As a plastic surgeon, I see breast cancer patients every week, though I have the gratifying job of doing the breast reconstruction and helping women get their lives back to normal. But it’s hard not to wonder why breast cancer is still so prevalent, after so many years and so many dollars of research. And why is it so much more common in our society than in other parts of the world? It has been said (somewhat cynically) that the entire economy of the Western world is built on things that cause cancer, an acknowledgment that environmental and dietary factors must be involved to some degree. And foremost among these appears to be alcohol consumption.
Statistics on consumption of alcohol and its correlation to breast cancer have been dissected and massaged for years, and the result is a mainstream consensus that there is a relationship between the two. The standard interpretation is that for every drink per day on average, the risk of breast cancer increases by about ten percent; a two-per-day habit means a 20% jump in lifetime risk, and so forth. But real life risks seldom behave according to such tidy patterns. While it is clear that high levels of alcohol consumption are associated with an increased risk of breast and other types of cancer, at lower levels it is much more difficult to measure accurately. In fact, there is mounting evidence that red wine in moderation might even reduce the odds of getting cancer.
So what’s really going on here? It is difficult to answer definitively, because it is virtually impossible to measure relationships of human behavior with specific outcomes in large populations with precision. Epidemiologists (scientists who study the patterns of diseases in populations) overcome this to some degree by pooling the data from different studies; if a true correlation exists, the pattern will be amplified and easier to discern. But in the case of breast cancer, there is wide variability in the data in different studies, with some actually showing a negative correlation of drinking and cancer. The granddaddy of all epidemiologic studies in the U.S., known as the Framingham study, in fact found no relationship between moderate drinking and breast cancer. What all of this means is that while heavy drinking is obviously risky in terms of cancer (and a number of other things), at low-to-moderate levels of drinking it is more a matter of extrapolation than proof.
Another problem with the presumed cause-and-effect relationship is that alcohol is not known to be a direct carcinogen. What we do know is that very high levels of alcohol consumption are associated with other risky behaviors, including poor dietary habits. Recent evidence has shown that inadequate intake if folate (vitamin B-9) contributes to cancer risk; so this, combined with other factors such as smoking, may be the real culprits, with alcohol as an abettor of the crime.
Further complicating the picture is the possibility that different types of alcoholic beverages might be associated with different risk levels. With breast cancer, in order to know for certain, we would need identify a population of women who drink only one type of alcoholic beverage (for example red wine) and on a daily basis in moderate amounts, and track their outcomes over a long period of time. Such a study is obviously impractical. But there is good reason to believe that the risk of breast cancer in such a group might be dramatically different.
What has motivated a serious look at the topic is an explosion or research in recent years on chemicals in red wine called polyphenols. Despite their off-putting name, these potent antioxidants turn out to have a range of intriguing properties including specific anti-cancer effects. Scientists are mapping out in extraordinary detail the ways by which some of these compounds help prevent the mutations that cause cancer, inhibit the transition phase from a mutation to a full-blown malignancy, and impair growth of tumor cells even after the cancer is established. The field was blown wide open with a study a few years ago demonstrating that breast cancer cells in tissue culture were killed by wine polyphenols, in doses corresponding to moderate consumption. Studies are now even looking at using polyphenols in conjunction with chemotherapy, to both enhance effectiveness and lessen side-effects.
The anti-cancer effects of wine polyphenols aren’t limited to breast cancer though. Similar properties have been found with prostate cancer cells, and a growing number of other types. This provides a plausible explanation for the finding reported from the Fred Hutchinson Cancer Research Center in 2005 that men who consumed primarily red wine, and in moderation, had correspondingly lower rates of prostate cancer. Other types of cancer fit the same picture, and it appears that overall cancer risk is about 20% lower for those who drink red wine on a regular basis and in moderation compared to nondrinkers.
Why not, then, just drink grape juice and get all the polyphenols without the alcohol? Simply put, wine isn’t just grape juice with alcohol. Juice grapes have much lower amounts of polyphenols than varietals grown for winemaking. This is because the polyphenols, especially the category called tannins, are what give the wine “structure” but these more astringent flavors are not considered an asset in juice. In wine grapes, polyphenols are concentrated in the skins; since red wine is made by fermenting the crushed grapes with the skins, they are further extracted and concentrated. (Not to mention that grape juice just isn’t as satisfying once you have been bitten by the “wine bug”.) There are other dietary sources of polyphenols, though, notably dark chocolate and pomegranate juice. While I endorse these for their antioxidant effects, they are low in the most well studied anti-cancer polyphenol called resveratrol. Where cancer is concerned, antioxidant potency may have less to do with it anyway.
Of course, you can always take a pill with wine polyphenols, as these are widely available now. But keep in mind that there are many unknowns with this approach. No one knows what the side-effects are at high doses, what the optimal combinations are, whether the effectiveness is altered by processing to remove them from wine, etc. What we do know, based upon literally thousands of scientific studies, is that wine in moderation is good for you.
Red wine is a truly unique substance, and the many effects of its constituent polyphenols are still being deciphered. Intriguing possibilities to counter diabetes, Alzheimer’s disease, and a wide variety of afflictions are being explored in addition to its well-known ability to thwart cardiovascular disease. The notion that it may be in the plus column for fighting cancer is still a hard sell, but research in this area is gaining momentum. We can certainly say with some assurance that red wine should be the beverage of choice for those who drink and are concerned about cancer. At least there is one enjoyable thing the diet police can’t take away!
