Alcohol and Cancer. Well, Alcohol and Everything

alcohol

 

Warning: Political Rant about Silly Political Leaders Below.

 

Most people who drink alcohol, or have family members who drink, will likely be aware of the potential for devastation associated with one of our most common recreational pastimes.

As a young medical student I spent a lot of time learning about Korsakoff’s syndrome, Wernicke’s encephalopathy, with a wide variety of memory loss disorders. Other neurological disorders arrising from alcohol abuse include cerebellar degeneration with loss of balance and motor control. We learned them in large part for their esoteric presentations, and strange names, like Machiafava-Bignami Syndrome, a form of dementia with spastic weakness. But it’s a great name!

Mild degrees of cognitive difficulties are very common, some of them reverting when alcohol is stopped for a significant length of time.

Serious degrees of cognitive impairment can occur when chronic heavy drinkers stop abruptly, too.

Of course, almost everybody knows about liver disorders, alcoholic hepatitis and chronic liver failure. Subtle forms of these liver disorders are suspected by cancer doctors when patients with apparently normal liver function by biochemical testing have nasty toxicities with drugs that are very sensitive to liver function, like the common chemotherapy Taxanes, Docetaxel and Paclitaxel.

The general public seems to have a sense of these problems, but they often don’t know about other illnesses caused by moderate to intermediate alcohol consumption, like cardiomyopathy (heart failure without obvious coronary blood vessel problems), gastrointestinal troubles like chronic gastritis and pancreatitis, blood disorders like sideroblastic anemia and chronic neutropenia, not to mention muscle loss and progressive deconditioning.

Blood pressure elevation is a common problem, which lay people often do not know.

Few people know that significant clues to alcohol abuse are apparent to the physician just by a simple blood film analysis, part of a routine Complete Blood Count or CBC. When I was reviewing blood films in my work as a hematologist, it would be a common occurrence that I might append a remark to the report reading ‘alcohol?’ to alert the GP to the potential concern, especially when I saw ‘fat’ red blood cells (elevated MCV) under the microscope.

These things are actually amazingly common. I don’t wish to scare away potential patients seeking help, but most experienced physicians can suspect, with significant degree of accuracy, the presence of alcohol abuse by the appearance of the patient’s face and skin when they walk in the door.

It is likely that most people do not realize that their doctors already know or suspect alcohol abuse, long before either party talks about it.

Please don’t be scared away from seeing your doctor.

Two characteristics of the ethical physician: kindness and confidentiality. The good doctor is NOT judgmental about these things; we are taught not to be. After all, we really do not want our patients hiding their issues, nor failing to come to see us about them, especially when we already suspect them.

If your doctor is harsh and judgmental about your alcohol consumption, as opposed to empathetic and caring, as opposed to seeking to help you deal with it all, while respecting your confidentiality … if your doctor is like that, YOU SHOULD CHANGE DOCTORS.

Being judgmental in our profession is terribly counter-productive. Being judgmental with you will encourage you to hide your issues and avoid your doctor, and having no doctor is probably better than having an uncaring judgmental physician.

Cancer

But many many of my patents have no idea of the influence that alcohol has on the incidence of cancer.

There is a direct correlation (meaning the more you drink, the more you get of whatever) between alcohol and many cancers. Overall, moderate or light drinkers have a 10% less incidence of cancer than do heavy drinkers, and that is regardless of smoking history.

Breast Cancer

One fact that most people find surprising is the relationship with breast cancer. Even a small intake such as three to six drinks per week can raise the risk. In fact, one rule of thumb is a 10% increase in risk for every 10 gm. of alcohol per day.

Here, you’re going task what 10 gm. of alcohol is, in real life drinks, for example.

A standard drink, or alcohol equivalent (AE), is about 15 gm. of alcohol, which is 12 ounces of  Canadian beer (not that watered-down American stuff), 1.5 ounces of spirits (like scotch straight) or 5 ounces of wine.

Well, 10 gm. is about 2/3 of a standard drink, 2/3 of an AE, or alcohol equivalent: 8 ounces of beer, 3.5 ounces of wine, 1 ounce of spirits (80 proof liquor).

So two AE (15 gm. x 2 = 30 gm.) per day will result in 30% increase in risk of Breast Cancer. In some countries, such as Italy where alcohol consumption is higher, alcohol may be responsible for as much as 11% of all breast cancer.

 Gastrointestinal Cancer

Mount, larynx, pharynx, esophagus, stomach, pancreas, liver, and colorectal cancers all have varying levels of relationship to alcohol consumption, with greatest relationship between head and neck, and esophageal cancers.

Lung Cancer

This one is harder, because many heavy drinkers may also be heavy smokers, and smoking is clearly related.

Other Nasty Conditions

Osteoporosis, diabetes, have been linked to excessive alcohol consumption.

Trauma is clearly related, and you don’t have to be Ben Carson (i.e. brain surgeon) to know this; whether it is falls, motor vehicle accidents, or violence, alcohol often makes the whole situation worse. Trauma to oneself, be it accidents or suicide, are more frequent when alcohol is involved.

Immune suppression and pneumonia are features of the chronic alcoholic.

Alcohol and pregnancy is a no-no as everyone knows.

Domestic violence. Well, enough said. Nobody needs convincing about that relationship. Family breakdown with marital conflict, enough said. Deteriorating work relationships, enough said.

If you know someone who is periodically angry for no good reason, well, that’s a pretty common sign.

Driving

This is horrific.

Three cheers for Candy Lightner who has probably been responsible for more lives saved than any other single individual! She started MADD, Mothers Against Drunk Driving, in 1980 after her thirteen year old  daughter was killed by a drunk driver. According to the National Highway Traffic Safety Administration, almost 18,000 people in the USA were killed by drunk drivers in the year 2006.

One year. And it hasn’t changed much since then.

Political Rant

We shudder at the sound of fireworks; indeed, it stampedes us in certain countries, especially this month, and yet what do we do about drunk driving?

Risk of DUI Compared to Terrorism

Canada is taking 25,000 Syrian refugees. Even France, the country most recently suffering, is taking 30,000.

France.

And yet, 31 mostly Republican Governors/Senators in the USA are refusing to support these victims, in particular Muslim victims, for fear there might be some terrorists among them. But when you think about DUI and Vehicular Deaths, what incredible irony.

Strict Muslims don’t drink and drive; they don’t even drink.

They don’t typically get DUIs, the one threat that beats out terrorism, in term of American mortality, by a factor of a thousand or more. Year after year after year.

Are these Governors/Senators just cowards?

No, I don’t think most American leaders are cowards. I think this is probably much worse. I think they are just using this specter of terrorist tragedy as a political pawn to demean and diminish their first black president. I think they’ll probably try to do the same thing to their first female president.

But I digress.

Look, if everybody in the USA turned to Islam tomorrow, they would save 18,000 deaths per year, just because devout Muslims don’t drink and drive! You get that, right? They don’t even drink.

And yet those Republican political leaders, and some democrats I think, are all afraid of terrorism, but they will drive home after a couple of glasses of wine at dinner out. A cocktail. A beer.

Threatening death on the streets that dwarfs anything terrorism has to offer, in real numbers.

Makes me wonder what their real motives are.

Safety

What is safe consumption? The tricky part here is that in some susceptible people, usually former heavy drinkers who have pulled themselves together, any amount of alcohol can lead to excessive amounts and therefore should be avoided.

For the rest of us, females: 4 to 7 AE per week; males: 7-10 AE per week. 

Why the difference between men and women? Probably mostly size, and theoretically, the difference in enzyme concentration in the stomach for destruction mechanisms of alcohol.

And NOTHING on the same day before driving! It will take, on average, one to four hours per AE to clear the blood of 15 gm. of alcohol, but even low levels, lower than the legal limit (BAC 0.05 in Canada), even down around 0.01-0.02, can be enough to impair driving abilities. And metabolism is SO variable, how do you ever know?

So don’t drink and drive. Ever.

The world might be better off if you were a terrorist!

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s