Alcohol and cancer risk
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I saw that yesterday. I think a couple things.
First, it's a little curious that it comes out at the very end of the Surgeon General's time in office. Was it rushed?
Second, while I haven't read the studies what I did read on this seemed incomplete. It doesn't give you much to go on rather than abstinence. How does risk go up based on quantity and frequency? Is it a greater or lesser risk than many other things like smoking, chemical exposure in daily life, air quality, etc.
I'm not terribly surprised as journalism these days is long on shock and short on details almost as a standard, but I'd like to know if these things exist.
“I refuse to answer that question on the grounds that I don't know the answer”
― Douglas Adams
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We used to rely on the media to bring attention to and to interpret information that we (the public) didn't have easy, or maybe any, access to. Now we can get to it ourselves, and with that comes the responsibility for interpreting what we see and read.
I think it's almost impossible for the media to cover everything the way it used to in an increasingly complex world that is flooded with information. I mean, they were trying to fill a half hour national news broadcast or a physical paper that had maybe a couple of editions a day. Now we're on the 24/7 constant watch, with people around the world having access to an unbelievable amount of information, and ways to disseminate it and their analysis.
The old model is changing to a profit machine based on eyeballs and clicks and I don't think it's ever going back to the way it used to be. We have to adjust accordingly. I think it means finding subject matter experts outside of traditional media and going to those sources for quality info.
Given all that, more and more often I'm turning to first sources and what I think are higher quality news sources for topics that I'm interested in. I posted the HHS press release because it has a link to the supporting material. Maybe these will provide some of the detail you're looking for:
https://www.hhs.gov/surgeongeneral/priorities/alcohol-cancer/index.html
https://www.hhs.gov/sites/default/files/oash-alcohol-cancer-risk.pdf
First, it's a little curious that it comes out at the very end of the Surgeon General's time in office. Was it rushed?
I don't see anything in the advisory that I haven't heard before. It just collated a bunch of information and presented it one place,, and it specifically addresses the fact that many people don't even know there is an association between alcohol and increased cancer risk.
Besides being the end of the Surgeon General's term, it's also Dry January, so it would seem a good time to present this info when people might give it the attention it deserves. So I don't think it was rushed. What makes you ask the question?
Is it a greater or lesser risk than many other things like smoking, chemical exposure in daily life, air quality, etc.
I think the advisory addresses something that an individual has direct control of. Smoking and drinking fall into that category. While air and water quality clearly affect our health too, an individual would find it much harder to influence those factors in the short term, so I guess I don't see that as a shortcoming of the Surgeon General's advisory.
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Yes. Alcoholic breakfasts are always worrisome.
WTG, what makes me ask about the timing is my nagging distrust of Washingtonians of all stripes. There are two kinds of people. One tells you its raining and you think "Oh, it's raining.". The other kind tells you the same thing and your thought is "Now why would they want it to be raining or for me to think it was raining?". DC critters all fall into the latter category.
“I refuse to answer that question on the grounds that I don't know the answer”
― Douglas Adams -
I can understand that, and asking the "why, and why now" question is not a bad idea. I just can't come up with anything with respect to this particular advisory that triggers any real red flags for me.
I wonder if Eric Topol at Scripps (one of the sources I trust for good science) will have anything on this down the road. He usually gets into the weeds on way more esoteric stuff, but who knows.
If he does, I'll post it.
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I don't even know what to make of this. It raises all kinds of questions. Like Mik asks, "Why now?" Also, what studies? Whose studies? Are they published and peer reviewed? Bacchus has been with us for millennia, now suddenly he's under indictment? Hm.
No, I don't dismiss news like this, but I also remember when butter was a death knell for those who partook. If you live in CA, practically everything causes cancer, and they "know" this according to labels one reads. From the sewing machine restoration forum I belong to I've learned that people in CA can't buy mineral spirits, it's banned.
The CDC website says "Some studies show that drinking three or more alcoholic drinks per day increases the risk ... ." "Some" studies. "Three or more!" The CDC site also says, "The Dietary Guidelines for Americans recommends that adults of legal drinking age (21 years or older) choose not to drink alcohol or to drink alcohol in moderation (2 drinks or less in a day for men, 1 drink or less in a day for women)."
So two drinks a day is moderate. Surely, not all drinks are created equal. 50% vodka vs 12% wine?
At the end of the day one has to balance things out. Is the risk from alcohol so great as to wipe away it's benefits? What happened to all those studies showing how red wine was good for you?
What disturbs me about these studies that are hard to get to and possibly hard to understand is you end up with the media--and lots of people--in hysterics, expounding that no amount of alcohol is good for you; they will get off on the ecstasy of sanctimony. That ignores everything about a person's existence except for the fact that they enjoy a good tipple.
The New York Times had an article saying the Surgeon General wants warning labels on alcohol stating it's link to cancer. I think warning labels on food are a waste of time and money and government overreach. It seems to me there are far better ways for the government to educate the public. Don't do it.
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@Bernard said in Alcohol and cancer risk
Bacchus has been with us for millennia, now suddenly he's under indictment?
Bacchus has been on the radar screen for a long time. I certainly have been aware of the alcohol risk with respect to colon cancer for several decades; it's on my radar big time. Same for breast cancer.
Here's the American Cancer Society website on cancer and alcohol, last updated 2020. It also addresses the question of what constitutes a serving.
https://www.cancer.org/cancer/risk-prevention/diet-physical-activity/alcohol-use-and-cancer.html
What happened to all those studies showing how red wine was good for you?
Science is an iterative process. Those studies haven't gone away, but they reflect the science and methods of a particular point in time. The conclusions of any studies may be re-thought or even reversed at some point in the future if new information comes to light.
In the particular case of red wine, I think as we've drilled down we think that it is resveratrol, which is in wine and also grapes, is what is beneficial. Maybe it's the case that eating grapes will get you all/most of the benefits of drinking red wine without the downside of alcohol. But wait! What about the effects of fungicides and other agricultural chemicals on grapes? Do they have to be organic grapes?
eta: Also see my post below about some of the possible shortcomings of studies that show positive correlation between alcohol consumption and healthy outcomes.
It never ends. It's turtles all the way down. You do the best you can with the information you have. And adjust when you have new data.
I think warning labels on food are a waste of time and money and government overreach.
As a consumer, I use the nutrition information to inform me about what is in a prepared product. For people with food allergies, the labels can be a life saver.
I'm not sure what the brouhaha is about labeling; maybe it's just the media's way to get clicks and get people to react. There are already government warnings on booze that say don't drink if you're pregnant and if you drink it may impair your ability to operate machinery or drive. As far changing that labeling on alcohol products to include "this may cause cancer" info, yea, I'm not sure if that does much of anything to influence people's behavior. There's probably some study about whether labeling cigarettes did anything to influence people's choices. I'll poke around and see if I can find anything.
What disturbs me about these studies that are hard to get to and possibly hard to understand is you end up with the media--and lots of people--in hysterics
Indeed. This is one of the challenges that comes with the wealth of information we have access to. The business model for media today is designed to do exactly that, to create, if not hysteria, at least a heightened interest. Clicks equal ad revenue. Not much else matters.
We do have to stop and examine things carefully, but I've come to the conclusion that we can no longer rely on the media to do that for us. See my response to @Mik.
I might note here that despite recent press reports, my black plastic utensils have been in constant use since I purchased them decades ago.
That was at least in part because I went and found the study and read it, in the process discovering that a major error in the study had been identified. But I'm geeky that way, and probably not typical. -
@Bernard said in Alcohol and cancer risk:
Also, what studies? Whose studies? Are they published and peer reviewed?
This hasn't come out of the blue and there is good science behind the HHS recommendation. Here's a meta-analysis that appeared in JAMA in 2023. It examined 107 studies about alcohol consumption that were done between 1980 and 2022. These were all-cause and not limited to cancer, so there is that.
It's worth noting that there is discussion in this analysis that talks about some studies that have shown a positive correlation between low to moderate alcohol consumption and that they may contain systematic biases that have not been taken into account and that would change the results.
This is where I'd look to @Piano-Dad or @Nina to tell us if the methods behind the JAMA article are solid. Above my pay grade.
Key Points
Question What is the association between mean daily alcohol intake and all-cause mortality?
Findings This systematic review and meta-analysis of 107 cohort studies involving more than 4.8 million participants found no significant reductions in risk of all-cause mortality for drinkers who drank less than 25 g of ethanol per day (about 2 Canadian standard drinks compared with lifetime nondrinkers) after adjustment for key study characteristics such as median age and sex of study cohorts. There was a significantly increased risk of all-cause mortality among female drinkers who drank 25 or more grams per day and among male drinkers who drank 45 or more grams per day.
Meaning Low-volume alcohol drinking was not associated with protection against death from all causes.
Abstract
Importance A previous meta-analysis of the association between alcohol use and all-cause mortality found no statistically significant reductions in mortality risk at low levels of consumption compared with lifetime nondrinkers. However, the risk estimates may have been affected by the number and quality of studies then available, especially those for women and younger cohorts.
Objective To investigate the association between alcohol use and all-cause mortality, and how sources of bias may change results.
Data Sources A systematic search of PubMed and Web of Science was performed to identify studies published between January 1980 and July 2021.
Study Selection Cohort studies were identified by systematic review to facilitate comparisons of studies with and without some degree of controls for biases affecting distinctions between abstainers and drinkers. The review identified 107 studies of alcohol use and all-cause mortality published from 1980 to July 2021.
Data Extraction and Synthesis Mixed linear regression models were used to model relative risks, first pooled for all studies and then stratified by cohort median age (<56 vs ≥56 years) and sex (male vs female). Data were analyzed from September 2021 to August 2022.
Main Outcomes and Measures Relative risk estimates for the association between mean daily alcohol intake and all-cause mortality.
Results There were 724 risk estimates of all-cause mortality due to alcohol intake from the 107 cohort studies (4 838 825 participants and 425 564 deaths available) for the analysis. In models adjusting for potential confounding effects of sampling variation, former drinker bias, and other prespecified study-level quality criteria, the meta-analysis of all 107 included studies found no significantly reduced risk of all-cause mortality among occasional (>0 to <1.3 g of ethanol per day; relative risk [RR], 0.96; 95% CI, 0.86-1.06; P = .41) or low-volume drinkers (1.3-24.0 g per day; RR, 0.93; P = .07) compared with lifetime nondrinkers. In the fully adjusted model, there was a nonsignificantly increased risk of all-cause mortality among drinkers who drank 25 to 44 g per day (RR, 1.05; P = .28) and significantly increased risk for drinkers who drank 45 to 64 and 65 or more grams per day (RR, 1.19 and 1.35; P < .001). There were significantly larger risks of mortality among female drinkers compared with female lifetime nondrinkers (RR, 1.22; P = .03).
Conclusions and Relevance In this updated systematic review and meta-analysis, daily low or moderate alcohol intake was not significantly associated with all-cause mortality risk, while increased risk was evident at higher consumption levels, starting at lower levels for women than men.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802963
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@wtg There's a lot to absorb in your posts and I'll have to come back to them. But a few quick responses to a few points...
My mother almost never drank any alcohol, maybe a quarter cup of beer, three times a year. She died of breast cancer at age 54. I know people who lived well into old age partaking almost every day.
The question I would love to have answered is: Are these studies simply uncovering correlation? Or does it go beyond that? Every one of the people who has ever come down with cancer got out of bed the day(s) it started. We don't say that getting out of bed increases one's chances of having cancer. There are a lot of people who drink who don't get cancer, there are a lot of people who smoke(d), sometimes heavily, who never got cancer.
I can see that if they've studied the effects of alcohol on a cellular level why they could say it's a possible carcinogen, and might increase one's risk, but not that it causes cancer. Else everyone who ever drank or ever smoked will have contracted cancer. The Surgeon General's advisory says about 3 men out of a 100.
As a consumer, I use the nutrition information to inform me about what is in a prepared product. For people with food allergies, the labels can be a life saver.
I don't have a problem with nutrition and ingredient labels, I also use them all the time. (There was talk not long ago about requiring the labels to appear on the front of products and I'm not for that. The back is just fine.) My beef is about warnings on food. Just no. The government could just as well require any and all point-of-sale displays to prominently show a government warning without marking every instance of the product. It would be a lot cheaper and just as effective it seems to me.
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Sidebar about forum stuff: If you're looking for an alternative to using italics to set off a block of text that you're quoting from somewhere, you can enter a > (greater than sign) in your post and paste your copied text immediately after the > No space.
@Bernard said in Alcohol and cancer risk:
There's a lot to absorb in your posts and I'll have to come back to them.
I get that a lot.
For the record, there is no obligation to read/respond to everything I post! My feelings won't be hurt. But I do think those links might answer a lot of your questions.
The question I would love to have answered is: Are these studies simply uncovering correlation? Or does it go beyond that?
I think that's an underlying problem with a lot of studies.
It's mentioned in the JAMA paper that I linked to above, but it was in reference to the opposite problem, namely whether studies that have shown positive link between low to moderate alcohol consumption and better health outcomes are flawed in some way. It was postulated that people who drink alcohol moderately take care of themselves a lot better in other ways, and that is the reason behind their being healthy rather than the alcohol alone. And that those factors weren't accounted for in some studies.People like @Piano-Dad have the skills required to identify when this happens. Don't know if you read the black plastic spatula thread, but after I posted about the error in that study where the concentration calculations were off by an order of magnitude, he talked about an experience he had. He and some other people identified certain problems in a dermatology study, resulting in it being retracted. Here's his post:
https://wtf.coffee-room.com/topic/963/throw-out-your-black-spatula/31?_=1736020377710\
It's unfortunate that the problem didn't get caught during peer review, but it didn't. And eventually a problem in a dermatology paper was identified by an economist. Go figure.
My mother almost never drank any alcohol, maybe a quarter cup of beer, three times a year. She died of breast cancer at age 54. I know people who lived well into old age partaking almost every day.
I have the flip side of the follow the rules and have a bad outcome..my grandfather was the classic case of breaking the rules and beating the odds...
He smoked two packs of cigarettes from the time he was a teenager. He ate smoked pork products (ham hocks and bacon). Fresh vegetables? If it wasn't a potato it didn't cross his lips. He filled his coffee cup halfway with coffee and filled it up the rest of the way with half and half and three teaspoons of sugar. With a piece of cake on the side.
His cholesterol was 180 and his blood pressure was 120/70. He broke all the rules and lived to be 92, far beyond the life expectancy of someone who was born in 1897.Lung cancer did finally get him at the end. It was six weeks from diagnosis to his death. But I'd say he beat the odds. Some kind of CES (Charmed Existence Syndrome).
Personal experiences with family members like yours and mine demonstrate that there are likely a lot of things that influence our health. But when the sample size is so small, it's impossible to generalize. That's where the studies come in.
I think there's a middle ground to be trod, both keeping up with the science but not assuming that it is gospel. I never gave up full fat dairy despite all the warnings, but I have avoided milk with rGBH. I still indulge in sweets on a semi-regular basis despite warnings about sugar. And on and on. If I'd have to boil it down to a life motto, it would be "All things in moderation, including moderation."
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@Bernard - I've been catching up a bit, reading other sources including what I think is the NYT article you mentioned. I see that people are talking about studies that seem to demonstrate that low to moderate alcohol consumption may be associated with positive health outcomes in some respects (cardiovascular in particular). In the other camp are the studies that seem to show an association with cancer. And of course the liquor industry is weighing in on everything because of its financial interest.
All of this made me think about the history of smoking and how things rolled out. Two Surgeons General, Leroy Burney in 1957, and Luther Terry in 1964, made headlines with their annoucements about the links between smoking and health.
Some background, if you're so inclined...
https://circulatingnow.nlm.nih.gov/2014/01/10/smoking-in-america-50-years-on/
https://www.health.harvard.edu/blog/surgeon-generals-1964-report-making-smoking-history-201401106970
Getting back to the alcohol debate...
My choice is easy. I'm someone who simply can no longer tolerate alcohol, so I don't consume it anymore because it makes me feel like carp within minutes. But you can bet your bottom dollar that if it didn't have that effect on me, I'd be having an occasional tipple myself.
For the rest of the country, I suspect the debate will go on for decades like smoking did.
Cheers!
