TODAY’S DOSE OF HONESTY

2 things I wish women knew about breast cancer

Here’s the first thing I want you to know: In the 20 years since I completed my residency in OB-GYN, this ranks near the top of the list of misconceptions women have about breast cancer: Almost no one realizes that the single behavior that either MOST increases or decreases our risk of developing breast cancer is consuming alcohol. 

In fact, the vast majority of women believe that taking birth control pills or HRT significantly increases their risk of breast cancer—which is not true—while precious few appreciate how much drinking alcohol increases that risk. So many women are terrified of developing breast cancer, yet few are willing to give up drinking completely. 

In honor of Breast Cancer Awareness Month, which started yesterday, I want to talk about this.

Let’s start with the facts. Alcohol has been classified as a Group 1 human carcinogen by the International Agency for Research on Cancer. It is linked to 7 types of cancer: Besides female breast cancer, alcohol increases the risk of oral cavity (mouth), pharynx (throat), esophagus, liver, larynx (voice box), and colorectal cancers. Even moderate alcohol intake is associated with a 30-50% increased risk of breast cancer. Studies consistently show that even low to moderate alcohol consumption increases your chances of developing breast cancer.

Combined with other factors, such as genetics and other environmental factors—including poor diet, lack of exercise, obesity, and exposure to secondhand smoke and certain chemicals—alcohol consumption can significantly elevate breast cancer risk, particularly in women with a family history of the disease. It’s undeniable.

Now, some science: Alcohol’s influence on breast cancer is closely linked to its effect on estrogen levels. Alcohol consumption raises estrogen and other hormone levels, through complex reactions in the liver and fat cells that can stimulate the growth of breast cancers. Another way alcohol contributes to breast cancer is through the body’s metabolism of ethanol, its primary component. When the body metabolizes ethanol, it produces acetaldehyde, a toxic substance that can cause DNA damage in cells, potentially leading to cancer development. Alcohol also weakens the immune system, making it more difficult for the body to detect and destroy cancer cells.

So, how much is risky? That’s the second thing I want you to know. The risk increases with the amount of alcohol consumed. According to research, women who drink about 7 servings a week have a 7-10% higher risk of breast cancer than non-drinkers. For those who consume 14 or more servings of alcohol a week, the risk increases by up to 20%. So there really is no completely safe level of alcohol consumption.

And here’s the important thing: When it comes to what “1 serving of alcohol” is, it’s all about the math and measurements. 

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a serving is generally defined as 5 oz. of wine, 1.5 oz. of hard alcohol like tequila, or 12 oz. of regular beer (not IPAs). The reality, though, is that almost no one drinks a 5 oz. glass of wine these days. Just so that hits home, do this experiment: Head to your kitchen, fill a measuring cup with 5 oz. of water, and pour it into a wine glass. Notice how minuscule it appears. If you were served a pour this skimpy in a restaurant and charged full price, you would probably complain!

The point is, THIS is what a real “serving” of wine looks like.

In other words, you may THINK you’re having 1 “drink” but in, reality, you’re having 2 “servings.” After some simple math, the hard truth is while you believe you’re enjoying just 7 drinks a week, you’re actually consuming 14 servings—which takes you from moderate to heavy alcohol intake. Given this AND all of the other risks, reducing or eliminating alcohol consumption is one of the most effective lifestyle changes women can make to lower their chances of developing breast cancer.

My experience: In the last year, I have drastically cut the amount of alcohol I consume. It went from several times a week to several times (if that) a month. Now, I only have a drink if I’m in an environment where I truly feel that 1 or occasionally 2 drinks will add to my enjoyment. That might be a party, a vacation (I love a nice margarita on the beach!), or a special occasion to celebrate. 

When I DON’T drink now: at regular dinners with friends, business dinners, and sporting events—basically, in my day-to-day life. In September, I had 3 drinks: 1 at a friend’s wedding, 1 at a tequila party event, and 1 on a romantic dinner date with my husband. A year ago, I would have had 3 drinks in just half a week. I realized that, given how much I try to optimize my health, it’s hard for me to justify consuming alcohol. There’s just too much evidence confirming how harmful it is to our brains, waistlines, heart, and breasts. 

So, your dose of honesty: Even cutting down your alcohol intake is beneficial. And don’t forget your mammogram—or put it off. Your life may depend on it.

SYMPTOM SOLUTIONS

The menopause symptom you might not know about.

We all know—and do not love—hot flashes, weight gain, poor sleep, brain fog…the list of aggravations brought on by the menopausal transition goes on and on. But there’s another, more wide-ranging symptom that hasn’t gotten a big enough share of the limelight: the musculoskeletal symptom of menopause. It can affect every physical aspect of our body structure, and the time to start protecting against its assault is well before your first night sweat wakes you up.

It’s also Menopause Awareness Month, so I asked my colleague and Core Expert, orthopedic surgeon and sports medicine specialist, Dr. Vonda Wright, to share more about this often-unrecognized symptom of menopause.

Just like a reduction in estrogen leads to other menopausal symptoms such as hot flashes and vaginal dryness, it also affects your muscles, joints, and bones. Every single musculoskeletal tissue contains estrogen receptors; when they’re depleted, it disrupts the regeneration of those tissues. Without estrogen, connective tissue breaks down, and we develop arthritis. Our bodies have a harder time building muscle and maintaining osteoclasts, or bone cells, which leads to bone loss and, ultimately, fractures. We also end up with more inflammation.

The decrease in estradiol, the most potent form of estrogen, leads to five significant changes: heightened inflammation, diminished bone mineral density, the onset of arthritis, reduced muscle mass, and a decline in muscle stem cells. To help prevent this from happening, I recommend pre-menopausal women follow these three steps:

• Decide on hormone replacement therapy (HRT). We need to make a science-backed choice, not a fear-based one, weighing the actual benefits and risks. As a musculoskeletal doctor, I’m a strong proponent of HRT—I take it myself. I see too many women die from fractures and frailty who might have benefitted from HRT.

• Build your muscles. Every woman must lift weights—and not the little pink ones. To make a difference, you must get under a bar and lift heavy weights. The U.S. Centers for Disease Control and Prevention recommends strength training for each major muscle group a minimum of two days per week.

• Eat right—and enough. To avoid burning your body’s supply of bone and muscle, you must eat the right foods. I recommend 1g of protein per pound, plus creatine and enough calories per day. For a 130-pound woman, that is 130 grams of protein daily, which is hard to get from food. So most women should take a protein supplement. Find one that provides a healthy amount of leucine; leucine is a branch-chain amino acid our bodies require but can’t make, so we have to get it from supplements or food.

These tips and advice are designed to not only guide you through five years of perimenopause but to ensure the next 40 years of your life are truly fulfilling. The time between ages 35 and 45 is crucial for cementing the future health of your body’s musculoskeletal system. Build awareness of your muscles and bones, lift weights, eat well with plenty of protein, and build better bones. You can’t start at age 65—it’s a challenging road back.

OUR CORE EXPERT

Vonda Wright, M.D., is a double board-certified, fellowship-trained orthopedic surgeon with subspecialty certification in sports medicine. She is an internationally recognized authority on active aging and mobility, harnessing innovative technology to provide integrative patient-centered orthopedic sports surgery and wellness programming. @drvondawright

COMMUNITY

“Why are people who don’t have diabetes wearing glucose monitors? Is this a thing?”

Interesting question! Here’s what I know:

Tracking sugar intake is standard practice for people who need to keep their blood sugar values low (i.e. people with diabetes). Traditionally, this has been accomplished via finger sticks. A tiny blood sample is taken and applied to a test strip, which is then inserted into a (generally) portable blood glucose meter that displays the results.

Contemporary continuous glucose monitoring devices (CGM), typically worn on the arm, leg, or abdomen, can remain in place for extended periods, offering a less invasive alternative to daily needle pokes. A sensor in the relatively discreet monitor detects blood sugar levels and transmits them to an app or other readable device. Results are delivered instantly with fewer chances of inaccurate results, which can occur with finger stick tests—residue on fingers, damaged test strips, and insufficient blood samples can all compromise outcomes.

So, to answer the question: CGMs have been trending big time on social media. Nondiabetic users who utilize CGMs for whatever reason have flooded platforms like TikTok and Instagram; even some health coaches and dieticians have extolled their virtues. According to the technology review site Engadget, the hashtag #insulinresistance has received a whopping 1.2 billion views on TikTok, while #continuousglucosemonitor has gotten more than 32.7 million views. But is there sound evidence that CGMs can significantly improve the health of people without diabetes? As of right now, no.

CGMs are a vital tool for people with diabetes. They help detect ketoacidosis, a life-threatening concern—particularly those with Type 1 diabetes. When sugar levels climb in these individuals, the body begins to break down fat as fuel, which can lead to a dangerous level of acid in the bloodstream. When it comes to healthy non-diabetics, however, we need more research to determine whether CGM use is worthwhile or simply a fad. Currently, there is no science-backed evidence to justify home monitoring of blood glucose levels in generally healthy adults.

ABOUT DR. JEN

In her roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has written several books, including the best-selling book, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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