According to the Ministry of Health‘s national plan, 2.7 million cancers were diagnosed in Europe in 2020 and 1.3 million lost their lives from this disease. It is also known that about 50% of cancer deaths and 40% of new cancer cases are potentially preventable as they are caused by risk factors that are modifiable. Among these, tobacco smoke undoubtedly represents the main single most important risk factor, being associated with the onset of about 1 cancer out of 3 and with 17 types of cancer in addition to lung cancer.
Passive smoking has also been recognized as responsible for cancer deaths, including an etiological role for even a small percentage of female breast cancer.
Even some chronic infections cause cancer, as well as environmental pollution, especially air pollution, even indoors, ionizing radiation, radon and exposure to ultraviolet rays. Eating healthy, maintaining the right body weight, doing regular physical activity can reduce the risk of getting cancer by up to 30%. Considering the importance that has been given to the consumption of alcohol, even minimal, and the onset of tumors within the European community with consequent important interventions proposed on the bottles in each package of alcohol, especially wine, proposed by the Ireland, we want to focus on the relationship between alcohol and cancer.
Excessive alcohol consumption has long been a major public health problem and in Europe around 4% more deaths and around 5% of life years are lost due to alcohol. This has led many countries to adopt the recommendation on the intake of certain alcoholic drinks, suggesting prudence as clearly expressed by the shared concept “less is better”.
It is known that ethanol can lead to the development of cancer through several metabolic alterations, including the alteration of the regulation of hormones such as estrogen and androgen and by acting as a solvent for other carcinogens such as chemicals found in tobacco.
In the last 10 years there has been a progressive increase in the share of female alcohol consumers and above all among young people where there remains a criticality which suggests that attention should be paid to this segment of the population, given that above all alcohol is very widespread among the age between 18 and 24 years not only with problems inherent in the development of diseases but also due to the risk of road accidents and other wrong behaviors such as aggression and so on.
However, the most important study that led Europe to act with proposals, which many did not agree with, including myself among them, is the one that appeared in the Lancet Oncology in August 2021 by European researchers and the Agency for cancer research in Lyon (among the authors there is not a single oncologist who has experience in cancer clinics) in which it was concluded that even moderate amounts of alcohol were associated with cancer. In this population-based study, the effects of alcohol consumption on the incidence of cancer worldwide in 2020 were calculated using a well-known statistical method. Globally, an estimated 740,000 cases constituted approximately 4% of all new cancer cases that were attributed to alcohol use. In males these cases were about 570 thousand while in women only about 170 thousand, moderate drinkers (two or less glasses a day) had 120 thousand cases and risk drinkers (from 2 to 5 glasses a day) 270 thousand cases and instead the heavy drinkers (over 5 glasses a day) 350,000 cases.
Above all, the males were the most affected and they were above all in Central and Eastern Europe. In particular, cases of cancer of the oral cavity, oesophagus, liver and female breast were studied. The most affected were mainly males from Central and Eastern Europe and among women also from Central and Eastern Europe.
As admitted by the authors of the work published in Lancet Oncology, the study has major limitations and in my opinion it cannot be considered a study on which a European policy can be based, as it would appear at least from Ireland. In fact, many cofactors are not considered which should instead be taken into consideration, in particular the use of tobacco concomitantly with alcohol, feeding problems such as obesity and the problems of concomitant infections in particular for liver cancer, for example hepatitis B and C.
Furthermore, it was not taken into account in this work that even the intervention on the awareness of problems attributable to tobacco such as tumors and many other diseases that have been explicitly reported on cigarette packages for many years have had no impact on tobacco consumption, because while this “terrorist” policy on the negative effects of tobacco was implemented, tobacco users have not decreased, but have actually increased.
Therefore one can think that if these same rules for alcohol were adopted that Ireland and the other countries seem to want to propose for Europe, i.e. putting recommendations on bottles of alcohol as for smoking, very probably one would not get a big plus as people would continue to drink as before. Instead it would be better to try to reduce the risk by inviting the entire population to moderate the use of alcohol, especially stronger liqueurs, such as vodka, whiskey, grappa, also remembering that red wine has health benefits as certain substances which are present in red wine, such as resveratrol, from the polyphenol family, are reductive of cardiovascular diseases and are considered the “sweepers” of the arteries and veins.
The paradox of the south of France is well known, where cardiovascular diseases are less common than in other areas of the country precisely because it is known that in that population they mainly drink red wine
In conclusion, to reduce the side effects not only of the medical side of alcohol abuse, all people are invited to moderate their use, even of wine, which is certainly very pleasant and reduces the hardships of life, leading to use it only during meals and only occasionally between meals. In this way the health problems related to alcohol intake would be greatly reduced. Since ancient times, man has always lived with alcohol which has been beneficial when used in moderate quantities, and today in Italy alone we have over twenty thousand centenarians and it seems that almost none of them have avoided moderate alcohol consumption. Obviously those who had abused alcohol did not make it to 100!
prof. Umberto Tirelli
scientific and medical director
Tirelli medical clinic, Pordenone