Alcohol is the next tobacco…
The American Society of Clinical Oncology published a review of the connection between alcohol consumption and cancer, and has decided to be proactive to try to decrease alcohol consumption. There may be a parallel when the causality between tobacco and cancer was known but not acknowledged. It was common to see nurses and physicians smoking in the break room while patients with lung cancer were being treated with futile chemotherapy in the infusion room next door.
At least, in the medical field, we do not have a bottle of wine over lunch while we are working.
The challenges are
· Getting physicians to take a second look at the data and revisit the perceived benefits of moderate alcohol consumption.
· Getting physicians who themselves may qualify to have excess alcohol consumption to recommend to patients to decrease their consumption.
· Getting patients to honestly report consumption. Patients routinely under-report the number of drinks to avoid the “you need to cut down” admonition.
· Recognize that the number of drinks that cross into the excessive drinking is lower than you think.
How much is too much? Binge drinking is downing four or more drinks in a single occasion for women and five or more for men. Heavy drinking for women is eight or more a week (or three or more in one day). Heavy drinking for men is 15 or more a week, or four or more a day. Moderate drinking is limited to one a day for women and two a day for men.
Alcohol use Women Men
Moderate one/day two/day
Heavy 8/week or 3/day 15/week or 4/day
Binge 4 at one occasion 5 at one occasion
Where I grew up, there were social taboos around drinking alcohol. Not that people didn’t enjoy a glass, but it wasn’t daily and excessive. Over the last few decades these taboos have dissolved and daily alcohol consumption has become commonplace.
Is moderate alcohol use good for heart health? Apparently not.
Besides our own personal habits, physicians were following reports that moderate consumption was good for heart health. However, follow up analyses have shown bias in those results and later studies have not shown a net benefit in mortality from any cause for moderate drinking compared to intermittent drinking or abstinence.
Does alcohol cause cancer?
According to the American Institute for Cancer Research and the International Agency for Research in Cancer (a branch of the WHO) there is convincing evidence that alcohol contributes to cancers of the oral cavity, the head and neck region, esophagus, liver, breast and colon. The more you drink, the longer you drink, the higher the risk. And like tobacco, if you quit, your risk will likely decline over time, although that still needs to be confirmed with ongoing studies.
How does alcohol cause cancer?
Alcohol and its byproduct, acetaldehyde has shown to cause tumors in animal models. Deficiency of an enzyme called alcohol dehydrogenase magnifies the effects of alcohol and its byproducts. In addition, alcohol causes chronic inflammation and oxidative stress, changes circulating estrogen testosterone levels and decreases nutritional intake of protective vitamins. Cirrhosis of the liver leads to liver cancer. And, all kinds alcohol contributes to cancer: wine, beer and spirits.
Does an alcoholic beverage help with cancer treatment and improve appetite in cancer patients?
We used to think a glass of wine helped cancer patients be able to eat more, but studies have not borne that out. There was no observed difference in appetite or weight in patients assigned to either consuming a glass of wine or a nutrition supplement.
So what should we recommend?
All the Cancer and Heart associations recommend that people who do not drink should not start imbibing for perceived health benefits. Women who do already imbibe should limit their consumption to one a day, men to two a day.
It may take a few more years and education to help these recommendations to be accepted by physicians and the public. We may have to go the route of “do as I say, not as I do” for a while, but I will certainly be more mindful going forward.
http://ascopubs.org/doi/full/10.1200/JCO.2017.76.1155