cancer. And even when breast cancer is successfully treated, that success is often accompanied by permanent disfigurement and psychological damage. For all these reasons, women are particularly concerned about the causes as well as the treatment of breast cancer, and eager to learn anything they can about how to reduce their risk of contracting it.

Unfortunately, only some risk factors, such as a high-fat diet, can be controlled. Many others -- age (over 50), for example, or a family history of the disease -- cannot. But evidence has been growing during the past several years that there may be one more factor women can do something about: the consumption of alcoholic beverages. Two studies published in last week's New England Journal of Medicine made that case even stronger.

One report, by researchers at Harvard Medical School, concluded that women who consume as few as three drinks a week have a 30% greater chance of developing breast cancer than those who seldom or never drink. In the other study, researchers at the National Cancer Institute went further, reporting a < 50% higher risk for women who drink any alcohol at all, and as much as a 100% increase in risk for those who have three drinks or more weekly.

Lawrence Garfinkel, vice president for epidemiology and statistics at ACS, was impressed with the results. "Women can't do anything about most of the risk factors associated with breast cancer," he said. "When you add something to the list that you can do something about, those women should especially be concerned."

Confronted with demands for specific advice on drinking behavior in light of the new findings, doctors begin hedging. Said Peter Greenwald, director of NCI's cancer-prevention-and-control division: "We don't have the information to be making a public recommendation at this point." Garfinkel agreed, "We need a lot more data." One problem is that these and earlier studies simply associate drinking with cancer; they do not show a cause-and- effect relationship or offer an explanation of the mechanisms involved.

Even if there is such a relationship, it may be far from direct: researchers have speculated that alcohol may make it easier for carcinogens to penetrate breast tissue or may affect hormones metabolized by the liver or released from the pituitary gland. Said Robert Hiatt of the Kaiser Permanente Medical Care Program in Oakland, who reported an alcohol-breast cancer link in 1984: "So far, this is an epidemiological finding that has been repeated, leading to concern. As yet, there is no linkup with biology." Indeed, even NCI's Greenwald conceded that alcohol may be less important than other risk factors.