Dr Justus Apffelstaedt: Alcohol and cancer – how much should you care?

The definitive answer to the question in the title is a typical South African “Ja/Nee”, indicating that the answer is not straightforward. A major component of wine is alcohol, which has been shown convincingly in large population studies to increase your cancer risk. This holds true for seven common cancers: Mouth, throat, esophagus, voice box, female breast, liver and colon. Other cancers have not been demonstrated to be clearly correlated to alcohol consumption. While there is no absolutely “safe” level for cancer risk related to alcohol consumption, there is only a marginal risk increase for “light” to “moderate” drinkers. For heavy drinkers, the risk increases exponentially. What is “light to moderate” consumption? Moderate drinking in medical terms means up to about 50gm of pure alcohol per day or about 4 glasses of 10% or about 2.5 glasses of 15% wine for men, less for women.

How does alcohol cause cancer? Very roughly, cancer is a disease of the genes. These contain the programming of cells to divide and locate to specific sites. After all, we develop from a single egg cell from our mother fertilized by a single sperm cell from our father. After a period, cells cease to divide rapidly – we don’t grow endlessly. Also, particular cells populate a place in the body and stay there – it is handy to have, for example, the nose universally in the middle of your face instead of randomly elsewhere. The information governing these processes is contained in the DNA. If DNA is damaged by chemicals, environmental radiation or viruses, these processes can become compromised; cells start to proliferate again and migrate to places they don’t belong: A condition we call cancer.

Alcohol per se is only a weak carcinogen (cancer causing agent). By order of magnitudes, acetaldehyde, which alcohol is first broken down to before further broken down to ultimately water and carbon dioxide, is a much more active chemical compound. Both alcohol but much more so acetaldehyde attack DNA directly, but also initiate a multitude of other chemical processes which indirectly result in DNA damage.

Luckily, over the course of evolution, humans have become highly efficient at detoxifying alcohol and acetaldehyde. A special mention is reserved for the combination of smoking and alcohol consumption: Cigarette smoke contains a lot of acetaldehyde; exposure of the mouth, throat, voice box and oesophagus to smoke and alcohol increases the risk of suffering cancer exponentially. As examples, the risk of suffering breast or colon cancers for moderate and heavy drinkers is increased by about 1.2-fold and 1.5-fold whereas for smokers these numbers for suffering cancers of the mouth, throat and oesophagus are two-fold and five-fold. It is best to stop smoking in general as it has no beneficial health effects whatsoever.    

While this may sound scary, things must be put into relation. The average risk of a modern woman developing breast cancer is approximately 10 in 100. If these hundred women were moderate wine-drinkers, the 1.2 fold risk increase translates to two more out of the hundred; conversely in 98 of the 100 the moderate alcohol consumption is irrelevant. A similar calculation applies to other cancers. Furthermore, we have shown in our practice, that due to rapid advances in early detection and treatment, a woman diagnosed at screening with breast cancer will enjoy a normal life-expectancy. Colon cancer can largely be prevented by regular colonoscopy and removal of polyps which would otherwise develop into cancer. Similarly, many other cancers have become very treatable and curable non-lethal diseases; a cancer diagnosis is often not the death sentence it used to be.  

But wait, there is more. Moderate alcohol consumption also has beneficial effects. Heart attacks and strokes account for a large part of deaths world-wide. These are decreased by light to moderate alcohol consumption, particularly as part of the “Mediterranean Diet” in the form of wine. The effect is so big, that overall life expectancy is significantly increased by consuming e.g. wine in moderate volumes. This means, that if you forsake your glass of wine with dinner for fear of suffering cancer which often is not lethal, you may in fact decrease your life expectancy by not preventing a deadly heart attack or stroke.

So, I don’t care for alarmist reports focusing on a single aspect. These are not helpful and a more wholistic approach is appropriate. I, for one, with more than 30 years of experience in cancer research and clinical management, regard heavy wine consumption as part of the substance abuse spectrum and it should be treated as such. On the other hand, I will continue to drink a lot of water and enjoy a glass of good wine every day with dinner. It is an integral part of a healthy life-style which includes regular exercise, weight control and a balanced diet; I encourage my patients to follow a similarly healthy life-style.

• Dr. Justus Apffelstaedt is a specialist in breast and thyroid health, leading Apffelstaedt & Associates in Cape Town and Windhoek. A surgeon, oncologist, and researcher, he was Associate Professor of Surgery at Stellenbosch University (1994–2017) and Head of Surgical Oncology, managing 1,000-plus cancer cases annually. He has more than 50 publications, shaped South Africa’s breast cancer screening policy, and co-founded Breast Surgery International. A sought-after speaker, he has given over 100 international lectures. He also holds an MBA and a Diploma in Wine. Through Apffelstaedt & Associates, he continues to advance specialized, patient-centered care in Southern Africa.