Estrogen, alcohol and breast cancer risk

Estrogen replacement has been used for many years to reverse the hypoestrog enic symptoms of menopause and prevent osteoporosis. Studies have found tha t estrogen replacement also decreases cardiovascular risk. In addition, soc ial use of alcohol has been found to decrease cardiovascular risk, Therefor e, both estrogen replacement therapy and alcohol use have been proposed to have cardiovascular benefits, and are often used in combination. Epidemiolo gic evidence indicates that estrogen replacement therapy after menopause in creases breast cancer risk. Regular alcohol consumption is also associated with increase in risk. However, interactions between the two are poorly und erstood. In addition, if alcohol alters circulating estrogen levels in estr ogen users, this may have implications in terms of altering the risks:benef it ratio of estrogen replacement in an undesirable direction. For example, there are data suggesting that the use of both alcohol and estrogen may inc rease breast cancer risk more than the use of either one alone. Data suppor t both acute and chronic effects of alcohol in raising circulating estrogen levels in premenopausal women on no hormonal medications. In postmenopausa l women studies focusing on acute effects of alcohol on estrogen metabolism indicate that alcohol has a much more pronounced effect in women using est rogen replacement than in those who do not. Studies evaluating chronic effe cts of alcohol ingestion on circulating estrogens in postmenopausal women a re needed. (C) 1999 Published by Elsevier Science Ltd. All rights reserved.