Can your drinking habits affect your cancer treatment? Many people taking tamoxifen (Soltamox) wonder about alcohol use and safety.

Tamoxifen is a hormone therapy used to treat hormone receptor-positive breast cancer. It works by blocking the effects of a hormone called estrogen on cancer cells, which may slow down or stop the growth of tumors.

Understanding tamoxifen interactions with alcohol can help you make informed choices during treatment.

Tamoxifen doesn’t work right away. It has to be metabolized (processed) by your liver into stronger, active forms, especially one called endoxifen. This process depends on liver enzymes, such as CYP2D6.

Alcohol is also processed by the liver. Drinking alcohol while taking tamoxifen may make your liver work harder, which may:

• Change how fast tamoxifen is broken down
• Affect how much active drug your body makes
• Put extra stress on your liver

What Does the Research Say?

Some laboratory (preclinical) studies suggest alcohol may weaken tamoxifen’s anticancer effects or change how cancer cells respond to treatment. But research is limited on whether alcohol directly makes tamoxifen less effective. More studies on the relationship between breast cancer, tamoxifen, and alcohol are needed.

Keep in mind that alcohol may also raise estrogen levels or change how the body handles estrogen. This could work against tamoxifen’s goal of blocking estrogen.

“My breast surgeon told me to stop drinking, but my oncologist told me I could drink in moderation and to ‘go live my life,’” wrote one MyBCTeam member.

The bottom line is that science is still developing. If you’re considering drinking occasionally while on tamoxifen, talk to your healthcare team about whether it’s safe. Your doctor understands your health history and can provide personalized advice that cuts through the confusion.

Both drinking heavily and taking tamoxifen can cause similar side effects, including:

• Hot flashes
• Insomnia (trouble sleeping)
• Headaches
• Nausea, stomach pain, or digestive issues
• Fatigue

Drinking alcohol while taking tamoxifen may make these symptoms feel stronger.

“Every time I have a drink since I started tamoxifen, I get hot flashes and have trouble sleeping,” reported a MyBCTeam member.

“Here’s a thought,” posted another member. “Why would anyone want to drink and feel worse?”

Your liver plays a key role in how your body processes tamoxifen. It helps convert tamoxifen into its active form so the drug can work properly.

Alcohol can affect liver health by:

• Causing inflammation
• Slowing how the liver processes medications
• Increasing the risk of liver damage over time

Both tamoxifen and alcohol rely on the liver, so combining them may put extra strain on your liver and reduce how efficiently tamoxifen is activated.

Talk to your doctor if you have a history of liver problems or develop symptoms such as fatigue, abdominal pain, or jaundice (yellowing of the skin or whites of the eyes).

People who don’t take their tamoxifen as prescribed or stop treatment early may have a higher risk of breast cancer recurrence (the cancer coming back) and are more likely to have a poor prognosis (outlook).

In one study, people who stopped hormone therapy before completing the recommended course were more likely to experience recurrence than those who completed treatment.

Make sure to follow the treatment plan that your healthcare team has laid out. Don’t avoid tamoxifen on days you’d like to have a drink.

If you’re finding it hard to stick to your medication schedule, talk to your doctor before making any changes.

Many studies have established that the more you drink, the higher your risk of developing breast cancer. However, it’s not entirely clear whether drinking alcohol after a breast cancer diagnosis affects the risk of recurrence.

Recent large reviews have found that:

• Alcohol use after a breast cancer diagnosis doesn’t appear to significantly increase recurrence risk overall.
• Alcohol doesn’t consistently worsen breast cancer-specific survival.

Importantly, most studies are observational and not randomized, which means results may differ based on factors such as menopause status, body weight, or tumor type, to name a few. More research is still needed, and individual risks may vary.

Living with breast cancer often involves balancing health goals and quality of life.

For some people, occasionally drinking alcohol may be part of their routine, while others may avoid it to reduce side effects or health risks.

Many members of MyBCTeam have discussed their attitudes toward alcohol consumption and their health.

“Honestly, after not wanting to drink for five months during chemo, I was so happy to be able to enjoy a nice drink. Moderation is what I try to stick to. Life is too short — I have to enjoy the NOW, within reason,” shared a member.

Another member shared this philosophy: “I was health-conscious before all of this and still got cancer. I’m just going to exercise daily, eat well, and enjoy a glass of wine when out to dinner. Treating myself with kindness and enjoying life are what I focus on now.”

There’s no one-size-fits-all answer. Your comfort, symptoms, and medical advice all play a role in deciding whether to drink alcohol.

While there’s no single rule for how much alcohol is “safe” during breast cancer treatment, it’s clear that it’s not a good idea to drink too much.

The Centers for Disease Control and Prevention (CDC) defines moderate drinking as:

• Up to one standard drink per day for women
• Up to two standard drinks per day for men

But many oncology experts now suggest that drinking less, or not drinking at all, may be safest, especially during treatment. Some oncology providers recommend stricter limits, such as having only a few drinks per week or avoiding alcohol altogether.

Ask your healthcare provider for recommendations regarding what amount of alcohol is likely safe for you.

Some members described having this conversation with their doctors. “My oncologist suggested not having more than three drinks per week in general, regardless of cancer,” reported one person.

As always, individual health conditions vary, and your doctor may have different recommendations based on their knowledge of your overall health.

What Counts as One Standard Drink?

In the U.S., one standard drink equals about 0.6 ounces of pure alcohol, which can be found in:

• 12 ounces of beer that contains 5 percent alcohol
• 8 ounces of malt liquor or beer containing 7 percent alcohol
• 5 ounces of wine
• 1.5 ounces of distilled spirits or liquor such as vodka, whiskey, or gin

If you’d like to limit or stop drinking during your breast cancer treatment, you have options.

Strategies that may help you cut back include:

• Setting a weekly drink limit
• Alternating alcoholic beverages with water, soda, or juice
• Making at least two to three days each week alcohol-free
• Tracking how often and what you drink
• Planning ahead for situations where you may be more likely to drink, such as social events or vacations

You may also swap alcoholic options for nonalcoholic alternatives or “mocktails.” These can be great options if you want to socialize without the pressure of drinking alcohol.

Served in a nice glass with a fancy garnish, a mocktail can feel like a treat. You can make your own at home by mixing and matching ingredients such as:

• Sparkling water
• Soda
• Coconut water
• Simple syrup
• Fruit juice
• Apple cider
• Fresh fruit
• Fresh herbs
• Edible flowers
• Nonalcoholic liquor

More companies than ever are making alcohol-free versions of beer, wine, and cocktails. You may be able to find these drinks locally or buy them online and have them shipped to you.

Many people drink more than the recommended alcohol limits and find it hard to cut back. However, this doesn’t always mean a person has alcohol use disorder.

For many people, drinking less is a matter of breaking old habits and creating new ones.

If you find it hard to stop or limit your alcohol use on your own, your healthcare team can offer extra help and support.

You may want to bring up your drinking habits to your doctor if you have signs of alcohol use disorder, which may include:

• Not being able to cut down on how much you drink, even if you want to
• Craving alcohol
• Spending a lot of time drinking or hungover
• Continuing to drink even though it causes problems at work, at school, in your relationships, or with your health
• Engaging in unsafe behaviors while drinking, including driving after drinking
• Experiencing symptoms of withdrawal, such as sweating, rapid heartbeat, and anxiety, when you try to stop or cut back on drinking

Various types of counseling and rehab programs can help you quit or limit drinking. For example, a therapist may be able to help you learn new ways to change your behavior and address problems caused by drinking.

Some types of medications may also help you drink less. Your doctor can help you figure out the approach that will work best for you.

Join the Conversation

On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

Have you changed your drinking habits while taking tamoxifen? Let others know in the comments below.