Cocktails cause cancer

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.


  • Sigh .... I would have hoped for just advice for moderation (post-chemo I generally don't drink anyway) rather than abstaining :)
  • alyce
    I don't drink. I recently had another mastectomy and have rheumatoid arthritis. I am taking methotrexate and prednisone to control it. So my liver will probably be rock soon. I also take folic acid, The R.A, is probably genetic. So I am caught between a rock and a hard place. I used to have an occasional glass of wine if we we nt out to dinner. I'd rather have a glass of wine on a special occasion than take drugs.
  • To Dr James Salwitz My father used morphine for more than 30 years. He contracted metastatic prostate cancer in 2009 and died in 2011. During the last 4 or 5 years he underwent personallity changes and lost memory. A New will was arranged for him by a non-family member and he is now a new beneficiary. I am looking for someone who might help me with a report on brain changes with long term MST use, hyponatremia and metastaic cancer. Can you please advise someone to me ? Annelie
    • James Salwitz, MD
      There are several issues here. The major one, I gather, was your father's competency to create a new will. This is, unfortunatley, a common problem and question, especially when the will was changed. This determination usually requires an attorney to retain the services of a medical expert, in this case either an oncologist or an neurologist, to review the old records or perhaps request a statement from the treating physicians. The hope would be that someone determined, while he was alive, the cause of his personality changes and whether he was competent to make decisions. When you refer to "MST", I gather you are talking about morphine (usually abbreviated MSO4). Although there are many problems with its chronic use, direct brain damage is not usually one of them. However, long term drug use can lead to other problems, which again gets back to the question of his medical records. Hyponatremia is common complication of cancer and several medications, and can cause sudden personality changes and lost memory, but is usually not a long term process. Metatastic cancer, even if it does not go to the brain, can occassionally cause personality changes and memory problems, but usually only in advanced disease. The best place to start may be directly discussion with his treating physician (if you and he are allowed to discuss the records) or having an attorney begin the investigation I outlined above. Very tough problem, jcs
      • Dr James, thank you for your answer. I read that a morphine dependent person cannot leave the morphine even if he knows it is killing him (making his cancer progress). My father made the doctor that sometimes gave him morphine as a present (and was a x-son-in-law) a new beneficiary as well. Could this gift be seen as linked to morphine dependend thinking ?
        • James Salwitz, MD
          Wow ... so many lines being crossed here that it makes my head spin. Some quick thoughts, other than getting a good attorney; Narcotics are very difficult to stop if a patient has taken for a long time and become truely addicted. However, narcotics do not make a cancer grow. On the other hand any drug addicted person may make poor decisions, and clearly if someone is addicted to morphine the relationship to the person supplying those drugs, especially as a gift, may be compromised. jcs

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