The New York Times has reported that:
Alcohol is a leading preventable cause of cancer, and alcoholic beverages should carry a warning label as packs of cigarettes do, the U.S. surgeon general said on Friday.
Should we do the same?
The reason is compelling. Alcohol does seriously increase the risk of cancer. The sugars in it, and related chemicals, are much the problem. They create the opportunities for cancer cells to grow, a fact known to oncologists as they use glucose as the marker to find cancer cells when testing for the disease.
And yet, cancer sufferers in the UK are not warned off alcohol to assist disease management and to prevent the risk of recurrence, and nor are health warnings given on alcohol.
Why not, is the question?
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Playing the devil’s advocate, the argument will be that although sugar may feed a cancer, it does not cause it.
In the same way that petrol does not start fires, but will fuel them.
But perhaps we should warn people of this too.
We do put flammable warnings on petrol.
Richard,
This article is interesting
https://www.theguardian.com/lifeandstyle/2024/dec/18/the-swedish-sobriety-secret-dry-december-and-off-licences-shut-on-a-saturday-night
May I suggest that
1. There are a lot of other ‘social and medical’ issues associated with alcohol – I am sure dont need to list them here!
2. There will be significant benefits to tackling the price and availability of alcohol, and I suggest we need some controls over the sort of alcoholic drinks that can be sold eg ‘white’ cider, cheap vodka and super strength lagers
Scotland and Wales have both introduced ‘Minimum Unit Prices’ which seem to have reduced harmful alcohol consumption but not public order issues, however the ‘Alcohol Duty Escalator’ – RPI +1% introduced by Alastair Darling as Chancellor in 2008 was abolished by the subsequent coalition government between 2013 & 2014
May I suggest that we need a UK wide ‘alcohol harm reduction plan’ which could potentially include a tobacco and ‘drugs’ harm reduction plan.
Whether we get it is of course another matter, I suggest unlikely under this government and a definite no under the Tories.
We do need a plan…. and a look at Norway might offer a solution.
Government monopoly on sales, restricted opening times, and high prices…… but good luck getting voters to approve it.
> cancer sufferers in the UK are not warned off alcohol
I no longer drink but in the days when I did enjoy my pints, I imagine that the last thing I would have wanted to hear after a cancer diagnosis is that alcohol would have to go as well. That would have been a serious double whammy.
Perhaps the reason the advice is not given is that the benefit is not considered to outweigh the psychological cost? Just to be clear, I don’t know whether it does or not, but maybe that’s the thinking?
What are the psychological benefits of intoxication?
Having given up drink, I have realised that many of the psychological benefits I thought I was getting from it were illusory. But I also know that I only gave up drinking when it was on my terms and when I realised myself that it was doing me more harm than good. But I did have many good times when drinking, and I do credit it with helping me make many lifelong friends at university where social life revolved around it.
My point is that someone who enjoys drinking, does not think it is a problem for them is going to be resistant to being told they should give it up, and the loss of a source of pleasure in life is going to have a psychological cost, which on top of having a serious illness may (again, I don’t know if this is true or not, it’s just a supposition on my part) be more than the benefits they will get from quitting.
Counter-example. A friend was diagnosed with pancreatic cancer 15 months ago. He gave up alcohol while being treated, presumably after medical advice to do so. He gave me all his spirits, liqueurs, wines, and hasn’t drunk alcohol in any form since. Fortunately, his treatment seems to be working.
I think that I have no more than two to four glasses of wine a month (and go weeks without actually) – usually red – and the odd beer thrown – usually a stout or porter (not big on lager). I don’t need to drink alcohol and when I do it is usually with a meal.
Am I making an enemy of my future by doing this?
I have no idea.
Probably not
I have not stopped drinking, but my alcohol consumption is very low now. My wife has stopped, but she is a cancer survivor (over ten years now).
Apparently – according to some writers – there is no safe level of alcohol at all, that is why I asked the question.
I’m not into drugs, I like a nice glass of red wine with something to eat so I usually get my highs naturally – and that is from music to be honest, listening to it or playing my guitar.
As I understand it, the argument for cancer health warnings on alcoholic beverages is not that they contain sugar that “feed” cancers (otherwise we would start by putting cancer warnings on, well, sugar – and perhaps oxygen too) but rather that the chemicals in alcoholic beverages and their digestion products such as aldehydes can themselves increase the risk of cancer. And also alcohol intake increases the absorption of other harmful chemicals that dissolve more readily in alcohol than in water.
According to CRUK alcohol causes seven cancers, including many of the most common – breast, bowel and liver, and cancers of the mouth and the throat (oesophagus, larynx, and pharynx).
https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer/how-does-alcohol-cause-cancer
I see no problem with mandatory health warnings – it is simply information. But do we have good evidence that people pay attention to health warnings on cigarettes and they have thereby reduced tobacco consumption?
Good question.
Smoking has declined, considerably. They must have had some impact.
That is a bit “post hoc, propter hoc”.
My feeling is that the tobacco health warnings must have had some impact – perhaps more on deterring people starting than encouraging them to stop – but it would be interesting to see some empirical evidence of causation. Perhaps consumption would have fallen anyway.
On another tack, warnings about the composition of food seem to have had relatively little impact on consumption. Whereas for example the modest sugar tax had a very substantial impact on recipes for sugary drinks and thereby on sugar consumption.
Alcoholic, tobacco, sugar, all have addictive or habit-forming tendencies, so I can certainly see a role for a variety of regulatory interventions – information, warnings, “sin” taxes, etc.
Ireland has plans to introduce warnings on alcohol along the lines of alcohol is linked to fatal cancers, according to the article.
The Scottish government had a monumental struggle to bring in minimum pricing on alcohol. The government was ultimately successful although the 2012 Act was delayed in coming into effect until 2018 due to the various Court cases.
Minimum pricing on alcohol was not supported by Labour.
Does anyone think that the Labour party has any intention of upsetting any large industry on anything? It’s pretty obvious they support industry/businesses before the people; they are, after all, their donors. It’s the big donors Labour are after (tears, I’m sure, that Rocket Boy has chosen to support Reform).
THIS REPLY IS TO JEAN
Indeed Jean – just because something is a marker of a disease does not require that it is also a causative agent of said disease (and ‘cancer’ is not a single disease).
“The Science” is sometimes intentionally hijacked by “vested interests” who use it to serve their needs and objectives. The US General Surgeon and the corporate press are not to be automatically trusted on many health matters.
Drinking alcohol is an established risk factor for several malignancies, including specific cancers, but to assume it is always a blanket cause of all cancers is premature and unscientific. More human tests and studies are required, as they say.
We will have to disagree on this one.
It seems the science on this has been settled for some time.
But of course it is not a cause of all cancers. That is obviously untrue. Public health is about risk mitigation.
” a fact known to oncologists as they use glucose as the marker to find cancer cells when testing for the disease. ”
Yes they do.. But that is because aggressive cancer cells are much more active against the background activity of the surrounding tissues, so they accumulate the detectable marker attached to the glucose more than their surrounding , “lighting them up” .The glucose is merely the carrier for the marker. Not the actual detection agent.
Which is something you get taught even at the lowest level of lab tech, as part of “general tissue staining/marking techniques 101”. A little bit of insight Richard could stop you jumping to the wrong conclusion.
I suggest you think a little more about what you have just written.
Some people have and made the link – you have not.
Thankfully, more people seem to be.
Jean is right, the use of glucose uptake to detect cancer is simply because those rapidly dividing aggressive cancer cells need more “fuel” than those around them. The cells don’t know or care which food the glucose ultimately came from, such cells in teetotal individuals will give exactly the same signal.
But that doesn’t negate the observation that there is a cancer risk associated with alcohol intake. From what I understand the direct risk to moderate drinkers is not high, the real problem is that it seems to magnify the risk from other exposure like smoking, probably via the mechanisms described in the link given by Andrew.
Hi Richard, I definitely agree with your sentiment that alcohol is not taken as serious as other carcinogens, and there should be warnings about the risk of cancer on alcoholic beverages.
For the sake of accuracy, I think you touch upon two different aspects of alcohol in relation to cancer in this post though.
Alcohol alone is a carcinogen when ingested, with the byproduct of alcohol acetyl aldehyde (the product our body converts alcohol into) being the actual carcinogenic chemical. The scientific evidence on this is overwhelming.
On your second point about current cancer sufferers, I think it makes sense to avoid alcohol but I am not sure of the mechanistic reasoning. Although cancer cells do use glucose as a primary fuel source, expert nutritionists don’t recommend avoiding healthy levels of carbohydrates. But the last point I think is important, alcohol has too much sugar (carbohydrate) so it brings its own metabolic risks anyway.
I dont drink because I dont like the taste.
Someone was describing going for a medical recently. They dont drink regularly but they are not a non drinker if that makes sense.
When they gave their alcohol consumption as one unit a week it seemed the Doctor didnt ‘get’ it which is worrying as it suggests Doctors don’t get not drinking and what’s even more worrying is that it was – probably an aviation medical!
In response to Jean. My partner is currently having cancer treatment and has had numerous PET scans. The reason a type of glucose is used is that this substance is the most readily utilised by cells for energy production. The marker is a radioisotope of the element Flourine.
https://en.m.wikipedia.org/wiki/Fluorodeoxyglucose_(18F)
Tut – spelling! Fluorine!
No, not sugars, which are not thought to be directly related to cancer risk – but obesity is.
Alcohol is broken down in the body into acetaldehyde, which can damage DNA and inhibit cell repair. Alcohol can also affect hormone levels such as oestrogen, which is thought to be partly why breast cancer is the most common cancer associated with alcohol. The mechanisms are not all well understood but the association is clear, as it is with smoking. Other possible mechanisms are generating reactive oxygen species that damage DNA and impairing the absorption of nutrients.
It’s also important not to be too scary. Only about 3.5% cancer deaths are attributable to alcohol, and the relative risks for light drinking are small. Here’s an example by a doctor I trust in the New York Times.
—————
https://archive.fo/59Rqr
For breast cancer — which is the cancer that seems to be garnering the most headlines — light drinking was associated with a relative risk of 1.04 in the announcement. Relative risk refers to the percentage change in one’s absolute (overall) risk as a result of some change in behavior. (And 1.04 is a 4 percent change from 1.0, which represents a baseline of no difference in risk between an experimental group and a control group.)
A 40-year-old woman has an absolute risk of 1.45 percent of developing breast cancer in the next 10 years. This announcement would argue that if she’s a light drinker, that risk would become 1.51 percent. This is an absolute risk increase of 0.06 percent. Using what’s known as the Number Needed to Harm, this could be interpreted such that if 1,667 40-year-old women became light drinkers, one additional person might develop breast cancer. The other 1,666 would see no difference.
Alcohol is a carcinogen regardless of glucose. Drinking vodka doesn’t prevent the risk.
Alcohol is big business, very big business. David Nutt offers great clarity on alcohol, he argues that if we invented it now we’d ban it and that it’s more harmful than most illegal drugs except heroin, if I remember correctly. Blair, well technically Alan Johnson, sacked him as Chair of the Advisory Council on the Misuse of Drugs for stating it was more harmful than cannabis. Seems to me alcohol carries few warnings except those targeted at pregnant women and is implicated in many mote diseases and conditions than cancers.
Well noted.
Oh no, now they want to take away my alcohol. I will have to try Professor David Nutt’s alcohol-free drink which can replicate some of the feelings of alcohol. I think it is a bit expensive until this stuff goes a bit more mainstream.
https://www.standard.co.uk/news/london/cheers-ex-drugs-adviser-launches-boozeless-drink-b1182957.html
I most often drink Adnams Ghost Ship 0.5% these days – it really is a good beer with so little alcohol it makes no difference.
Another opportunity for me to jump on my second favourite hobbyhorse – Social conditioning: The sociological process by which we are taught to behave and respond in a manner approved by the society we live in. Smoking is now disapproved of by society at large and is on the wane. Drinking alcohol is not. Drinking alcohol is not just socially acceptable, its consumption is a social requirement and anyone that doesn’t drink even the odd social drink is regarded with suspicion. Much the same goes for eating meat. Both to the point of cognitive dissonance. We love animals but kill and eat them and we know alcohol is bad for us but to not partake risks peer group exclusion or at least being viewed as a bit of an oddball. The solution is of course, critical thinking. But that requires effort and questioning and confronting pretty much everything that has been ingrained in us since birth. Failing that though, I guess a cancer warning on alcohol might get the ball rolling.
I am always cautious of correlations when there will be a lot of confounding factors. But if you want to go this route, there is good evidence linking poverty to increased cancer risk. e.g. https://pmc.ncbi.nlm.nih.gov/articles/PMC9194626/. The mechanisms and confounding factors will be even more complicated. But perhaps the Government should issure official warnings advising people not to be poor. Cheaper than an economic strategy that would reduce poverty-linked cancer.
Neil Kinnock did that once.