Just one drink! This is the beginning of every alcoholic irrespective of age, gender, and caste. 

According to Center for Disease Control, more than 140,000 people die every year in the US due to heavy alcohol consumption (380 deaths per day). About 13% of the US population engage in extreme binge drinking at least once in a year. Furthermore, it is also suggested that most heavy drinkers start their drinking habit from childhood and adolescence. A study done earlier showed in the US, 23% of adolescents (12-20 years old) were regular drinkers, 10% were involved in episodic drinking, 2% were heavy drinkers and 6% demonstrated alcohol use disorder. Alcohol use patterns also vary by sex and sexual orientation; while in general, men are known to be more heavy drinkers than women, higher rates of alcohol consumption have been reported in lesbian, gay, bisexual, transgender and intersex individuals.

Alcohol consumption is the leading risk for cancer. Alcohol consumption has been associated with cancers of the upper aerodigestive tract cancers (oral cavity, pharynx, esophagus, larynx) which involves tissues that come in direct contact with alcohol. Alcohol use is also indicated as a risk factor in breast, liver, and colon cancers. Evidence suggests that more the number of drinks and greater the duration of alcohol use, more is the risk for cancers, particularly, head and neck cancers. And this association is regardless of type of alcoholic beverage. The cancer risk due to alcohol use is further confounded by cigarette smoking especially in lung cancers. Further, smoking and alcohol in cancer patients especially oral and oropharyngeal cancers is linked with osteoradionecrosis of the jaw. For patients, alcohol consumption even after diagnosis is known to increase hospitalization, delay recovery, and increase the cancer-specific mortality risk. Survivors of upper aerodigestive cancer who continue sipping alcohol are a threefold increased risk of developing second primary tumors.

Although there is limited evidence suggesting impact of alcohol cessation on cancer risk, studies done so far suggest that the risk of upper aerodigestive cancers decreases in individuals who quit drinking versus those who do not. While ethanol in alcohol per se is not harmful, it is the metabolism of ethanol to acetaldehyde that confers the cancer risk as acetaldehyde is a known mutagenic and carcinogenic agent. This aldehyde is usually eliminated by an enzyme, acetaldehyde dehydrogenase 2; however, an inactive form genetic variant of this enzyme commonly seen in the East Asian populations results in excessive accumulation of acetaldehyde within the body and confers greater susceptibility to cancer. Alcohol-induced oxidative stress further worsens the disease due to increased inflammation 

While alcohol drinking guidelines are available in more than 40 countries worldwide, The American Heart Association, American Cancer Society and the US department of Health and Human Services recommend no more than one to two drinks a day for all adult men and no more than one drink a day for adult women. The National Institute of Alcohol and Abuse suggests 14 g of pure alcohol as a standard drink. This is equivalent to 12 ounces of beer and 5 ounces of wine. Unfortunately, alcoholics are far away from the given measurements. This lack of awareness and knowledge amongst public and physicians along with the wrong perceptions associated with drinking in certain communities makes it difficult to address this burning issue.

To address this, ASCO suggested the following guidelines to provide and support better public health strategies against alcohol exposure.1

• Restrictions should be brought on alcohol for minors (the legal drinking age is below 21) and preventing youth from being influenced by advertisements for alcoholic beverages.
• Healthcare providers should have the right to screen patients and pregnant women who are at risk of alcohol-related disorders. Counseling and guidance should be provided to such patients to abstain from alcohol. 
• Outlet licensing is one of the important strategies to prevent alcoholism. Regulating alcohol outlet density decreases the number of outlets and hence consumption. Another important strategy that ASCO supports is imposing heavy taxes on alcoholic beverages.
• Alcohol control strategies should be part of comprehensive cancer control plans. Research and studies should be used as a weapon against alcohol consumption and hence support cancer control.
• A bigger change is required in the industry. ASCO demands the elimination of pink washing in advertisements for alcoholic beverages. The picture which is a contrast to evidence should not be painted by alcohol-promoting advertisements.

The burden of cancer will be reduced if alcohol consumption is under control. A healthcare practitioner and oncologist can influence and educate patients about the side effects of alcohol, destroyed lifestyles, and risks of cancer. Only when oncologists and general practitioners turn into counselors, alcohol abuse may forget its path. Prevention is better than cure!

Reference:

1. LoConte NK et al. Alcohol and cancer: A statement of the American Society of Clinical Oncology. J Clin Oncol. 2017;36:83–93.