Dame Sally Davies, Britain’s chief medical officer has come out fighting with regard to a glass or two and the risk of breast cancer. “I would like people to take their choice knowing the issues and do as I do when I reach for my glass of wine,” she told a Commons committee last week. “Think – ‘do I want a glass of wine or do I want to raise my risk of breast cancer’ – and I take a decision each time I have a glass1
.” I understand that it is Dame Sally’s job to make policy and to motivate us all to follow it BUT how does it feel to be on the receiving end of such advice AFTER a diagnosis? Before we explore feelings, let’s look at the evidence (far be it from me to doubt the Chief Medical Officer – I have no doubt, but I am nosy…..) Cancer Research UK tell us Regularly drinking even small amounts of alcohol can increase the risk of breast cancer <2,3>. A review of the evidence in 2012 concluded that having 1 drink a day (around 1.5 units) could increase the risk of breast cancer by 5% <2>. And the risk increases the more a woman drinks, several studies have found that each additional 10g of alcohol drunk a day increases the risk of breast cancer by about 7 - 12% <4-7>. Breast cancer is much rarer in men than in women, and less is known about things that may affect the risk. The small number of cases also makes this difficult to study. But a 2014 review that included 20 different studies suggested that alcohol wasn't linked to breast cancer in men <8>. Is that clear? Not to me it’s not, an ‘increased risk’ is a relative risk – it is relative to the risk you were at in the first place. 5% more than zero is still zero. In order to interpret that information, one needs to be aware of one’s absolute risk. The chance that one will develop cancer, in this case breast cancer. Alone, this information is not helpful or informative. Dame Sally’s considerations might be helpful to her – as she is very specific in mentioning her risk. The risk of one developing breast cancer depends upon a lot more than alcohol intake, the most significant factor has got to be genetics (just ask the BRCA ladies). Cancer Research UK list 46 risk factors and 5 factors that will decrease risk. We are still no closer to knowing our individual risk but we have a bigger picture. When one has been diagnosed, there is a test9 that will help a medical team to decide if chemotherapy is needed. The test takes a lot of the risk factors into account as well as an analysis of cells removed from the tumour. The quantification of risk (the % likelihood for each of us) appears to be a complicated business eh? With all of that in mind – how does it feel to hear this advice? Thankfully I haven’t been through the life changing experiences that others have – maybe that’s why this sounds ‘finger wagging’ to me? Maybe I have reacted badly to it as I understand risk & react badly to poor risk definition and communication – what a nerd I am! Jo, hasn’t been through treatment either – Jo feels rebellious As a stand-alone quote I'm afraid it sounds very preachy and self-righteous to me. And scare mongering. It wouldn't change my behaviour - I think life is too short to think about breast cancer every time I pick up a glass of wine! I eat healthily, drink moderately, check my breasts regularly and have just been screened for breast cancer and all is well. I have a very fatalistic approach to these things and to be told how and when to enjoy myself in this way doesn't sit well with me. Must be my rebellious nature! We have to give the last word to Sam. Sam has been diagnosed 3 times, all before the age of 35. Sam says, Dame Sally’s words make me feel like I am not the only one who has a dislike of alcohol for health reasons. It makes me feel I have someone on my side and supported. It makes me feel empowered actually! Fiona, diagnosed a long time in the past, soon after her son was born, says, “It can’t be my fault…..I have to have the odd glass of wine, it can’t be my fault.” Please don’t think I am encouraging binge drinking- I’m not. Alcohol is a risk factor in sooooo many diseases and, as my children remind me, it is a neurotoxin (thanks for that High School Education). It is up to you to make your decision each time you raise a glass, or not. My only advice would be, whatever you decide, take great joy in it. If you are to take Dame Sally’s good advice…..Lent starts today……what more of a reason do you need?
By Jennifer Young
References 1.http://www.theguardian.com/commentisfree/2016/feb/07/sally-davies-wine-cancer-drinks-industry-helen-mirren (accessed 8th February 2016) 2. Seitz, H., et al., Epidemiology and pathophysiology of alcohol and breast cancer: Update 2012. Alcohol and Alcoholism, 2012. View summary on PubMed (link is external) 3. Bagnardi V, Rota M, Botteri E, et al. Light alcohol drinking and cancer?: a meta-analysis. Annals of Oncology. 2013;24(3):301–8. View summary on PubMed (link is external) 4. Smith-Warner, S., et al., Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA, 1998. 279: p. 535-40. View summary on PubMed (link is external) 5. Key, J., et al., Meta-analysis of studies of alcohol and breast cancer with consideration of the methodological issues. Cancer Causes Control, 2006. 17(6): p. 759-770. View summary on PubMed (link is external) 6. Hamajima, N., et al., Alcohol, tobacco and breast cancer – collaborative reanalysis of individual data from 53 epidemiological studies, including 58, 515 women with breast cancer and 95, 067 women without the disease. Br J Cancer, 2002. 87(11): p. 1234 View summary on PubMed (link is external) 7. Allen, N., et al. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst, 2009. 101(5): p. 296-305. View summary on PubMed (link is external) 8. Cook MB, Guenel P, Gapstur SM, et al. Tobacco and Alcohol in Relation to Male Breast Cancer: An Analysis of the Male Breast Cancer Pooling Project Consortium.; 2014:1–33. View summary on PubMed (link is external) 9. https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/diagnosed-breast-cancer/diagnosis/oncotype-dx accessed 8th Feb 2016