In 1988 the International Agency for Research on Cancer (IARC) of Lyon of the World Health Organization (WHO) included alcohol (ethanol) in the list of substances with a certain carcinogenic effect, i.e. in group 1. Yet, unlike other molecules included in the same list such as those contained in cigarettes, the perception of the risks associated with the consumption of alcohol has not reached the general public, due to the cultural superstructures associated with alcohol and the commitment of producers to ensure that this does not would happen. Just make a comparison between what you see on television, at the cinema, in TV series: while characters who smoke are increasingly rare and generally negative (criminals, drug addicts and so on), there is almost no visual production that does not involve the protagonists drinking alcohol at all hours, and attributing the most diverse meanings to this gesture.
In the case of US productions, then, the presence of spirits in every situation, drunk at all hours in quantity, from homes to offices, is evident. What is essential to do is therefore a massive cultural operation, as the leaders of organizations such as the WHO itself or the European Parliament have recalled several times and put in writing in an official statement in 2023. Now a new meta-analysis, supported by very relevant numbers, helps to strengthen the theoretical basis on which to set up educational campaigns and other initiatives, also clarifying the particularities of risk in different population subgroups.
The data of millions of people
Table of Contents
The meta-analysis, just published in Cancer Epidemiology by specialists at the University of Florida, examined 62 studies from recent years, which together involved a number of people between eighty and one hundred million subjects: probably a record. The research examined was of various types, from classic observational ones to those with a control and concerned the links between alcohol consumption and different types of cancer, as well as the role of factors such as age, socioeconomic conditions, gender, lifestyle, the presence of illnesses (especially mental, but not only), without neglecting to verify the numbers based on the quantity of alcohol and the habit of drinking it.
A series of confirmations and some surprises
First of all, the evidence is strengthened that associates consumption with an increased risk of at least nine types of cancer, together with the fact that the probability of getting ill is directly proportional to the frequency and quantity of alcohol drunk. The most closely related types are cancers of the esophagus, liver, larynx, stomach, mouth, breast, and colorectal.
Furthermore, the consumption of alcohol worsens the progress and therefore the prognosis of various pathologies that may be present, starting with those of the liver: liver cancer worsens more rapidly, and leads to shorter survival, but hepatitis also tends to evolve into fibrosis first and then cirrhosis more quickly than what is seen in those who do not drink.
There are predisposing factors, such as certain types of genes and the presence of some hereditary characteristics, belonging to a certain ethnic group (among those most at risk are African Americans), as well as some pathologies that increase the risk of cancer associated with ethanol such as obesity and diabetes.
Education and socioeconomic status
A great contribution is made by the level of education and socioeconomic condition: some more disadvantaged social groups are affected to a degree that is defined as disproportionate compared to others, because both exposure and general vulnerability to the damage caused by alcohol increase in them. The poorest have worse consequences than people with less economic difficulty even for the same amount of drinking.
The age of first exposure and the type of alcohol consumed regularly also count: for example, some studies show a clear association between beer or white wine and tumors, others essentially exonerate liquor, probably because it is drunk occasionally by the majority of those who appreciate it.
The risk then changes based on gender, which influences the type of consumption: males are more used to drinking regularly or often, and these behaviors, for them, represent the maximum increase in risk. Women, on the other hand, have another factor: excessive drinking, even if more episodic.
Smoking, sun and alcohol
Smoking, in turn, amplifies the risk, although the extent of this increase depends on (alcohol) consumption and gender.
A further situation that can worsen the risk deriving from ethanol is exposure to ultraviolet rays. Similarly, a high or low body mass index, poor physical activity, infections that can lead to cancer such as helicobacter pylori stomach infections or hepatitis (especially B and C), poor nutritional nutrition, certain eye or hair colors and certain hormones may play a role.
The great variety of elements that can increase the risk given by ethanol is explained by the main suspect: acetaldehyde, its first metabolite in the organism. This substance directly damages DNA and increases the permeability of cell membranes, leading to various negative effects. For example, they stimulate tumor proliferation or in any case support the multiplication of cells that are getting out of control. They also improve the absorption of other carcinogens, increasing the probability that these carry out their function and cause the formation of a lesion, and then increase the oxidative stress of the cells, and alter hormones and the immune system.
What to do
Those who scrupulously follow the guidelines, which either do not include alcohol or tolerate very low quantities, are still protected, and this is what we need to focus on, according to the authors, to improve people’s awareness and push them to reduce consumption, if not to abandon alcohol altogether. However, there is not just one approach: it is necessary to frame each of the interventions in a strategy that also includes, for example, fiscal levers and legislative restrictions. Finally, we need to study targeted interventions for the people most at risk, also to try to reduce the medical inequalities that arise from socio-educational and economic ones.
© All rights reserved Photo: Depositphotos.com
