It is difficult to think that drinking wine and alcohol has anything to do with breast cancer. Yet as many as 6,000 diagnoses every year are linked to alcohol abuse. This was underlined by the oncologists gathered in Rome for the annual congress of the Italian Association of Medical Oncology (Aiom), which opens today.
A campaign to raise awareness
“English research has estimated that only one in 5 women (19.5%) identifies ethanol as a risk factor for breast cancer. It is necessary to fill these gaps as soon as possible, which we also find in our country”, he underlines Saverio Cinieri, National President of Aiom, who launched the first national campaign aimed at women aged 20 and over, to encourage correct lifestyles at all ages, with the aim of reducing the incidence and mortality of breast cancer: “A campaign aimed at the female population with direct messages, which focuses above all on modifiable risk factors to prevent breast cancer and, in turn, all pathologies influenced by lifestyles. One of the areas in which it is necessary to take targeted and immediate action is precisely the level of awareness of the female population on the serious damage of alcohol abuse”.
by Tina Simoniello
The link between alcohol and breast cancer
In fact, it is estimated that almost a quarter of breast cancer cases (23%) are caused by avoidable risk factors. In particular, up to 11% of new diagnoses can be traced back to excessive alcohol consumption. The limit threshold for alcohol consumption is established at 20 grams per day for men (two 125 milliliter glasses of wine) and 10 grams per day for women (about one glass of wine), although it should be remembered that, when talking about cancer, there is no safety threshold.
Ethanol and estrogen
The reason for this association lies in ethanol and its greater toxicity in women who – as experts explain – have less Alcohol Dehydrogenase (ADH), the enzyme that metabolises ethanol. And ethanol stimulates the action of estrogen, the hormones responsible for the growth of about 70% of breast tumors. “It is currently recognized that alcohol consumption, even low levels, is associated with an increased risk of developing breast cancer, with more than 100 studies supporting this relationship – underlines Federica Miglietta of Medical Oncology 2, IRCCS Veneto Oncological Institute of Padua and of the Department of Surgical, Oncological and Gastroenterological Sciences of the University of Padua -. Alcohol consumption increases the risk of developing breast cancer in a dose-dependent manner: in particular, the relative risk increases by 7% for each additional unit of alcohol consumed per day.” Furthermore, alcohol consumption may be associated with an increased risk of overweight and obesity, which in turn are related to a greater likelihood of developing breast cancer, especially in post-menopausal women, where one of the main sources of estrogen production is adipose tissue. , resulting in excessive hormonal stimulation on the mammary gland. “It should be remembered – continues the expert – that the suggested alcohol limits are further reduced in old age. In the elderly, in fact, the ability to metabolize ethanol progressively decreases.”
The lifestyles of the female population in Italy
Yet the data show that almost 9% of women consume alcohol in quantities that are at risk for their health, a sedentary lifestyle is reported for around 37% of Italians, overweight and obesity are respectively present in 26.8% and in 11% and 15.3% smoke. It must be said that healthy lifestyles also play a decisive role in tertiary prevention, that is, in reducing the risk of relapse for those who have already fallen ill, as recalled Federica Martorana, researcher at the Department of Clinical and Experimental Medicine of the University of Catania: “The DELCaP study (The Diet, Exercise, Lifestyles, and Cancer Prognosis Study), published in JAMA Network Open, evaluated adherence to lifestyle recommendations from the American Cancer Society and the American Institute of Cancer Research of 1340 high-risk breast cancer patients. And it shows that strict adherence to these rules before, during and after treatment can reduce the risk of relapse by 37% and the risk of mortality by 58%.
by Irma D’Aria
Self-examination and screening
The Aiom awareness project also includes a focus on self-examination, which should be carried out every month starting from the age of 20, in the first or second week after the end of the menstrual cycle. It must be said that, in older age, this simple practice, very useful for learning to know your breasts and noticing any suspicious changes, does not replace screening exams. To date, however, participation by the target population (50-69 years) stands at 53.6% at a national level and in fact important differences remain between the different areas: in the North the rates reach 61.7%, in 48.3% in the Centre, 40.5% in the South. “This test – says Martorana – is part of secondary prevention and is fundamental, because it allows you to identify the disease in its initial phase, when the chances of recovery are very high”.
50 years of achievements in one book
In fact, it is also thanks to mammographic screening that breast cancer has today achieved high survival rates: at five years it is equal to 88% (on average) and exceeds 90% when the disease is detected in the initial stages. The goals achieved in the last 50 years by Italian oncology – since the AIOM was founded at the National Cancer Institute in Milan – are described in the book “From condemnation to healing. How 50 years of research have changed breast cancer treatment”, by Saverio Cinieri e Mauro Boldrini (Cairo Editore): “5-year survival has gone from 30% to almost 90% in half a century – states President Cinieri -. Today more and more people, thanks also to early diagnosis, are overcoming breast cancer. And advanced disease is becoming a chronic pathology, thanks to effective tools such as targeted therapies and immunotherapy, in addition to surgery, chemotherapy, hormonal therapy and radiotherapy.” As emerged from the recent Congress of the European Society of Medical Oncology, important prospects are also opening up for patients with already treated metastatic disease thanks to drug-conjugated antibodies, which combine a cytotoxic agent with an antibody directed towards a target found on the cell tumoral. This approach has also proven effective in HER2-low tumors, which do not have high expression or amplification of the HER2 receptor and constitute 55% of all breast cancers. “Aiom – continues Cinieri – has contributed, as a scientific society of medical oncology, to promoting these progress, becoming a point of reference not only for doctors, but also for patients, citizens and institutions. Without our Association, these significant advances would hardly have been translated into an improvement in standards of care.”
From prevention to early diagnosis and treatment
The Aiom campaign is created with the non-conditioning contribution of AstraZeneca: “Our commitment in oncology is to offer a cure for the main oncological diseases, with the ambition of eliminating breast cancer as a cause of death – he concludes Alessandra Dorigo, Head of Oncology of AstraZeneca Italy -. This vision pushes us to continue taking care of patients with breast cancer by promoting screening and early diagnosis but also by seeking new standards of care which, thanks to new classes of drugs and new mechanisms of action, improve people’s quality of life” .