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Women & Alcohol
by Jane E. Brody
Sept 15, 1993
New York Times
THE Janus faces of alcohol have emerged once more, this time throwing health-conscious women into what could be a life-and-death quandary. Should they drink to protect their hearts or not drink to reduce their risk of breast cancer?

As evidence mounts for the protective effect of moderate drinking against heart disease in both men and women, it is also accumulating for the potential hazards of even one drink a day to the breasts. To decide how to reconcile these opposing effects, it helps to understand the nature of the evidence and the relative risks of the two diseases.

The Heart

More than half a dozen very large long-term studies have linked moderate alcohol consumption to a reduced risk of suffering a heart attack and dying of coronary heart disease. While most of the studies involved men or mostly men, a recent report from the continuing Nurses' Health Study of 89,000 middle-aged women at the Harvard School of Public Health found that women who typically consumed three to nine drinks a week were 40 percent less likely to develop heart disease than nondrinkers.

A report from a 10-year study of nearly 130,000 men and women by researchers at the Kaiser Permanente Medical Center in Oakland, Calif., found that people who typically consumed one or two drinks a day were 30 percent less likely to die from coronary heart disease than people who abstained from alcohol.

And then came the so-called French paradox: the apparent fact that despite a diet rich in animal fats, the French seem to be spared Americans' epidemic rates of heart disease. The French penchant for wine, particularly red wine, was singled out as the likely protector against saturated fats and cholesterol.

Researchers at Cornell University and the University of California at Davis quickly isolated from red wine substances called phenolic flavonoids, which they say act as antioxidants, preventing LDL cholesterol from clogging coronary arteries.

Another Kaiser Permanente researcher, Dr. Arthur Klatsky, reported that white wine appeared to be equally beneficial, based on coronary rates among the 82,000 people in the study who drank various kinds of alcoholic beverages. In fact, Dr. Klatsky said in reviewing the various large studies, benefits to the heart have been seen not just from wine but also from beer and hard liquor.

In addition, the Framingham Heart Study, among others, has linked alcohol consumption to an increase in the protective HDL cholesterol, which acts like arterial Drano, cleaning out accumulated fatty deposits. Alcohol also seems to have an anticlotting effect, accounting for a related benefit in moderate drinkers: a reduced risk of stroke.

Breast Cancer

Unfortunately, the adverse effects of alcohol on the breast occur at the same levels of drinking that protect the heart. In the Nurses' Health Study, for example, women who typically consumed three to nine drinks a week were 30 percent more likely than nondrinkers to develop breast cancer. Other studies have indicated that one drink a day is associated with an increased breast cancer risk of from 18 to 40 percent.

Dr. Matthew Longnecker of the University of California at Los Angeles analyzed 38 studies on alcohol and breast cancer. He concluded that one drink a day increased breast cancer risk by about 10 percent and two drinks increased it by 25 percent.

This spring, Dr. Marsha E. Reichman at the National Cancer Institute showed that premenopausal women given the equivalent of two drinks a day had a shift in estrogen hormones that could be the mechanism behind the rise in breast cancer associated with alcohol. Breast tissue is acutely sensitive to estrogen, and certain types of estrogen are known to stimulate growth of breast cancer cells.

Benefit and Risk

Dr. Longnecker has pointed out that fewer than 3 percent of American women have two or more drinks a day. Indeed, more than half of women report that they average zero drinks a day. Those who do drink typically have one or fewer a day.

Furthermore, Dr. Meir Stampfer, a Harvard epidemiologist who is a co-investigator on the Nurses' Health Study, points out that heart disease is by far the more important cause of death in American women, at least for women over 50. Whereas 4 percent of women die of breast cancer, about 40 percent die of heart disease. And while heart disease is most likely to be fatal late in life, from the ages of 50 to 70 the coronary death rate in women is still two to four times the death rate from breast cancer.

Even for women with a family history of breast cancer, Dr. Stampfer believes that "a drink a day is not too much" and "there's little health reason to stop."

He has also noted that how much women drink in midlife may not be the critical factor in breast cancer risk. He cited one study suggesting that drinking before the age of 30 accounted for the entire association between alcohol and breast cancer.

Even if a cause-and-effect relationship is established between alcohol and breast cancer, he said, "differences in alcohol intake would explain only a small fraction of breast cancer rates." In other words, alcohol at worst would account for only a small percentage of the breast cancers that afflict American women.

Consume Cautiously

For women, one drink a day is the definition of moderate. That means one four-ounce or five-ounce glass of wine, one 12-ounce beer or a single one-ounce shot of hard liquor. This amount has a biological effect similar to that of two drinks a day in men, who tend to weigh more, have less body fat and who metabolize alcohol more efficiently than women do. Heavier drinking -- more than two drinks a day -- actually harms the heart, erasing the benefits of alcohol.

Nutrition Action, a consumer newsletter published by the Center for Science in the Public Interest in Washington, further cautions pregnant women and those trying to become pregnant to abstain from alcohol entirely, because of the risk of damaging the developing fetus, a position taken by many doctors' groups.

Similarly, the newsletter warns, alcohol should be avoided by people taking antihistamines or prescription drugs that interact with alcohol, those who expect to be driving or operating machinery within two hours and those who are addicted to alcohol and cannot stick to moderate levels.

Finally, women with a family history of alcoholism might think twice about drinking at all.