Alcohol, smoking and cancer

[Guest guest]

Hi All,

We, as CRers, smoke less often than the general public, I

believe. Wanting to live longer is not coherent with smoking.

We often consider the alcohol calories and heart health

associations, but may worry about the cancer risks of smoking.

Now a new paper that is pdf-available suggests that we,

as generally non-smokers, have little or maybe even less

risk from cancer due to alcohol intake.

Half of men and few women smoked.

I was surprised that gastric and colon cancers, both

major cancers in these Japanese, were not considered

to be smoking-related. See the below the Medline abstract

for the discussion and some results in which I thought might

we be interested.

The total cancer deaths with alcohol and without smoking

do appear to me to represent compelling data for tipping

the wine glass in our practice to reduce heart disease, in

which my family history is at increased. Lung cancer,

which was not given to be alcohol-related, is not in our

family for the extensive list and types of cancer deaths.

Alcohol, as well as fish, seems to also boost HDL, which

for me was low before taking them. This is also reported

in the literature, I believe.

Br J Cancer. 2004 Dec 14; [Epub ahead of print]

Impact of alcohol drinking on total cancer risk: data from a large-

scale

population-based cohort study in Japan.

Inoue M, Tsugane S.

... 73 281 subjects (35 007 men and 38 274 women) aged 40-59 years

old at baseline over a 10-year follow-up period. During 1990-2001, a

total of

3403 cases of newly diagnosed cancer and 1208 cancer deaths were

identified. In

men, the lowest risk of developing cancer was observed among

occasional

drinkers, and a linear positive association with increased ethanol

intake was

noted (hazard ratio 1.18 for 1-149 g per week, 1.17 for 150-299 g per

week, 1.43

for 300-449 g per week, 1.61 for >/=450 g per week, P for trend

<0.001). The

positive relation was similar for cancer incidence and mortality, but

was more

striking among current smokers and alcohol-related cancers.

Relatively few women

were regular drinkers. Our results suggest that increased ethanol

intake

linearly elevates the risk of cancer, and that nearly 13% of cancers

among males

in this study were due to heavy drinking (>/=300 g per week of

ethanol), to

which smoking substantially contributed. The simultaneous reduction

of smoking

is therefore important for reducing the effect of alcohol on cancer

risk.

PMID: 15597102 [PubMed - as supplied by publisher]

... Table 3

Total never smoker cancers

----------------------------------------------------------------------

-----------------

Drinkers, g/week: None Occasional 1-149

150-299 300-499 >/=500 p for trend

Health risk (95% CI): 0.90 (0.62 –1.31) 1.00 (reference)

0.87 (0.60–1.28)

0.86 (0.57–1.29) 1.03 (0.66–1.62) 1.02 (0.64–1.64) 0.370

Nonalcohol-never smokers-related cancers

----------------------------------------------------------------------

------------------

Drinkers, g/week: None Occasional 1-149

150-299 300-499 >/=500 p for trend

Health risk (95% CI): 0.85 (0.57–1.26) 1.00 (reference)

0.81 (0.55–1.20)

0.80 (0.53–1.23) 0.92 (0.57–1.48) 0.85 (0.51–1.42) 0.733

[For cancer deaths, respective values for never-smoker values were

even more impressive, at:]

Drinkers, g/week: 0.67 (0.40 –1.12) 1.00 (reference)

0.53 (0.31 – 0.92)

0.49 (0.27 – 0.91) 0.33 (0.14 – 0.78) 0.55 (0.26 – 1.16)

0.634

----------------------------------------------------------------------

----------------

Alcohol-related cancers consist of cancer of the

oral cavity, pharynx, oesophagus, liver, and larynx.

Nonalcohol-related cancers consist of all other

cancers not considered to be alcohol related.

... At baseline, 70% of men were regular drinkers and 48%

consumed alcohol 3–4 times per week or more; in women, 77%

were nondrinkers and 12% regular drinkers. The average

frequency of alcohol consumption among regular drinkers was

5.2 days per week in men and 3.6 days per week in women. Both in

men and women (Table 1), the proportion of current smokers was

increased in the higher ethanol intake groups, in which leisure-time

physical activities were less frequent. However, no consistent

trend in green vegetable intake was observed across the alcohol

categories.

... The HRs for cancer in men were estimated separately by

smoking status at baseline for each alcohol-drinking category

(Table 3). For cancer incidence, no risk fluctuation was observed

among never-smokers, whereas current smokers exhibited a

constantly elevated risk compared with occasional drinkers (1 –

149 g per week: HR ¼1.69, 150–299 g per week: HR ¼1.64, 300–

449 g per week: HR ¼1.93, X450 g per week: HR ¼2.32, P for trend

o0.001). Similar trends were observed for cancer mortality, with a

somewhat decreased risk tendency among never-smokers. A

statistically significant interaction between alcohol and smoking

status applied to the risks of both total cancer incidence

(P ¼0.018) and mortality (Po0.001).

The HRs for cancer in men were also separately determined for

alcohol-related and other cancers (Table 3). As expected, increased

risks were more evident for alcohol-related cancers than those for

other cancers. In a further analysis restricted to alcohol-related

cancers by smoking status, increased risks for the high-alcohol

categories were also observed among never smokers, though less

than among current smokers.

... DISCUSSION

In this cohort study, the lowest risk of cancer was observed among

male occasional drinkers, and a linear positive association with

increasing ethanol intake was seen, with up to a 61% excess cancer

risk among subjects with an ethanol intake of X450 g. The positive

association was similar for both the cancer incidence and

mortality, but was more striking among current smokers and for

alcohol-related cancers. Considerable interaction between smoking

and alcohol drinking was observed. On the other hand, no clear

association between alcohol drinking and cancer was found in

women, probably because few of them were regular drinkers.

Among males, nearly 13% of the cancers were considered

attributable to heavy drinking (X300 g of ethanol per week).

... Our results indicate that the combination of alcohol drinking

and smoking is associated with a particularly increased risk of

cancer and presumably makes a major contribution to both

incidence and mortality of the overall cancer risk, while no such

tendency was detected among never-smokers. Except for our

previous work, studies of the effect of interaction between drinking

and smoking on the total cancer risk in the Japanese are sparse

(Tsugane et al, 1999; Hara et al, 2002). CYP2E1, the expression of

which is induced by alcohol, metabolises procarcinogens, such as

N-nitroso compounds, present in tobacco smoke and foods

( et al, 1994); it also catalyses the conversion of alcohol

to acetaldehyde. Animal experiments have suggested that carcino-gens

in tobacco smoke are metabolised more slowly among

drinkers (Van de Wiel et al, 1993; et al, 1994). Although

interaction between alcohol and smoking may greatly contribute to

the risk of both cancer incidence and mortality, alcohol may also

be an independent risk factor, at least for alcohol-related cancers.

Cheers, Al Pater.