Studies have shown that “high-risk behaviors are higher in [AYA] survivors,” Dr. DuVall said. The results, the study team argued, should be a wake-up call for all those involved in cancer care. But results from a new study suggest that this information may not be reaching narcissism and alcoholism people who fall into either of these two categories. More research is needed to understand some of the disparities seen in this study, such as with age, Dr. LoConte said. “We need to better understand these root causes and how best to address them,” she said.
As with most questions related to a specific individual’s cancer treatment, it is best for patients to check with their health care team about whether it is safe to drink alcohol during or immediately following chemotherapy treatment. The doctors and nurses administering the treatment will be able to give specific advice about whether it is safe to consume alcohol while undergoing specific cancer treatments. There is a strong scientific consensus that alcohol drinking can cause several types of cancer (1, 2). In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.
Quitting Smoking Improves Lung Cancer Survival
The study confirmed that most American adults aren’t aware of the link between alcohol consumption and cancer. It also found that, even among those who are aware, there’s a belief that it varies by the type of alcohol. For example, more participants were aware of the cancer risks from hard liquor and beer than about the risk from wine, with some participants believing wine lowers your cancer risk. The study also found that people who believed drinking alcohol increased the risk of heart disease were more aware of the alcohol–cancer risk than those who were unsure or believed drinking lowered the effect on heart risk.
Increased awareness of the alcohol-cancer link might encourage some people to warn family and friends about consumption, although the efficacy of such communication on behavior is unclear. Given the study’s findings, “there’s also a need to better understand why so many cancer survivors have such high alcohol consumption,” she continued. The study team used DNA samples from approximately 150,000 participants (roughly 60,000 men and 90,000 women) in the China Kadoorie Biobank study and measured the frequency of the low-alcohol tolerability alleles central nervous system cns depression for ALDH2 and ADH1B. The data were combined with questionnaires about drinking habits completed by participants at recruitment and subsequent follow-up visits. The participants were tracked for a median period of 11 years through linkage to health insurance records and death registers. To address these unknowns, researchers from Oxford Population Health, Peking University and the Chinese Academy of Medical Sciences, Beijing, used a genetic approach by investigating gene variants linked to lower alcohol consumption in Asian populations.
- In people who produce the defective enzyme, acetaldehyde builds up when they drink alcohol.
- For example, one way the body metabolizes alcohol is through the activity of an enzyme called alcohol dehydrogenase, or ADH, which converts ethanol into the carcinogenic metabolite acetaldehyde, mainly in the liver.
- Evidence from Western countries already strongly indicates that alcohol is a direct cause of cancer in the head, neck, oesophagus, liver, colon and breast.
- Despite the large body of scientific evidence on the topic, the full cancer burden due to alcohol remains uncertain because for many cancer (sub)types associations with risk and survivorship are inconsistent or there are few studies.
- A better understanding of alcohol consumption’s effects on therapeutic response, disease progression, and long-term cancer outcomes may support medical decision making and improve survivorship.
Participants can also allow access to their electronic health records (with all identifying information removed), providing important insights on treatments received and other relevant health information. To conduct the study, the researchers used data from more than 15,000 people with a history of cancer who were participating in the National Institutes of Health All of Us Research Program. A person’s risk of alcohol-related cancers is influenced by their genes, specifically the genes that encode enzymes involved in metabolizing (breaking down) alcohol (27). The first mutation is a loss-of-function mutation in the gene for the enzyme aldehyde dehydrogenase 2 (ALDH2). The oxidative metabolism of ethanol to acetaldehyde by alcohol dehydrogenase (ADH), and at high blood alcohol concentrations by ethanol-inducible cytochrome P4502E1 (CYP2E1) and catalase, also appears to play a role in carcinogenesis (10).
What is alcohol?
Evidence from Western countries already strongly indicates that alcohol is a direct cause of cancer in the head, neck, oesophagus, liver, colon and breast. But it has been difficult to establish whether alcohol directly causes cancer, or if it is linked to possible confounding factors (such as smoking and diet) that could generate biased results. It was also unclear whether alcohol is linked to other types of cancer, including lung and stomach cancers. Alcohol drinking disorders can lead to liver fibrosis and cirrhosis (12)–an established cause of liver cancer. Greater collaboration with other specialties and clinicians who regularly interact with people with cancer, such as oncology nurses, to develop ways to reduce risky drinking behaviors will be needed moving forward, Dr. Agurs-Collins said.
Since women rarely drink alcohol in China, the main analysis focused on men, a third of whom drank regularly (most weeks in the past year). Because these alleles are allocated at birth and are independent of other lifestyle factors (such as smoking), they can be used as a proxy for alcohol intake, to assess how alcohol consumption affects disease risks. “The high prevalence of cancer survivors drug addiction substance use disorder symptoms and causes engaged in hazardous drinking highlights the need for immediate interventions,” they wrote. Particularly troublesome is that so many younger people—those within the 15–39 age range of adolescents and young adults, or AYAs—reported heavy drinking, said Adam DuVall, M.D., of the University of Chicago Cancer Center, who specializes in treating blood cancers in children and AYAs.
Epidemiology and biology of alcohol and cancer risk
A better understanding of alcohol consumption’s effects on therapeutic response, disease progression, and long-term cancer outcomes may support medical decision making and improve survivorship. Ethanol–the principal form of alcohol in alcoholic beverages–is a widely-used, psychoactive, and dependence-producing substance. Alcohol research and control efforts supported by multiple governmental and non-governmental organizations (NGOs) internationally have found that the public health impact of harmful alcohol consumption is substantial. In 2016, it resulted in an estimated 5.1% of the global burden of disease and injury, and 5.3% of deaths (1).
However, in a cross-sectional survey of cancer survivors, only 14% of regular drinkers recalled receiving counselling from a clinician to quit drinking, although those who did were five-fold more likely to report reducing or stopping drinking compared to those who did not receive counseling (46). These findings suggest that clinicians may underappreciate cancer risks due to alcohol, and need additional guidance to reinforce clear and consistent messaging to effectively discuss this issue with their patients. Addressing knowledge gaps related to alcohol-cancer communication has potential to increase awareness and affect alcohol consumption behavior. For people being treated for cancer, regularly consuming a few beers or cocktails also has other potentially harmful consequences, including making their treatments less effective. And for longer-term cancer survivors, there is some evidence that regular alcohol use may increase the chances of their cancer returning.
Noelle K. LoConte
And although people who identified as Hispanic were less likely than White participants to report drinking alcohol, those who did drink were more likely to drink heavily. For the study, the research team identified 15,199 participants who, between May 2018 and January 2022, reported a history of cancer on their initial survey. By comparison, according to the most recent data from the Centers for Disease Control and Prevention, about 17% of US adults binge drink and 6% report heavy drinking (15 or more drinks a week for men, 8 for women).
The plant secondary compound resveratrol, found in grapes used to make red wine and some other plants, has been investigated for many possible health effects, including cancer prevention. However, researchers have found no association between moderate consumption of red wine and the risk of developing prostate cancer (32) or colorectal cancer (33). Worldwide, alcohol may cause around 3 million deaths each year, including over 400,000 from cancer. With alcohol consumption rising, particularly in rapidly developing countries such as China, there is an urgent need to understand how alcohol affects disease risks in different populations. Interpersonal influences, including interactions with family and friends, also shape knowledge and behaviors (42, 43). Because overt behaviors appear to be more susceptible to normative influence than clandestine behaviors (44), alcohol consumption behaviors in groups might be especially subject to social sanction.
Is it safe for someone to drink alcohol while undergoing cancer chemotherapy?
Alcohol regulations are designed to ensure an orderly marketplace, and to minimize or reduce the health, social, and economic harms due to consumption. The U.S. Community Preventive Services Task Force’s (CPSTF) Guide to Community Preventive Services (54), and WHO’s 2010 Global Strategy to Reduce the Harmful Use of Alcohol(8) describe a range of evidence-based alcohol control policies. Another enzyme, called aldehyde dehydrogenase 2 (ALDH2), metabolizes toxic acetaldehyde to nontoxic substances. Some people, particularly those of East Asian descent, carry a variant of the gene for ALDH2 that encodes a defective form of the enzyme. In people who produce the defective enzyme, acetaldehyde builds up when they drink alcohol.
However, the federal government retained power to regulate alcohol through control of foreign and inter-state commerce, federal taxes, federal property, and financial incentives. Binge drinking was most common among men, people under the age of 50, and former and current smokers. Among those who drank, binge and hazardous drinking was also much more common in those diagnosed and treated for cancer before the age of 18. For example, one way the body metabolizes alcohol is through the activity of an enzyme called alcohol dehydrogenase, or ADH, which converts ethanol into the carcinogenic metabolite acetaldehyde, mainly in the liver. Recent evidence suggests that acetaldehyde production also occurs in the oral cavity and may be influenced by factors such as the oral microbiome (28, 29).
