Alcohol after breast cancer: how much is too much?

Alcohol is a well-established risk factor for developing breast cancer. It raises levels of oestrogen and other hormones, can damage DNA through a breakdown product called acetaldehyde, and adds calories that contribute to weight gain. Even small amounts, such as one drink a day, are linked with a modest increase in the risk of developing breast cancer in the first place. For people who have already had breast cancer, the evidence about alcohol and recurrence is less clear. Some studies suggest that regular drinking may be associated with a higher risk of cancer returning or of a new breast cancer, especially in postmenopausal women and those with hormone receptor positive cancer, while other studies have found little effect at low levels. Because alcohol offers no health benefit that cannot be gained in other ways, and because it is linked with other health problems such as liver disease, heart problems and poor sleep, many cancer organisations advise breast cancer survivors to avoid alcohol or keep intake as low as possible. If you choose to drink, having fewer drinks, having several alcohol-free days each week, and avoiding binge drinking are sensible steps. Alcohol can also interact with some medicines, worsen hot flushes and disrupt sleep, and it should be avoided during chemotherapy unless your team says otherwise. Your personal choice can be discussed openly with your care team.

Less is better

The lower your alcohol intake, the lower the associated risk.

There is no completely safe level

Risk rises gradually with the amount you drink.

Ask about medicines

Check whether alcohol affects any medicines you take.

Weddings, parties and work events often involve alcohol.

Plan ahead

Decide what you will drink before you arrive.

Have a simple response

A polite no thanks, I am driving, or I am looking after my health usually works.

Hold a drink

Holding a soft drink can reduce repeated offers.

Enjoy the company

Focus on conversation, food and dancing rather than drinks.

It can be hard to know how much alcohol you are really drinking, because drink sizes and strengths vary widely, especially when drinks are poured at home or at parties.

Strength varies

Spirits such as whisky, rum and vodka contain much more alcohol per serving than beer, and strong beers and some wines contain more than people expect. Check the alcohol percentage on the label.

Serving sizes grow

Large glasses, generous home pours and topping up before a glass is empty can mean a single drink is actually two or more standard servings.

Mixed drinks and cocktails

Cocktails may contain several measures of spirits, plus sugary mixers that add calories.

Local and home-made drinks

Traditional or home-brewed drinks can be very strong and unpredictable in strength, and some can be unsafe.

Keep track

Counting drinks over a week, rather than per occasion, gives a clearer picture of your overall intake.

Use simple swaps

Choosing smaller measures, lower-strength drinks or alcohol-free alternatives can reduce intake without giving up social occasions.