The present publication is an attempt by the American Society of Clinical Oncology to describe the relation between alcohol consumption and cancer, including the effects on the risk of developing cancer and effects among subjects currently being treated for cancer. It came to the conclusion that there is a need for the public to be warned about the use of alcohol because of its effects on cancer, and describes numerous approaches for decreasing alcohol use in the population.
Forum members considered this paper to markedly distort the associations between alcohol consumption, especially light drinking, and health outcomes. The authors were particularly remiss in not describing the net health effects of light to moderate consumption: longer longevity of life. Their long discussion of policy implications, and ways of decreasing alcohol use in the population, were unrelated to the data they presented, and failed to describe how complex and culturally specific such recommendations are. The authors describe many ways of decreasing alcohol consumption in the population, but do not provide any data about whether or not the measures they propose are successful.
While all Forum members agree that heavy alcohol consumption increases the risk of several cancers (information that oncologists should be aware of), light drinking has generally been associated only with a slight increase in breast cancer, but not with other types of cancer (especially when under-reporting of intake is considered). Further, factors such as dietary folate intake, patterns of drinking such as binge versus regular moderate drinking, and type of beverage generally consumed have been shown to modify even this relation. Also, regular light or moderate drinking has been consistently shown to decrease the risk of cardiovascular disease (the leading cause of death), diabetes, dementia, and even total mortality, associations largely ignored in this paper.
Our Forum considers that this publication from the American Society of Clinical Oncology misses an opportunity to provide, for oncologists and for the public, up-to-date and balanced information of the true relations of alcohol consumption to the risk of cancer and other health outcomes. They have especially ignored the effects of moderate drinking on the risk of total mortality.
Reference: LoConte NK, Brewster AM, Kaur JS, Merrill JK, Alberg AJ. Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. J Clin Oncol 2017;35:pre-publication. DOI: https://doi.org/10.1200/JCO.2017. 76.1155