Al­co­hol and can­cer risk

The Middletown Press (Middletown, CT) - - NEWS - DR. DAVID KATZ Dr. David L. Katz;www.david­

Per­haps no sub­ject in nu­tri­tion is a source of more con­cen­trated am­bi­gu­ity than al­co­hol con­sump­tion and health. Con­sider the irony and in­trin­sic con­tra­dic­tions of the wide­spread prac­tice, across many cul­tures and languages, and, can­didly, my own fam­ily ta­ble — of toast­ing to one an­other’s health with a prod­uct that the Amer­i­can So­ci­ety of Clin­i­cal On­col­ogy just told us con­sti­tutes a sig­nif­i­cant can­cer risk.

The po­si­tion state­ment just re­leased, rightly re­ceiv­ing high-pro­file me­dia at­ten­tion, does not rep­re­sent new re­search. Rather, the Can­cer Pre­ven­tion Com­mit­tee of ASCO ap­par­ently judged that the ag­gre­gated ev­i­dence avail­able was suf­fi­cient to make a state­ment, and that a re­al­ity check on the topic was timely.

Their ba­sic con­clu­sion is that even mod­er­ate and light al­co­hol in­take con­trib­ute mean­ing­fully to can­cer risk. Mod­er­ate al­co­hol in­take is de­fined as up to one drink (1.5oz of dis­tilled spir­its; 5oz of wine; or 12oz of beer) daily for women, up to two for men. The dif­fer­ence is based in sci­ence, not sex­ism, of course; even when body size is com­pa­ra­ble, men have higher lev­els of the key, me­tab­o­liz­ing en­zyme, al­co­hol de­hy­dro­ge­nase, than women. Less than that thresh­old is light drink­ing; more is heavy. Achiev­ing that “av­er­age” by hav­ing six or seven drinks on both Fri­day and Satur­day night is binge drink­ing.

The ASCO re­port tells us that roughly 3.5 per­cent of all can­cer deaths in the United States are at­trib­ut­able to drink­ing al­co­hol. Mod­er­ate al­co­hol con­sump­tion roughly dou­bles the risks of oral and esophageal can­cer, and con­trib­utes mean­ing­fully but less to the risk of col­orec­tal and la­ryn­geal can­cer. Light to mod­er­ate al­co­hol in­take in­creases the risk of breast can­cer in women be­tween about 5 per­cent and 20 per­cent.

The im­me­di­ate temp­ta­tion is to call these “sober­ing” statis­tics, and al­low that char­ac­ter­i­za­tion to have two mean­ings. But these risks, while real and wor­thy of at­ten­tion, re­quire con­text. The life­time risk of esophageal can­cer in the U.S., for in­stance, is less than 1 per­cent in men, and less than 0.25 per­cent in women. A dou­bling of such risk is cer­tainly not triv­ial, but the prod­uct is still a small num­ber.

An­other im­por­tant con­sid­er­a­tion is the life­style pat­tern in which al­co­hol in­take fig­ures. Drink­ing might be ac­com­pa­nied by smok­ing, or even just rou­tine ex­po­sure to sec­ond-hand to­bacco smoke. That smoke is the far more car­cino­genic of the two ex­po­sures, and the harms of al­co­hol are much com­pounded by the pair­ing. Drink­ing might ac­com­pany a poor diet, lack of ex­er­cise, or obe­sity — each of which con­trib­utes to can­cer risk. Obe­sity on its own has been as­so­ci­ated with in­creased risk for al­most ev­ery can­cer, and is thought to ac­count for some 14 per­cent of can­cer deaths in men, 20 per­cent of those in women in the U.S.

Or, to the con­trary, mod­er­ate al­co­hol in­take might take place in the con­text of a gen­er­ally health­ful life­style and healthy weight. This, ap­par­ently, is the pat­tern in the Blue Zone pop­u­la­tions where wine in­take is cus­tom­ary, no­tably Ikaria, Greece. The Ikar­i­ans have low rates of all chronic dis­ease, can­cer in­cluded, and like all Blue Zone pop­u­la­tions, live to 100 and die peace­fully in their sleep far more of­ten than the rest of us.

Does this mean that Ikar­i­ans are some­how se­lec­tively im­mune to any harm­ful ef­fects of al­co­hol? Cer­tainly not. Rather, it means that, within rea­son, the over­all im­pact of life­style is greater than a com­po­nent in iso­la­tion. Can­cer risk is re­duced if obe­sity is rare, if smok­ing is rare, if other chronic dis­ease is rare, and per­haps even if stress is at low lev­els. If al­co­hol in­creases can­cer risk from its base­line, a lower base­line means lower ab­so­lute risk with drink­ing. Per­haps the Ikar­i­ans would have even less can­cer if they gave up that wine.

Drink­ing al­co­hol for the sake of health, per se, seems mis­guided to me; there are far more re­li­able ways to get there from here. But I con­fess I con­sider a fine Bordeaux with a great meal one of life’s sig­na­ture plea­sures, and plea­sure is good for health. Per­haps more im­por­tantly, plea­sure and over­all qual­ity of life is why health mat­ters in the first place. Other things be­ing equal, healthy peo­ple have more fun, or health would be less im­por­tant than it is. Dose mat­ters. Trade­offs are likely. Un­cer­tainty is in­escapable. Plea­sure and health both mat­ter, and in­ter­act. To that con­stel­la­tion, I raise a toast.

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