What alcohol is really doing to Michelle

Do you have a beer or wine most nights? Maybe two? The big C is more of a risk than you might think.

What would be a good enough reason for you to actually cut back on booze? If you were gaining weight? If you were tired all the time? Having relationship difficulties?

What about cancer?

Chances are, this one didn't make your list.

But five in every 100 Australians who exceed 14 drinks a week will develop cancer by age 85, according to Dr Peter Sarich, a research fellow at the Daffodil Centre who led a landmark study published in the British Journal of Cancer.

Dr Sarich found by age 85, the absolute risk of alcohol-related cancer was 17.3 per cent for men and 25 per cent for women who were drinking less than 14 drinks a week.

This is a risk increase of 4.4 per cent for men and 5.4 per cent for women, compared to those who only have between 0 and 1 drinks per week.

But so few of us (less than 30 per cent) are even aware that alcohol increases our likelihood of developing certain cancers.

And it is not only heavy drinkers who are at risk.

Routine drinking, like that wine you have every night after the kids are in bed or that beer at every knock-off, is enough of an assault on your body to give rise to cancer, says Emma Miller, an epidemiologist and expert in alcohol and cancer at Flinders University.

In fact, if you're over 45 and have just one drink every night of the week, your relative risk of alcohol-related cancers increases by 10 per cent.

If you have four per night, your risk jumps up 41 per cent.

But if most of us are unaware of this, how can we reliably weigh up the risks of our own drinking?

Meet Michelle*. She's a 52-year-old Australian woman who usually drinks one or two glasses of wine each night. (Although if she's being honest, since COVID-19, she has reached for a few more wines per week.)

Michelle isn't the only one filling her glass frequently. The Australia Talks National Survey 2021 captured the views of more than 60,000 Australians, and found 30 per cent of women drink alcohol several times a week or more.

Michelle views drinking as just normal — completely acceptable as long as she feels "in control" of her consumption. She doesn't drink to get drunk, just to de-stress after work or be sociable with friends on the weekend. She exercises and maintains a healthy diet, and feels this balances out her consistent drinking.

Again this is common — the Australia Talks survey found that although 94 per cent of women believe Australia has a problem with alcohol/drug abuse, only 13 per cent of those women believe they have a problem personally.

Michelle, like many women, doesn't know there's a link between drinking and breast cancer and perceives breast cancer to be "survivable" and "treatable".

Let's get the full picture though.

When Michelle drinks any alcohol, no matter the type, her body metabolises the ethanol and breaks it down into a toxic compound called acetaldehyde.

Acetaldehyde is carcinogenic and can damage Michelle's DNA and prevent her body from repairing that damage.

When the DNA of a cell is damaged, it can start dividing at an accelerated rate, creating a cancerous tumour.

"Your immune system would usually see a strange thing and destroy it, but if you have alcohol coming in all the time causing excessive cellular division, then the chances of something getting through are much higher," Dr Miller says.

Although Michelle's drinking habits are quite typical of women her age, she is still drinking above the recommended guidelines (no more than 10 drinks a week), and increasing her risk of eight different cancers.

Michelle's drinking is putting her at risk of developing mouth cancer. In fact, around 30 per cent of mouth cancer cases in Australia are caused by drinking. If Michelle was a smoker, her risk would be significantly increased.

Because she drinks every day, the upper part of Michelle's throat is consistently exposed to ethanol, so cancers of the pharynx (the tube that runs from nose to windpipe) and larynx (voice box) are also more likely. About 30 per cent of pharynx cancers and 20 per cent of larynx cancers are caused by drinking.

Michelle is slowly damaging the lining of her oesophagus, because ethanol is an irritant to the cells in her food pipe. About 25 per cent of oesophageal squamous cell carcinoma cases can be attributed to alcohol.

But as a female drinker, the type of cancer Michelle needs to be particularly worried about is breast. One in five breast cancers in Australia are linked to alcohol consumption.

Given the increasing rate of drinking among middle-age women, alcohol's connection to breast cancer is a critical public health issue, Dr Miller says.

Breast cancer is the most common cancer among Australian women and it's estimated 830 cases a year are attributable to alcohol.

The reason why experts believe drinking is so strongly linked to breast cancer is because alcohol increases the level of oestrogen in the blood.

Around two-thirds of breast cancers are hormone receptor-positive, which means they need hormones (oestrogen and/or progesterone) to grow and reproduce.

Put simply, oestrogen effectively feeds breast cancer cells, particularly in women who have gone through menopause.

The average age of first diagnosis of breast cancer for women is 62.

Let's continue our journey down Michelle's body.

Ethanol can cause damage to the mucous membrane layer of Michelle's gastric system, exacerbating her risk of stomach cancer. Evidence is still emerging in this area, but research suggests stomach cancer is more common in those who have three or more drinks a day.

Michelle's regular drinking increases her risk of liver cancer the most. As she has between seven to 14 drinks per week, her relative risk of liver cancer is up by 48 per cent. Despite this, alcohol-related liver cancer affects far fewer Australians than breast or bowel cancers.

Finally, Michelle may have a 14 per cent increased risk of bowel cancer due to her intake, although the evidence for this is generally stronger in men than women.

The facts are sobering, but Michelle is somewhat tempted to shrug it off.

The reality is many of us are conditioned to look for the good in drinking and ignoring the things we don't want to hear.

"Those messages that purport there are health benefits from drinking are wildly exaggerated, but still my GP told me the other day he recommends all his patients have a glass of red every day … so this is a really difficult message to sell," she says.

In fact, research has shown only 50 per cent of people considered changing their drinking habits once they became aware of the cancer link.

Experts say they have to get clever with their messaging and sell something all humans love — immediate benefit.

Cancer is often an invisible threat and people think of it as something that will affect someone else, not them.

However, the promise of improved mood, a slimmer waistline, and better sleep, are some of the top reasons women become motivated to reassess their drinking, Dr Miller says.

So, in the hope of seeing some of these more immediate benefits, Michelle decides to set herself a daily limit of one drink and commit to four alcohol-free days a week for the rest of 2021.

She tells her friends of her new drinking goal, so they can help keep her accountable, and commits to having less alcohol in the house to curb temptation.

If she feels stressed and feels like reaching for a glass, she will call a friend for a chat, meditate or go for a walk to break the routine.

By cutting back, she will notice some positive changes to her energy levels — and hip pocket — in the first few weeks.

Her cancer risk will also decline. It will just take longer.

"If you have incurred some damage that could lead to cancer, that's called carcinogenesis, and that period is very, very long, so you're going to have to sustain a behaviour to reverse that for quite a while," Dr Miller says.

"It's not possible to give an exact timeframe when it comes to cancer, but it's fair to say that by the time this genuinely becomes a new lifestyle, it will be doing her some good."

So ideally Michelle will stick with her new habits for the long term.

To do this, she really needs to ask herself why she drinks, and how it makes her feel.

*Michelle's habits and attitudes are based on common themes identified in research led by Dr Miller and women's health expert Julie Dare of Edith Cowan University.

Credits:

• Illustrations: Stacy Gougoulis

• Production: Claudine Ryan and Tegan Taylor

• Editing: Claudine Ryan, Genelle Weule and Joel Zander