January 11, 2012 — When it comes to the consumption of alcohol, the message has been decidedly mixed. Some studies show that moderate consumption might offer some health benefits, especially for the heart; other studies show an increased risk for certain cancers with the consumption of a very small amount of alcohol.
A new study has found that the consumption of red wine might offer some degree of protection against breast cancer. The results of this small study, published online December 7, 2011 in the Journal of Women's Health, challenge findings suggesting that all types of alcohol consumption can raise the risk of developing breast cancer.
In the study, researchers from Cedars-Sinai Medical Center in Los Angeles, California, found that, in healthy premenopausal women, red wine is associated with significantly more free testosterone (mean difference, 0.64 pg/mL; P = .009) and less sex-hormone-binding globulin (mean difference, 5.0 nmol/L; P = .007) than white wine.
In addition, luteinizing hormone was significantly higher with red wine than with white wine (mean difference, 2.3 mIU/mL; P = .027). Follicle-stimulating hormone levels were also higher with red wine, but not reach statistical significance.
These data suggest that red wine acts as a nutritional aromatase inhibitor (AI), the study authors note, which might explain why drinking red wine does not appear to increase the risk for breast cancer.
Intriguing, but More Research Needed
Although this is a small study, the data suggest that all alcohol does not necessarily confer the same risk, explained Therese Bartholomew Bevers, MD, professor in the Department of Clinical Cancer Prevention at the University of Texas M.D. Anderson Cancer Center in Houston.
"This study is also unique in that it was well controlled and the authors actually looked at the effect of red wine on hormone markers," said Dr. Bevers, who was approached by Medscape Medical News for independent comment. "It...certainly provides interesting data on the different effects of red and white wine on hormone markers."
More definitive research is certainly needed, she added. "Many women occasionally enjoy an alcoholic beverage but have begun to have concerns that consuming even small amounts is harmful," Dr. Bevers said. "We need to definitively answer this question so that we can appropriately counsel a woman and guide her to the alcoholic beverages that do not affect her breast cancer risk — or may even have protective effect — [and away from] those that adversely affect her risk of getting breast cancer."
Study coauthor Glenn Braunstein, MD, agrees that more research is needed. "A large prospective study looking at hormones, other biomarkers, and breast density as a surrogate for breast cancer risk would be reasonable," said Dr. Braunstein, who is vice president for clinical innovation and the James R. Klinenberg, MD, Chair in Medicine at Cedars-Sinai.
"A true breast cancer 'prevention' trial would have to have a very large number of women followed for a long period," he added. "Also, we do not want women who do not currently drink to start drinking."
The data from this trial suggest that red wine has some aromatase inhibiting properties. "Whether this is sufficient to offset at least epidemiologic data that indicate that alcohol is a risk factor for breast cancer is unknown," he told Medscape Medical News.
For now, both Dr. Bevers and Dr. Braunstein believe that red wine is the better option for women who currently consume alcoholic beverages. "For those who consume wine, I would suggest red wine," said Dr. Braunstein. "For those who drink other alcoholic drinks, I would suggest switching to red wine. For those who don't drink, don't start — just eat grapes."
Research Shows Higher Risk
As previously reported by Medscape Medical News, a number of studies have found an association between alcohol consumption and an increased risk for cancer. Data from the large observational Nurses' Health Study, which looked at more than 100,000 women, found that even a modest amount of alcohol — 3 to 6 glasses of wine per week — over a long period of time increased the risk for breast cancer by a small but statistically significant amount.
Another study (J Clin Oncol. 2010;28:4410-4416) reported that alcohol consumption appears to increase the risk for breast cancer recurrence. However, that study also suggested cardioprotective benefits associated with alcohol consumption, and the study authors acknowledged that the evidence can be difficult for patients to interpret.
Results from the Million Women Study, conducted in the United Kingdom, found that even low to moderate alcohol consumption significantly increased the risk for cancer. The risk was increased not only for breast cancer, but for malignancies of the liver and rectum, and for the mouth and throat in women who smoked.
Dr. Braunstein and colleagues note in their study that naturally occurring AIs have been identified in grapes, grape juice, grape seed extract, and red wine, but not in white wine. The AI activity observed in red wine has been attributed to the phytochemicals, not the alcohol content.
AIs play an important role in the management of estrogen-receptor-positive breast cancer in postmenopausal women, but their role in premenopausal women is still being investigated, the authors write. These agents prevent the conversion of androstenedione and testosterone to estrogen, and thus lead to increased serum levels of testosterone and decreased level of estradiol, estrone, and sex-hormone-binding globulin.
In their study, Dr. Braunstein and colleagues tested whether red wine is a nutritional AI in premenopausal women, and whether red and white wine produced serum hormone levels in a pattern consistent with an AI.
Using a randomized crossover design, 36 premenopausal women were assigned to 8 ounces (237 mL) daily of red wine or white wine in the first cycle, and the other wine for the second cycle. Blood samples were collected twice during their menstrual cycles for hormone measurement.
"To our knowledge, this is the first report of a controlled clinical trial testing the hypothesis that red wine is a nutritional AI in healthy premenopausal women," write the authors. "These results combined with prior observational and laboratory data suggest that red wine may serve as a nutritional AI, which may ameliorate the elevated breast cancer risk associated with alcohol intake."
They emphasize that larger-scale studies are needed "to determine the safety and efficacy of red wine as an AI for breast conditions."
The study was funded by the Women's Guild of Cedars-Sinai Medical Center, the Edythe L. Broad Endowment, and the Barbra Streisand Women's Cardiovascular Disease Research and Education Program. Coauthor Noel Bairey Merz, MD, from the Cedars-Sinai Medical Center, reports receiving lecture honorarium, owning stock, being a consultant, and being a member of advisory boards. The other authors have disclosed no relevant financial relationships.
J Womens Health (Larchmt). Published online December 7, 2011. Full text
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Cite this: For Women Who Imbibe, Red Wine May Be Healthier Option - Medscape - Jan 11, 2012.