New Advisory Brings the Alcohol-Cancer Connection to the Forefront

by Specialdocs Consultants | Feb 25, 2025 | Healthy Aging, Patient News

Alcohol and Cancer Risk

Our year was off to a sobering start with the advisory on alcohol and cancer risk issued by the Surgeon General in January. The key points, which were concerning, and for at least half of Americans, seemingly unknown until now, included:

• A direct link was reported between alcohol consumption and higher risk for cancers of the breast, colorectum, esophagus, liver, mouth, throat (pharynx), and voice box (larynx).
• Four pathways were posited: 1) As it metabolizes, alcohol breaks down into acetaldehyde, a chemical which damages DNA in multiple ways. This can cause a cell to begin growing uncontrollably and create a cancerous tumor. 2) Alcohol induces oxidative stress, damaging DNA, proteins, and cells, and increasing inflammation. 3) Alcohol may alter hormone levels, which can play a role in development of breast cancer. 4) Carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier to be absorbed into the body, and increasing risk for mouth and throat cancers.
• Citing a 2019 survey showing that just 45% of Americans recognize alcohol as a risk factor for cancer, a strong recommendation was made to raise awareness by updating the current warning label on alcoholic beverages.

There is no doubt that the Surgeon General can greatly influence recognition of a health issue, as evidenced by the landmark 1964 report on the risks of tobacco, laying the groundwork for public regulations in the decades to follow. Then, 42% of Americans smoked, now just 11% do. The impact of the current alcohol advisory may not be as profound, but it is significant for several reasons.

While the science behind the advisory is not new, as alcohol-related cancer risk has been noted previously by many healthcare organizations, it has grown increasingly stronger over the years. Particularly for women who drink, recent studies have added to the mounting evidence of their higher risk of developing breast cancer, as well as increased susceptibility to liver disease, cardiovascular disease, and neurotoxicity compared to males. A more widespread public campaign with prominent warnings on alcohol-containing products will help underscore these findings.

The advisory may also add impetus to the cultural shift around alcohol use that’s been occurring over the last decade. As noted, the percentage of Americans who agreed that 1-2 drinks per day is bad for one’s health is low at 45% in the most recent Gallup poll but still reflects a marked improvement compared to 26% in 2016. Most promisingly, the younger generation is leading the charge, with 65% of adults aged 18 to 34 agreeing that alcohol consumption negatively affects health vs. 38% on average of their elders.

Highlighting the risk of disease associated with alcohol requires a more nuanced approach than tobacco, where no consumption is considered safe. Instead, alcohol consumption is viewed along a continuum where risk for most people remains relatively low at 2 standard drinks or less per week, and moderately low at 3 to 6 standard drinks per week – yet fully acknowledging that individual risk is determined by a complex interaction of biological and environmental factors. As long-time researchers wrote in the Harvard Public Health Journal, while heavy drinking is indisputably harmful at every age, the data may not justify sweeping statements about the effects of moderate alcohol consumption. They point to research with mixed results e.g. studies showing decreased mortality, lower risk of cardiovascular disease in moderate drinkers, and a widely cited UK study of one million women that reported higher rates of breast cancer among drinkers but lower rates of thyroid cancer, non-Hodgkin lymphoma, and renal cell carcinoma. Recognizing that a gold-standard randomized control study would be well-nigh impossible to conduct, the most reasonable approach is to equip people with information that allows them to understand why less alcohol is better, and zero risk is only possible at zero consumption.

Our recommendations:

If you don’t drink, don’t start, as benefits are unproven, and the downsides are clear. Avoid alcohol completely if you are pregnant or trying, have a personal or family history of alcohol use disorder (AUD), have a medical condition that alcohol can aggravate (e.g., liver disease, precancerous conditions of the digestive tract), use medication that can cause interactions, or operate potentially dangerous machinery. However, if you are debating whether you can enjoy an occasional glass of chardonnay, please talk to us. We’ll help you make an informed decision based on multiple factors, including age, gender, medical history, diet, fitness, and lifestyle.

Symptoms of Alcohol Use Disorder (AUD)

What defines a heavy drinker, or a person with AUD? If you’ve experienced two or more of these symptoms in the past year, you may benefit from professional guidance to help you decrease or stop alcohol consumption:

1. Had times when you ended up drinking more, or longer, than you intended?
2. More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
3. Spent a lot of time being sick from drinking, or getting over other aftereffects?
4. Wanted a drink so badly you couldn’t think of anything else?
5. Found that drinking—or being sick from drinking—often interfered with taking care of your home or family, or caused job troubles?
6. Continued to drink even though it was causing trouble with your family or friends?
7. Given up or cut back on activities important to you to drink?
8. Gotten into unsafe situations while or after drinking e.g., driving, walking in a dangerous area?
9. Continued to drink even though it was making you feel depressed/anxious or after an alcohol-related memory blackout?
10. Found that your usual number of drinks had much less effect than before?
11. Experienced withdrawal symptoms when the effects of alcohol were wearing off e.g., trouble sleeping, shakiness, restlessness, nausea, sweating?

Sources: Harvard Public Health, Journal of Internal Medicine, Journal of the National Cancer Institute, Surgeon General’s Advisory on Alcohol and Cancer Risk, UptoDate, Rethinking Drinking, National Institutes of Health

Heart Health Update: All Roads Lead to Prevention

by Specialdocs Consultants | Feb 24, 2025 | Healthy Aging, Patient News

Whether you’re a healthy 40-something with a family history of premature cardiac events, a 50-year-old mother who experienced a complicated pregnancy decades ago, or a 65-year-old man whose statin treatment has failed to lower high cholesterol levels, take heart in the growing arsenal of tests and therapies aimed at preventing disease. A long-time advocate for proactive, preventive cardiac care, Dara Lee Lewis, MD, a cardiologist at Boston’s Lown Cardiology Group and Assistant Professor at Harvard Medical School, shares insightful updates in the Q&A below.

Q: What do you see as some of the most promising recent developments in preventive heart care?

A: As a cardiologist, I’m trained to help patients live well with chronic conditions like coronary atherosclerosis, heart failure and atrial fibrillation. But let’s face it – by the time patients are referred to me, their cardiac disease is already established. Wouldn’t it be better to prevent these diseases from developing in the first place? While we can do an excellent job minimizing symptoms and stabilizing disease, I’m just treating the tip of the iceberg.  We know that atherosclerosis, or hardening of the arteries, takes decades to develop. The time for intervention is in the iceberg itself, before that first heart attack, when someone may feel fine but under the surface, disease is brewing. That’s where risk factors such as inflammation, pre-diabetes, high cholesterol levels, and unhealthy behaviors are putting the patient at risk. We have the opportunity to make a huge impact by working with our primary care colleagues to identify high-risk patients at the earliest stages and reduce the chance of having a cardiovascular event in the first place.

Q: In addition to the well-documented factors that can signal a person at high risk for heart disease – unhealthy cholesterol levels, hypertension, diabetes, metabolic syndrome, smoking, lack of physical activity, age, family history – have others been identified?

A: Yes, we’re beginning to better understand the key role inflammation plays in the development of coronary artery disease, and now consider chronic inflammatory conditions such as gingivitis, rheumatoid arthritis and certain autoimmune disorders to be risk factors. Women who experienced a complicated pregnancy history, premature menopause or certain cancer treatments are also at a higher risk of heart disease and require close monitoring and screening throughout their lifetime.  Most notably, elevated levels of lipoprotein (a), known as Lp(a) (a subtype of LDL cholesterol), have been identified as an independent risk factor.

Q: Why is Lp(a) so significant?

 A:   An elevated Lp(a), greater than 30-50 mg/dl, is often present in otherwise healthy people. It is a genetically determined risk factor for heart disease, peripheral artery disease, and ischemic stroke. What makes this challenging is that traditional strategies for lowering cholesterol such as statins or exercise and diet modifications have little to no effect on Lp(a); however, PCSK9 inhibitors (non-statin therapy for lowering cholesterol), hormone replacement therapy and Tamoxifen can work for certain individuals. There are also some promising newer medications currently being studied.

Q: Sometimes statins (e.g. Lipitor, Crestor) don’t work to lower LDL or ‘bad’ cholesterol either…are other options available?

A: A number of non-statin therapies can be prescribed, including:

• Ezetimibe (Zetia), a relatively inexpensive pill that can be used alone or given with statins to reduce cholesterol absorption.
• PCSK9 inhibitors (e.g. Praluent, Repatha), monoclonal antibodies given as a shot every two to four weeks. These inactivate the protein PCSK9 to promote more LDL receptors and help clear LDL from the bloodstream.
• Bempedoic acid (Nexletol), a daily pill that causes the liver to make less cholesterol, but with fewer of the muscle aches experienced by some who take statins.
• Inclirisan (Leqvio), given as a shot twice yearly, blocks production of PCSK9.
• Evinacumab (Evkeeza), a monthly infusion approved only for people with a family history of hypercholesterolemia.

Q: Are there any new tools for calculating an individual’s risk of heart disease?

A: I’ve found the American Heart Association’s new PREVENT calculator to be a convenient resource to assess an individual’s risk of heart attack, stroke or heart failure over the next 10 and 30 years. It’s more comprehensive than earlier versions, as it includes measures of kidney function and metabolic health and can be used to predict risk in patients as young as age 30, which is extremely valuable in terms of early detection.