There is no completely safe dose or form of alcohol

There is no completely safe dose or form of alcohol

We live in a strange world. What would happen if tomorrow a common sedative was found to cause 21,000 cancer deaths every year? What if it resulted in breast cancer, mouth cancer, hepatoma and esophageal malignancies, and if the average patient lost 19 years of life?  What if the drug also killed by cirrhosis, massive upper GI bleeding, accelerated dementia, and for good measure slaughtered thousands innocent children in car accidents.

Do you think this caustic concoction would last in the pharmacies for a month … a week … a moment?  Of course not.   Let us raise a drink to that.

One month ago, we believed that in the United States only 2% of breast cancer is caused by alcohol, and that the highest risk is in Italy at 11%. Now Dr. David Nelson, of the National Cancer Institute, has published data showing that more than 15% of breast cancer in America is from alcohol. Equally horrifying is that alcohol consumption results in an estimated 18,200 to 21,300 yearly cancer deaths.  This includes not only breast cancer (60%), but also upper airway and esophageal cancer, especially in men.

No big deal you say, you don’t drink much?  The NCI research found, as have multiple prior studies, that there is no safe minimum.  While it is true that the more alcohol you drink the more likely you are to die of tumor growth, most of the cancer in this study occurred in people that drink less than one and half drinks a day.  This is made worse by smoking, obesity, estrogen, limited exercise or inherited genetics, but cannot be completely avoided no matter how little one imbibes.

Now the good news.  While we know alcohol also causes mouth, throat, and liver cancer, it has not been proven to increase colon or pancreatic neoplasm rates.  In addition, we know from the Iowa Women’s Health Study that drinking women, who take more than 300mcg of folic acid daily, are less likely to get breast cancer.  Kind of a hangover-anti-cancer-morning-after pill; pretty pale comfort.

There is an ongoing debate about the dangers of alcohol verses its potential benefit.  Studies appear to show that modest alcohol intake in older persons decreases atherosclerotic heart disease, diabetes and stroke, while the negative affects seem to be more in younger populations and include not only cancer, but hepatitis, pancreatitis, trauma, domestic violence, fetal alcohol syndrome, osteoporosis and multiple forms of brain damage.  Nelson’s added information showing higher cancer risks than we assumed, will likely change the balance of the conversation.

There will never be a randomized trial of alcohol intake, and the science is complex. However, there can be no doubt that alcohol destroys millions of lives and many more than we thought die by cancer. In the end, drinking is a personal decision we make regarding lifestyle, risk and how we treat our bodies, of which we are each given only one.  Nonetheless, this disturbing study should reinforce the fact that there is no completely safe dose or form amount of alcohol.  Friday night? Perhaps a double club soda and lime.  Cheers to your health.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • Tom

    “most of the cancer in this study occurred in people that drink less than one and half drinks a day.”

    Most cancer also occurs in people that [sic] drink between 1 and 6 glasses of water a day.

    Most cancer also occurs in people who watch between 30 and 240 minutes of television a day.

    Most cancer also occurs in people who drive a car at least three times a week.

    Most cancer also occurs in people who shower between 5 and 7 times a week.

    Most cancer also occurs in people who admit to having gone to bed without flossing 2 to 5 times in the past 12 months.

    Most cancer also occurs in people who have visited a doctor at least once in the past 5 years.

    The only solution? BAN ALL THE THINGS! You know it makes sense.

  • Sara Glendenning

    In 1917 the American Medical Association voted to support prohibition.

    The resolution passed in June of 1917 at the annual meeting of the American Medical Association read as follows:

    –Whereas, We believe that the use of alcohol is detrimental to the human economy and,
    –Whereas, its use in therapeutics as a tonic or stimulant or for food has no scientific value; therefore,
    –Be it Resolved, That the American Medical Association is opposed to the use of alcohol as a beverage; and
    –Be it Further Resolved, That the use of alcohol as a therapeutic agent should be further discouraged.

    Nevertheless, the prohibition laws allowed medicinal use of alcoholic beverages through prescription..

    “Everything old is new again.”

    • Dr. Drake Ramoray

      It’s interesting to see that the AMA was pretty useless other than as a political arm as far back as 1917. “Everything old is new again” indeed.

      • Sara Glendenning

        The AMA, the KKK, the Women’s Christian Temperance Union (WCTU) and the mob were all avid political supporters of prohibition. Strange bedfellows :)

      • Mengles

        We would all be a lot better off if the AMA butted out of political issues in general.

    • querywoman

      Prohibition policy was staggeringly similar to contemporary Iran, where alcohol is available for medicinal purposes. An Iranian bootleg market also flourishes.
      In Saudi Arabia, alcohol also flourishes.

  • NormRx

    Coffee good, coffee bad, alcohol good, alcohol bad, butter bad, butter good, I could go on and on but you get the point. Give it a couple of years and a new study will show the benefits of alcohol in moderation.

  • Kimberlein

    Who cares? The argument is flawed to begin with. There is nothing excessively dangerous about Alcohol–what becomes dangerous is when so much is consumed that adverse health effects take place. Like most things, true risks are highly individualized, so why bother creating a study designed to distill to a homogenized conclusion? It’s a total waste of time, and accomplishes nothing.

    Let’s be honest–alcohol enhances many people’s lives. I enjoy wine very much, and I’m sure that the dopamine rush I get from savoring a fine wine, and the time I take to gather with friends and enjoy a thoughtfully prepared meal to do it contribute to my happiness and therefore my health. How joyless life would be if we traded epicurean pleasures for caution after being bullied into fearfulness from reports that “no completely safe dose or form of alcohol/cupcakes/some other delicious treat” could be established?

    Shame on you for using fear tactics to villify something that is an enabler of pleasure, laughter, and good times for the majority of people who enjoy it. Go focus on people who are abusing it. They need help and awarenees more than I do.

    • AJ

      In that case, LSD should be allowed to be recreationally used as it has been shown to be one of the least harmful drugs when taken in moderate amounts. As you’ve implied, it is more of a culturally accepted belief to enjoy alcohol. That doesn’t make it any less harmful, but I see your point. And by the way, that dopamine rush can be triggered from a variety of other drugs so you probably don’t mind legalization of those too. Alcohol’s so-called “benefits” are negligible. One can get the same benefits from a glass of grape juice without the detrimental effects of ethanol.

  • Stephen Wuebker

    “…the negative affects seem to be more in younger populations and include not only cancer, but hepatitis, pancreatitis, trauma, domestic violence, fetal alcohol syndrome, osteoporosis and multiple forms of brain damage.”

    I can tell you right now that no matter how many glasses of wine I drink, I will never get fetal alcohol syndrome.

  • Paul Dorio

    ” most of the cancer in this study occurred in people that drink less than one and half drinks a day” — and yet the study purports to link alcohol to cancer as a causative agent. REALLY? Call me a skeptic.

    As I say almost every day – all things in moderation. Most physicians accept it as fact that alcohol in moderation is protective, eliminates cancer-causing free radicals, etc.

    One report from a government agency does not impress me to admonish all people to become teetotalers.

  • euonymous

    Hmmm. “Tom” is, of course, right: everything correlates with cancer. Generally speaking age correlates with cancer, too, so whatayagonnado? The alcohol question is one the US tried to solve with Prohibition. We all know how well that worked out. In a time when we are legalizing marijuana, suggesting any kind of ban on alcohol seems silly. Yes, alcohol can be a killer. No, we can’t get rid of it. So what’s left? Education and cultural influences. And there’s the rub. Our families, our schools, and our cultural influences (TV, movies, video games, organizations like the Boy or Girl Scouts, neighborhoods) determine the popularity and variety of drugs, including alcohol and cigarettes. There’s no solution other than the hard work of drilling it into the heads of our children that these are not acceptable practices or, at least, that they are to be experienced in some level of moderation. (For the record, I enjoy the occasional glass of wine.)

  • Lezlee

    Can’t find the published data by David Nelson of the NCI with that link.

  • Guest

    Didn’t they show that some of the isolated communities with the highest life expectancies had very high ETOH consumption? The NYT published articles about this.

    That said, it can be difficult to moderate in a culture that celebrates alcohol as we do.

    Any time I’ve cut down on my drinking I’ve been met with heckling or criticism. It’s fascinating. I know we have lower alcoholism rates compared to other countries globally, but we definitely LOVE our alcohol here, and it’s not healthy.

  • thomas

    Alcohol does not come with dosage instructions. Been sharing that for years. Glad I quit. Responsible drinking is stupid directive. Check that out when next vodka commercial is aired.

  • querywoman

    There is no completely safe type of blood pressure medicine nor is there a completely safe dose of any blood pressure medicine!

  • querywoman

    I am always at risk of being squashed to death by a meteorite.
    I have a much higher risk of being drowned in a flood caused by a severe thunderstorm.

    Lightning could hit me at anytime, though it seems more common for it to strike a man.
    I have live half of my life as a Texan under a tornado alert.
    Earthquakes are rare where I live, but one could happen and the earth could swallow me.
    I’d enjoy a good stiff drink if I survived many disasters.

    Life is degenerative and full of risks!

  • Ari Teman

    Many lives are caused by alcohol!

  • Philip Thwing

    There’s no completely safe amount of bacon or Doritos or car driving, either. What’s your point?

  • Jim K

    Cancer is a concern, but mortality from all causes is the real concern. Until I see good numbers that abstinence increases lifespan–and the numbers seem to say the opposite fairly strongly–I’ll continue to have a beer with dinner.

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