The corner bar is no longer filled with smoke. But the alcohol-tobacco connection still exists. Drinkers smoke, smokers drink — and both pay a price.
Smoking is a well-known factor for many cancers, most notably lung and pancreatic, but also stomach, kidney, bladder, colorectal, cervical, uterine and ovarian. It is also often a factor in acute myeloid leukemia. Alcohol is associated with liver and breast cancers. And both tobacco and alcohol have been linked strongly to cancers of the mouth and throat, including lip, oral cavity, pharynx, esophagus and larynx.
Tobacco contains more than 34 known carcinogens, and the risk comes not only with cigarettes, but also cigars, pipes and smokeless tobacco. Alcohol is most closely linked with liver cancer. Carcinogens and toxins are metabolized by the liver, and heavy use of alcohol over time limits its ability to disable them.
ORAL CANCERS: In Utah, populated largely by Mormons whose religion calls for abstinence from both tobacco and alcohol, the rate of oral cancers is the lowest in the country. And these cancers are rarely found in developed countries where smoking and drinking are not prevalent.
Of Americans diagnosed with oral cancer, about 75 percent have used tobacco products. Since most were also drinkers, it is hard to sort out which is the greatest risk. But they seem to act together. Some experts believe that this may be because alcohol has a dehydrating effect on cells that it touches on the way down the throat. These cells are then made more vulnerable to the carcinogens in tobacco smoke.
PANCREATIC CANCER, one of the deadliest of cancers with mortality rates approaching 100 percent, is believed to be caused by some combination of genetic mutations and lifestyle factors such as smoking, a diet high in animal fat and excessive intake of carbonated soft drinks.
The association with tobacco is strong and fairly well known, but still not as strong as the link between smoking and lung cancer. In cultures where drinking habits are low to moderate, a link between pancreatic cancer and alcohol has not been found. But recent studies suggest that persons who drink heavily have an increased risk, regardless of smoking.
A multi-center study published in the American Journal of Gastroenterology  found a dose-related increased risk for early pancreatic cancer among both smokers and drinkers. Heavy smokers and drinkers tended to be diagnosed about five years earlier.
BREAST CANCER: An analysis of data from 53 epidemiological studies [British Journal of Cancer, 2002] suggested that about four percent of breast cancers in developed countries can be attributed to drinking of alcoholic beverages.
The same study concluded that the relative risk increased by 7.1 percent for each additional 10 grams of alcohol consumed per day.
A major factor is believed to be the hormonal changes it creates. Alcohol increases the production of estrogen and other hormones.
Some epidemiological studies have found that even moderate drinking — one or more drinks a day is associated with a higher risk of breast cancer, and some experts are recommending abstinence, particularly for women at risk.
Recent thinking, however, is that reported levels of alcohol consumption used in epidemiological studies do not adequately take into account pattern and timing of drinking. Binge drinking, four or more drinks at a time, particularly during youth, is believed to be a bigger risk than having one or two drinks a day in later life.
An American Cancer Society study that followed half a million middle-aged women for about 20 years found that mortality rates were 20 percent lower for women who consumed one alcoholic drink per day, compared to those who never drank.
SO WHAT SHOULD YOU DO? With tobacco, there is no question: the health risks are great enough that you should quit. If you’re a non-smoker and a moderate drinker (one or two drinks a day) with no special cancer risks, you should probably continue what you’re doing.
Heavy smoking and binge drinking are another matter. In addition to the risk of alcoholism and its many related problems, heavy drinkers have an increased vulnerability to many cancers, particularly when drinking is combined with smoking.
Rupp is a certified information and referral specialist on aging for NODA Area Agency on Aging. Contact her at 237-2236.