The Link Between Alcohol and Breast Cancer

Source:  JAMA 1988;260:652-6 Longnecker, M.P., et al. A meta-analysis of alcohol consumption in relation to risk of breast cancer.

A Harvard meta-analysis of prospective studies found two drinks per day were associated with a 70 percent increased risk of breast cancer. The researchers found that the relationship between alcohol and breast cancer was "dose-dependent." This means the more women drank, the higher their risk. Women in the prospective studies consuming one-half drink per day had a 20 percent excess risk, while those having three drinks a day had 100 percent higher risk than did teetotalers. "Compelling: is the way the Harvard researchers described the evidence supporting dose dependency."

Why does alcohol cause breast cancer? "Some alcoholic beverages contain carcinogens, and alcohol is also metabolized into ... carcinogens in the body," according to the National Cancer Institute. (Journal of the National Cancer Institute 1992;85:700-1)

Authors Austin and Hitchcock in their book, "Breast Cancer -- What You Should Know (But may Not be Told) About Prevention, Diagnosis, and Treatment," Prima 1994, point out that alcohol also suppresses the immune system. Finally, a more compelling reason for the link, the authors cite, is that estrogen levels increase when women drink alcohol and "most breast cancer risk factors also tie to estrogen levels. The alcohol-induced increase in estrogen is therefore most likely to be the primary problem."

Comment by Merrily Manthey. As a psychotherapist I would not only support the studies that show a correlation in breast cancer increase as a result of women drinking alcohol, but also wonder about the lifestyle that is associated with the women that drink alcohol. For example, are they less physically active? Do they use anti-depressants? Are they restrained in their emotional expression? Do they manage stress well? Are they Type A or Type B personality? These are other questions that need to be pursued. -- Merrily Manthey, M.S.

 

 

Does your hospital offer life-saving natural medicine treatments?

If not, ask them, why not? Here's an article about one activist and her efforts to bring natural treatments to a publicly owned hospital in Seattle.

The Simple Measure of CAM's Value

Source:   April 2001   Trustee ... The magazine for health care governance

Merrily Manthey, a trustee at Harborview Medical Center in Seattle, has long been ahead of the complementary and alternative medicine (CAM) curve. A therapist and an organizational and psychological consultant to business, she originated the landmark King County (Wash.) Natural Medicine Clinic Project, helping to create the first U.S. public integrative primary care clinic.

So, even though it might not have come as a total surprise to her fellow trustees when she proposed introducing CAM therapies at Harborview in the early 1990s, she said that she was "met with worry .... These were startling and fear-producing concepts to the board." But she had done her homework. Through her therapy and consulting work she had attended many workshops in the CAM field and had met many of its pioneers, including David Eisenberg, M.D., just when his groundbreaking study on the widespread usage of CAM therapies appeared in 1993.

"In the course of my practice, I looked at alternative therapies and found them necessary. I realized there was a lot that Harborview could do to integrate CAM," Manthey says. With these thoughts in mind, she asked Eisenberg if he would respond to her CEO's questions at Harborview, should he call. He did, and Manthey, another trustee, and a Harborview physician all attended Eisenberg's first-ever CAM conference in Boston in 1994.

They made a report to the board upon their return, and Manthey suggested that Harborview's medical staff be encouraged to research whatever CAM therapies interested them, with the idea of incorporating it into their practice. It's working. In fact, the other trustee who attended the conference with her, a physician, was already and coincidentally well-versed in Chinese medicine -- very useful to Harborview's service community which comprises many diverse Asian and other immigrant populations. "A lot of our patients would not consider any of this 'alternative,'" Manthey says.

Her advice to hospitals that would follow in her footsteps: education. Whether attending one of the many CAM conferences now available or bringing in experts to speak, she advises trustees and executive staff to dig into the research literature that proves CAM is safe and that it works. She calls skepticism about CAM's ability to be scientifically proven "a precognitive commitment to a myth."

"Trustees should be overseeing the quality of care. I think board members have a real obligation in this era of outcomes research to ask, 'Are our treatments getting people better?' The scientific research exists, the outcomes are there. The success of CAM therapies can be measured concretely. When [the medical field] is having lawsuits and medical errors, CAM therapies have had zero injuries."

Setting hospital policy for CAM therapies comes after education, Manthey says, and Harborview is addressing that this year at a retreat. The board plans to more formally support and encourage physician CAM education, suggesting a physician task force to do more extensive CAM research and reporting.

"Doctors have thanked me for allowing them to do this research," Manthey says. As examples, one Harborview physician is now testing the use of magnets to treat depression, and another is using hypnosis in the burn unit.

The board also plans to set policy to offer patients more choice of treatment among allopathic and CAM health care professionals.

"Public dollars are involved in the running of our [county] hospital. When I saw that [nationally] 90 percent of CAM therapies are paid out of pocket, that seemed wrong to me," she says.

Collaboration is the other key to setting CAM therapies in motion, creating a task force of trustees, executives, physicians, medical directors, and whoever in the hospital believes CAM works and wants to see what others have done. In addition to field trips, that group should look to their community and see what it needs most. She suggests finding out where the largest share of charity care dollars go -- and turn that into a "center of excellence" for the most appropriate CAM therapies.

"We could have a quantum leap forward," Manthey says. "It's our job to serve our mission population even if it's not my job [as a trustee] to tell doctors how to practice medicine. The only questions to ask are: 'Are we helping people? Are we really getting people better?'"--Laurie Larson, Trustee Magazine Staff Writer

        For more information contact: merrily@msn.com