Alcohol Consumption & the Risk of Cancer

Q1.  Does consuming alcohol increase the risk of developing cancer?

A1. Yes, consuming alcohol increases the risk of developing cancer. This risk is more in heavy drinkers but significant in all persons who consume alcohol regularly.

Q2. What are the reasons for this increased risk?

A2. The reasons are varied. Some of these reasons are that alcohol increases inflammation in some organs of the body, leads to nutritional deficiency, increases the amount of the female hormone estrogen in the body and causes obesity.Other factors are reduction of the immunity of the body as well as an increase in the harmful effects of tobacco.

Q3. Does this increased risk pertain to some specific cancers and if so, which cancers are these?

A3. Alcohol increases the risk of cancer of the mouth, throat, food-pipe, large intestine, liver and breast.

Q4. Why does alcohol increase the risk of developing cancer of the alimentary tract, i.e.,  throat, food pipe and  intestine.

A4. Alcohol is metabolised into a toxic substance called acetaldehyde which causes inflammation in the alimentary tract.  In addition, it also potentiates the ill effects of tobacco by increasing  the absorption of carcinogens (cancer causing substances).

Q5. Does alcohol increase the risk of cancer of the breast in older women, or is age irrelevant ?

A5. Alcohol increases the level of oestrogen in the body and this in turn leads to an increased risk of breast cancer, irrespective of the age or menopausal status of a woman. The increased risk of breast cancer is also related to obesity and the deficiency  of folates induced by alcohol.

Q6. Alcohol induces cirrhosis of the liver. Is that somehow related to cancer?

A6. Yes, the same inflammatory process that causes cirrhosis of the liver also causes cancer. Liver cancer is one of the most common causes of cancer related death worldwide, though all of this is not related to alcohol.

Q7. How significant is the problem of alcohol related cancer in the Indian context.

A7.Though less significant than countries like China or the developed world, alcohol is an important cause of cancer in Indian men, with over 7 % of cancers in Indian males being attributed to alcohol. Happily, the number of alcohol induced cancers  in Indian women is negligible.

Q8. Does stopping the intake of alcohol help?

A8. Stopping the consumption of alcohol helps but slowly, the risk of developing cancers becoming equivalent to a non drinker in about ten years.

Pap smear: Why, when, how ?

Pap smear: Why, when, how?

A few facts about female anatomy: The womb is also known as the uterus. It communicates with the vaginal canal; its opening into the vaginal canal is called cervix.

What is a Pap smear?

The name Pap is derived from the name of Dr.   George Papanicolaou, the originator of the Pap test. This is a simple painless test comprising two steps. The first step is collection of easily shed / scraped off cells from the opening of the womb i.e. the cervix, on a slide or in a bottle. The second step is examination of these cells under the microscope by a cytopathologist to detect abnormal cells.

What does an abnormal Pap smear indicate?

An abnormal Pap may indicate inflammation, infection, precancerous or cancerous change.

 

How does finding pre cancerous cells help?

Cancer of the cervix is India’s most common cancer as well as that of the developing world. It mainly occurs as a consequence of infection with the human papilloma virus. This infection results in transformation of  cells in the region of the cervix into abnormal dysplastic cells. Dysplastic cells left untreated, may transform into cancerous cells over a few years. However, if identified by a Pap smear and treated, conversion to cancer may be prevented. 

Why is a simple gynecological examination inadequate to do what a pap smear does?

Pap smears help in identifying abnormalities that are not visible  to the naked eye during examination. An abnormal pap smear in a lady with no obvious abnormal finding on examination, prompts the doctor to examine her under magnification using an instrument called colposcope. 

Who should undergo a Pap smear?

All women between the ages of 21 and 65-70 years, who are or have been sexually active, should undergo a Pap smear examination. 

How long does a Pap smear take? Is it painful?

Pap smears take around 5 minutes to perform. There is no pain; there may be some mild, transient, discomfort.

When should this test be performed?

The ideal time for women to undergo this test is 10 to 20 days after their period. Women who have undergone menopause may get the test done anytime.

It should be performed every 3 years. In case the test reveals an abnormality, a repeat test may be advised earlier than 3 years.

Why should a woman get a Pap test done?

The incidence of cervical cancer is very high in the developing world. The map above, courtesy the GLOBOCAN project,  illustrates the magnitude of the problem in South Asia, Africa and Latin America. A quarter of the world’s cancer cervix patients are Indian!

Pap smears can prevent this cancer, since precancerous abnormalities are amenable to outpatient gynecological procedures.

In patients in whom this disease has already occurred but is not causing symptoms, Pap smears may help detect the disease at an earlier stage.

In countries where Pap smears are performed regularly for screening, cervical cancer has become very infrequent.

 

Obesity & Cancer : Some Q & A.

Q: Medically speaking, how does one decide whether someone in obese?

A: While colloquially one refers to anyone with extra fat in their body as obese, medical speaking, an obese person in someone who has a Body Mass Index (BMI) of 30 or more , the BMI being calculated using the formula BMI = weight in kilograms / ( height in m X height in m).

Q: Is being obese the same as being over weight.

A: No, an overweight person is someone who’s BMI is equal to 25 or more, but is less than 30.

Q: Is the issue of obesity relevant to India?

A:  Studies have found that approximately 30 – 35 % of women in Delhi and Punjab are obese. Kerala and Goa follow closely.

 Q Is it true that obese persons are prone to certain cancers.

A4: Yes, obese persons are more prone to certain cancers, the risk also being dependent on gender and some other factors.

Q : Is obesity associated with an increased risk of breast cancer?

A  :Breast cancer is known to occur due to prolonged exposure to the female hormone estrogen. While the ovaries stop producing estrogen at menopause, fat cells continue to produce estrogen even after menopause. The higher levels of estrogen production in obese women predisposes them to developing breast cancer. This risk is highest in women aged 70 year and above. 

Q: Does obesity impact the chances of recovery from breast and other cancers?

A: A higher BMI results in poorer chances of recovery from breast cancer, cancer of the gall bladder as well as cancer of the uterus , kidney and food pipe, i.e. oesophagus.

Q  :Does being obese predispose women to any other cancers besides breast cancer?

A : Yes, obese women are more prone to developing cancer of the uterus. Besides this there are certain cancers, which occur more often in obese persons irrespective of gender.

Q : Which are these cancers that occur more often both in obese men as well as obese women?

A  : Cancer of the large intestine occurs more often in obese men and women but the risk is higher for men. This is likely to men being more likely to have fat deposits as the waist level, unlike women in whom the fat deposition may also be in the hips and thighs. This cancer has a stronger association with fat at the waist level.

Cancer of the lower end of the food pipe is also seen more often in obese persons likely due to reflux of acid from the stomach, leading to chronic irritation of the lower end of the oesophagus.

Gall stones occur more often in obese persons. These in turn predispose to cancer of the gall bladder.  Cancer of the pancreas also occurs more often in obese persons; this is thought to be due to higher levels of insulin in the body and its resultant ill effects

Obese men are also more likely to develop prostate cancer as compared to their slimmer counterparts.

Q : Does losing weight help?

A: Always. Not only does it reduce the risk of diabetes and heart ailments , losing weight also decreases the risk of breast cancer and prostate cancer. The impact of weight loss on other cancers is under study.

Tobacco & Cancer : Some FAQs

      Does tobacco really increase the risk of developing cancer? 

     The association of cancer with tobacco has been known since the 1930s, and the US Surgeon General’s report of 1964 identified that smokers had a 10 fold increase in the risk of developing lung cancer while  heavy smokers were 20 times more likely to develop lung cancer than a non smoker. The harmful effect of tobacco is best illustrated in the increased risk of cancer among passive smokers. i.e. those who inhale “second hand” smoke, exhaled by a smoker or from the burning end of a cigarette / bidi etc. ; their risk of developing cancer has been estimated to be 20 – 30 % higher than a person who does not live with a smoker.  

     Is any form of tobacco safe? 

     No form of tobacco is safe. Hence cigarettes, bidi, pipe, hookah, tobacco laced pan and pan masala, chewed tobacco as well as snuff (naswar in Hindi) are equally harmful. Chewed tobacco is associated more strongly with cancer of the cheek, tongue and tonsil, while smoked tobacco is associated with a higher risk of lung cancer and cancer of the voice box. All forms of tobacco induce “field cancerisation” wherein, the inner lining of the pathway for food and air, i.e. mouth, throat, food pipe and airways becomes prone to cancer. 

        

    Does the quantum of tobacco use, daily as well as cumulative, have any impact on the risk of developing cancer? 

     Yes, the number of “pack years” determines the risk of developing cancer. In addition, it may worsen the outcome of treatment in some situations. Patients who continue to smoke while receiving treatment for cancer do worse than patients who quit.
 

     Is tobacco implicated in any other cancers besides those of the mouth, throat and lung? 

     In addition to cancer of the mouth (lips, cheek, tongue), throat ( tonsil, voice box, pharynx), persons consuming tobacco in any form are more likely to have cancer of the food pipe, stomach, pancreas, kidney, urinary bladder, large intestine, cervix ( the opening of the uterus) and ovary. In addition they have a higher chance of developing a form of blood cancer, acute myeloid leukemia

       

     

     Are women equally at risk of developing tobacco induced cancers? 

      Women are at least  equally at risk of developing cancer, if not more. According to the United States Surgeon General’s report  of 2014, women smokers have 27.5 times the risk of  developing lung cancer compared to women who do not smoke. According to the same report, this figure is 25 times for men. Certain cancers specific to women i.e. those of the cervix and ovary, occur more commonly in smokers than in women who do not smoke.

     Are low tar cigarettes safer or are they a marketing gimmick? 

      It has been proven that  those who smoke low tar cigarettes pull harder on the cigarette to achieve the  “desired effect” of tobacco thus making these cigarettes as harmful as  regular cigarettes.  “ Low tar”, “ slim” etc. are calculated sub liminal messages that marketers of tobacco send out to women smokers that the latter need to be aware of. In addition, there has been a concerted campaign by the tobacco industry to associate smoking with glamour.  In North America, this campaign has been thwarted, somewhat, by the anti smoking movement, which has been successful in reducing rates of smoking. This in turn has lead to a drop in the rate of lung cancer. A similar downward trend has not been noted in India, in either the prevalence of smoking or in the risk of developing tobacco induced cancers.

     Is tobacco implicated only in cancer causation or does it cause other diseases too?  

      While the association of tobacco and heart disease is well known, consuming tobacco also increase the risk of  facial wrinkles and osteoporosis; hip fractures are more common among smokers. In addition women (and men) who smoke are more likely to have a severe lung ailment , chronic obstructive lung disease. Tobacco also interferes with fertility and increases the chances of   stillbirth and low birth weight babies.