Control what you can control: What research tells us can reduce your risk of breast cancer, recurrence, and support better quality of life | SABCS 2025

On December 9, sessions at the 2025 San Antonio Breast Cancer Symposium explored a few of the factors that people with breast cancer can take action on. If you are looking for ways to cope that help you feel in charge of your health, understanding the relationship between alcohol use, obesity, treatment-related menopause, and breast cancer can set you up to have a successful conversation – and build a plan – with your healthcare team.

Alcohol and breast cancer

Alcohol was first linked to breast cancer in 1977. Since then, many studies have confirmed that drinking alcohol increases the risk of breast cancer by affecting hormone levels and causing DNA damage. Here’s what we know:

Does risk change with the number or frequency of drinks? While light drinking is still being studied, the takeaway from this session is that there is no safe level of alcohol use for breast cancer prevention. Risk increases with amount of alcohol consumed. Binge drinking (four or more drinks at a time for women), even just once a month or among younger women, is especially harmful.

Does the type of alcohol make a difference? No. Drinking alcohol of any kind may increase risk of breast cancer.

Does age matter? Drinking alcohol raises the risk of breast cancer in both pre- and post-menopausal women, but the risk increase is higher in post-menopausal women.

Does risk change after quitting alcohol? Research is limited but suggests that stopping drinking can lower the risk of developing estrogen receptor-positive breast cancers.

Does breast cancer subtype matter? Alcohol is linked primarily to estrogen receptor-positive breast cancer. The connection to estrogen receptor-negative breast cancer is weaker.

Does drinking affect risk for people with BRCA gene mutations? As of now, no specific guidance exists for people with BRCA mutations. To understand your personal risk, talk with your doctor. Studies have not yet shown increased risk of breast cancer due to drinking for people with a BRCA mutation. One theory behind this is because BRCA mutations are more strongly linked to ER-negative breast cancer, while alcohol is linked more closely to ER-positive breast cancer.

Can drinking alcohol increase the risk of a second primary breast cancer in the other breast? The research has been inconsistent. A recent large study found that drinking alcohol increased risk of developing breast cancer in the other breast, especially among older women who drank more.

Obesity and breast cancer

Obesity is linked to 13 different cancers, including breast cancer. Extra weight can affect insulin levels and hormones leading to DNA damage, increasing cancer risk. In breast cancer, obesity is most strongly connected to ER-positive breast cancer in post-menopausal women.

Much of the research on obesity and breast cancer is preclinical, meaning they are animal studies often done in mice. Studies focus on how fatty tissue promotes cancer growth and whether damage caused by fat tissue can be reversed. Key updates in this field include:

• More fat tissue can lead to faster cancer growth or spread in people who have breast cancer. Early research suggests that the diabetes drug metformin may be able to reverse this, but this has not been confirmed in humans.
• Early data shows potential for GLP-1 agonist drugs (one example is semaglutide or Ozempic) to reduce risk of breast cancer caused by obesity.
• Females with BRCA mutations who maintain a healthy weight and are physically active early in life have a lower risk of developing breast and ovarian cancer later in life.

Putting knowledge into practice

Many people are still unaware that alcohol and obesity can increase risk of breast cancer. Clinicians and patients may sometimes avoid straight talk about alcohol use and weight.

Healthcare providers can open lines of communication by asking about alcohol use in a way that gives people the opportunity to share honestly. People who report binge drinking, or who simply want to drink less, can benefit from guidance on reducing alcohol use. Similarly, doctors can discuss weight management in a more open and productive way. For support on managing weight, LBBC offers resources on nutrition and exercise specifically for people with breast cancer.

Making menopause more manageable

Menopause can cause symptoms that affect sleep, mood, and quality of life. Menopause is defined as no menstrual bleeding for a year. On average, women in the U.S. reach this point at age 51.

Natural menopause occurs over a period of years triggering symptoms typically ranging from mild to moderate. In contrast, women with breast cancer often enter menopause abruptly or early due to cancer treatment. Their symptoms are often more severe and last longer. Vasomotor symptoms include hot flashes and night sweats that disrupt sleep and result in fatigue, brain fog, and mood changes.

In Tuesday’s presentation, researchers reported that 70% of breast cancer survivors who are in menopause experience genitourinary syndrome of menopause. Genitourinary symptoms include vaginal dryness, painful sex, low sex drive, thinning or drying of the vaginal walls, and urinary symptoms. And the impact is not only physical – these symptoms also affect body image, relationships, and sexual health.

Although hormone replacement therapy is effective at managing symptoms of menopause, it has been mired in controversy since the early 1990s when doctors mostly stopped prescribing it. The studies that raised alarms in the past tested an older drug different from what is prescribed today.

The FDA’s recent announcement that it will remove the black box warnings on all hormone therapies reflects newer research about the safety of hormone therapy, but confusion remains.

By having open conversations with your healthcare team about options that are right for your situation, you can take an important step to regaining control of your menopausal symptoms.

Treatment options for menopausal symptoms include:

• Medications to relieve vasomotor symptoms like hot flashes and night sweats are newer options for people diagnosed with breast cancer.
• Vaginal moisturizers and lubricants may help with vaginal dryness. Moisturizers can be used daily while lubricants are used as needed. While these products bring some relief, they do not always work well enough.
• Menopausal hormone therapy, sometimes referred to as HRT, is a therapy that restores hormones to the whole body (systemic therapy). It is effective for preventing bone loss and can restore vaginal cells, potentially improving dryness and sexual side effects. But systemic hormone therapy is not recommended for women with breast cancer by the American Society of Clinical Oncologists. Confused by mixed messages? Make a plan to discuss your options with your healthcare provider.
• Low-dose vaginal estrogen and vaginal dehydroepiandrosterone (DHEA) are forms of estrogen therapy that are applied only to the vaginal tissue. Major health organizations have endorsed the use of low-dose vaginal estrogen even in women with a history of early-stage breast cancer, but many doctors are still wary of offering these options. It is important to discuss the safety data as it relates to your health situation and balance your quality of life considerations. DHEA has not been studied as much in women with breast cancer but may be a good option for people who are nervous about vaginal estrogen. Research is ongoing in women with metastatic breast cancer on ovarian suppression.

Your personal action plan

While the need for more research on alcohol, obesity, and menopause is clear, these sessions emphasized the importance of sharing knowledge, especially within the medical community and between doctors and their patients.

Wherever you are on your breast cancer journey, open conversations with your healthcare team can help move the needle on your personal risks and benefits of taking related actions. As advocate Thelma Brown said during the menopause presentation, “We’re asking for honest partnerships, up-to-date science, and care for the whole patient.”