With headlines such as “Cutting back on alcohol can prevent cancers”1 and “Even light drinking may raise your cancer risk,”2 media reports may be generating questions from patients about the ASCO statement summarizing evidence linking alcohol to an increased risk of cancer.3 “What I personally counsel my patients, since I take care of breast cancer patients, is I tell them several servings per week is a reasonable amount,” Wendy Y. Chen, MD, MPH, told The ASCO Post. She is Senior Physician, Breast Oncology Center, at Dana-Farber Cancer Institute, and Assistant Professor of Medicine at Harvard Medical School, Boston.
Assess and Advise
“Alcohol is causally associated with oropharyngeal and laryngeal, esophageal, hepatocellular, breast, and colon cancers,” according to the statement. “Even modest use of alcohol may increase cancer risk, but the greatest risks are observed with heavy, long-term use.”
“The important thing to remember, and what people are misinterpreting, is we are not telling everyone you need to stop drinking immediately. And we are not telling oncologists to tell people that. We are telling oncologists to assess,” Dr. Chen stated. “After you assess, you then provide advice that we recommend limiting alcohol consumption for women to one serving a day or less.” For men, the recommendation is to limit alcohol consumption to two drinks per day or less.
As oncologists, “part of our job is general health promotion,” Dr. Chen said. “Even though smoking does not significantly increase the risk of breast cancer, I see it as part of my job to tell people not to smoke and to advocate that. I tell them about exercise and a healthy diet.” Advising about alcohol, she added, is another facet of promoting a patient’s overall health.”
It is easier to tell people not to smoke than not to drink because moderate drinking may have some cardiovascular health benefits, but “there is no health benefit of tobacco whatsoever,” Dr. Chen remarked. In addition, “smoking is not seen as a social behavior in most parts of this country. Whereas, at least in the United States and Europe, alcohol is still considered a socially acceptable -behavior.”
Risk Related to Ethanol Content
“I often get questions about whether there is a difference between red wine and white wine, beer, and liquor in terms of the association with cancer,” Dr. Chen said. “And the answer is no. There are multiple studies that have looked at this, and the cancer risk appears to be related to the ethanol content. It is not as if wine is safer, even though there may be data in the cardiovascular literature to suggest wine may be better than other forms of alcohol in terms of cardiovascular risk protection. But in terms of the cancer association, it appears to be the amount of ethanol alcohol in it, not what type of alcohol it is.”
As reported in the ASCO statement, “the associations between alcohol drinking and cancer risk have been observed consistently regardless of the specific type of alcoholic beverage.”
DISCLOSURE: Dr. Chen reported no conflicts of interest.
REFERENCES
1. Weinstock CP: Cutting back on alcohol can prevent cancers: Experts. Reuters, November 7, 2017.
2. Preidt R: Even light drinking may raise your cancer risk. Health Day, November 7, 2017.
3. LoConte NK, Brewster AM, Kaur JS, et al: Alcohol and cancer: A statement of the American Society of Clinical Oncology. J Clin Oncol. November 7, 2017 (early release online).
