Alcohol
use is a common feature of both social and professional interactions in
many countries. Wine is served at professional dinners, social events
often centre around alcohol consumption, and alcohol use in general is
considered to be a normal and natural part of life, save for those who
suffer from alcoholism.
zly
under-appreciated aspect is in its relationship to cancer. For the
purpose of this article therefore, we will focus on the effects of
alcohol consumption and cancer.
Does Alcohol Lead to the Development of Cancer?
Robust
epidemiological and scientific evidence has recognised that alcohol is a
carcinogenic agent, with even low and moderate doses of alcohol
contributing to the development of cancers of oropharynx, larynx,
oesophagus, liver, breast, and colon.[ii] In 2012, almost 6% of all cancer-related deaths and 5.5% of all cancer occurrences were attributable to alcohol.[iii]
Alcohol
is carcinogenic even in small doses and the risk of developing cancer
continues to increase with increasing doses of alcohol consumption.
Epidemiological evidence supports that daily drinking, even at low
levels, is harmful to one’s health and any drinking at all contributes
to cancer risk.[iv] Even
moderate alcohol intake is associated with almost a doubling in the
risk of developing cancers of the oral cavity and pharynx; the risk in
heavy drinkers is increased more than five-fold.[v] The
World Cancer Research Fund/AICR recommend that, ‘…for cancer
prevention, it’s best not to drink alcohol.’ And: ‘If alcoholic drinks
are consumed, limit consumption to two drinks a day for men and one
drink a day for women.’[vi] Acknowledging
that alcohol intake is a modifiable risk factor for the development of
various cancers, the Cancer Prevention Committee of the American Society
of Clinical Oncology (ASCO), has suggested a proactive stance by the
Society to minimize excessive exposure to alcohol.
How Does Alcohol Lead to the Development of Cancer?
The
exact mechanism by which alcohol leads to the development of cancer is
not fully understood. Alcohol can seep through virtually all tissues in
the body, leading to alteration in essentially all systems of the body.[vii]
DNA
is the building block of the human body – and DNA damage is a feature
of cancer development. Alcohol use damages the tissue through several
mechanisms, including oxidative stress (an imbalance between important
compounds in the body, leading to tissue damage), inflammation, and
formation of harmful compounds such as acetaldehyde generation and
adduct formation. These lead to a decrease in protective barrier
functions, impairment of tissue building, an increase in the breakdown
of tissues, activation of cell turnover and injury to mitochondria (the
energy-producing subunit of the human cell).[viii] Several
factors contribute to alcohol-induced cancer development (i.e.
carcinogenesis), principal among them being the effect of acetaldehyde,
the first and primary breakdown product of alcohol, along with
‘oxidative stress’. However, there are also other suggested mechanisms
that lead to alcohol-induced cancer development.[ix]
Does Alcohol Impact Cancer Treatment?
There
is evidence to suggest that high alcohol consumption and alcohol abuse
are known to be associated with higher risk of death in those
undergoing cancer treatments.Alcohol abuse and high alcohol intake is
known to increase the length of stay in hospital because of slow
recovery, surgical complications, and higher utilisation of healthcare
resources. Cancer patients who abuse alcohol have increased
treatment-related problems because of alcohol-related damage to the body
such as deficiency of essential nutrients, suppression of the immune
system and diseases of the cardiovascular system.
Cancer
survivors who consumed the highest amounts of alcohol have an 8%
increased risk of death and more than one in six (17%) risk of cancer
recurrence as compared to those who consume nil or minimum amounts of
alcohol.[xix] A
meta-analysis (a study of all clinical studies) provides evidence that
alcohol intake in moderate and heavy amounts increases the risk of dying
from cancer by two- to three-fold in patients with upper aerodigestive
tract cancer. In these patients, continued drinking can increase the
risk of developing a further cancer by up to three-fold.[xx]
There
is evidence that moderate alcohol intake can increase the risk of
second primary cancer in some breast cancer survivors from 30% to 90%.[xxi],[xxii] Women
who consume moderate to heavy levels of alcohol are at an increased
risk of breast cancer-specific mortality and/or risk of recurrence.[xxiii],[xxiv] The impact of alcohol consumption on the outcome of bowel cancer shows conflicting evidence.[xxv],[xxvi] In
addition, the quality of life is found to be poorer in head and neck
cancer survivors who are known to excessively consume alcohol as
compared to those who are not known to excessively consume.[xxvii],[xxviii]
The
evidence from large epidemiological studies shows that the risk of
developing cancer of the aerodigestive system declines after abstinence.
The risk of cancer decreases to the level of non-drinkers after 20
years of abstinence.[xxix],[xxx],[xxxi] However,
this evidence needs to be verified longitudinally, quantifying the
amount of alcohol consumed and the duration of cessation more
thoroughly.
Alcohol and Cancer: A Reason for Abstinence?
There
is a clear, irrefutable and dose-dependent relationship between alcohol
and cancer. Alcohol in any amount can contribute to cancer development.
Studies have provided evidence and it is up to people to rationally
assess the evidence and develop an informed opinion. Individuals have
the freedom of choice to accept or reject the evidence and face the
associated consequences. It appears that the well-informed youth of
today have heeded this emerging evidence as abstinence from alcohol has
increased among the youth. A large study showed that rates of abstinence
amongst young people increased from 18% in 2005 to 29% in 2015, largely
attributable to increases in lifetime abstention. [xxxii]
The Philosophy of Free Will in Islam
The philosophy of choice is beautifully captured in the Holy Qur’an:
‘And
by the soul and its perfection. And He revealed to it what is wrong for
it and what is right for it. He indeed truly prospers who purifies it;
and he who corrupts it is ruined.’[xxxiii]
Islam
teaches that God has embedded in human nature the capacity to
distinguish between right and wrong. By virtue of their faculties of
reasoning and understanding, humans are empowered to exercise free will
and accept the consequences of their decisions. Hazrat Mirza Ghulam
Ahmad(as), the Promised Messiah and founder of the Ahmadiyya Muslim
Community, writes:
‘All
the inevitable consequences of our actions that have been appointed by
God Almighty under the law of nature are all God’s actions, inasmuch as
He is the Cause of causes. For instance, if a person swallows poison,
his action would be followed by the divine action that he would suffer
death.’[xxxiv]
The Holy Qur’an further explains this concept by stating in the following passages:
‘Allah burdens not any soul beyond its capacity. It shall have the reward it earns, and it shall get the punishment it incurs.’[xxxv]
‘We have shown him the way, whether he be grateful or ungrateful.’[xxxvi]
In
other words, the philosophy of Qur’anic teaching is that Islamic
commandments are paths through which humans can develop and perfect
their faculties or harm them. Those who choose to accept these
commandments or guidance show gratitude, and this will help them attain
their full physical and mental potential, developing into the best
version of themselves. In contrast, those who choose to abandon such
guidance and show ingratitude thereby incur God’s punishment, and risk
losing their mental and physical capabilities.[xxxvii] Thus,
the freedom to choose to follow Islamic commandments or abandon them
would determine whether a person is grateful and blessed or ungrateful
and unblessed.
Islam and Alcohol
Muslims
are taught to assess matters objectively and make choices where the
consequent advantages outweigh the disadvantages. The philosophy behind
Islam’s prohibition of alcohol is based on the sound principles of
choice and a harm versus benefit assessment. The Holy Qur’an states:
‘They
ask thee concerning wine and the game of hazard (gambling). Say: “In
both there is great sin and also some advantages for men; but their sin
is greater than their advantage.”’[xxxviii]
Thus,
Islam acknowledges that there are beneficial properties in such things
that are otherwise forbidden, and it teaches us to make the best use of
the positive properties of everything, however small.[xxxix] Therefore
Islam permits alcohol to be used in such circumstances, taking
advantage of its other properties as a solvent, as with pharmaceutical
products, while completely forbidding the consumption of alcohol as a
social beverage.
Islamic
teachings are that if a substance has harmful effects in large doses,
it should be forsaken. Thus, the Holy Prophet (sa) is reported to have
said, ‘Every intoxicant is unlawful and whatever causes intoxication in
large amounts, a small amount of it is (also) unlawful.’[xl] The followers of the Prophet Muhammad (sa) are forbidden from brewing, serving, selling or storing alcohol.[xli] Evaluating the evidence regarding alcohol and cancer highlights the wisdom of this Islamic commandment.
Having
recognized the destructive consequences of alcohol consumption, Islam
vied to safeguard society from the devastating consequences of alcohol
use. The Holy Prophet (sa) once said that, ‘The beauty of Islam is also this, that whatever is pointless should be abandoned.’[xlii] Thus,
one should never waste their good health by giving in to temptations
and indulging in harmful practices. Of course, it could be argued that
the prevention of cancer is but one benefit of not drinking alcohol – a
fact not known at the time of the Holy Prophet (sa) – and thus the
primary aim of the prohibition of alcohol was not for health issues but
for spiritual development. The Promised Messiah (as) explains this
concept by saying
‘…the
Qur’an does not permit its followers to drink alcohol, so long as they
are not intoxicated by it. Rather,
it forbids its consumption completely. Otherwise, you would be lost from
the path that leads to God and His converse, nor would God cleanse such
a person of their impurities. The Qur’an says that such things are the
invention of Satan and you should guard yourself against them.’[xliii]
As it is stated in the Holy Qur’an:
‘O
ye who believe! Wine and the game of hazard and idols and divining
arrows are only an abomination of Satan’s handiwork. So shun each one of
them that you may prosper. Satan desires only to create enmity and
hatred among you by means of wine and the game of hazard, and to keep
you back from the remembrance of Allah and from prayer. But will you
keep back?’ [xliv]
Evaluating the numerous destructive consequences of alcohol consumption, the Promised Messiah (as) explains:
‘The
Shari’ah (Islamic law) has clearly settled that those things which are
harmful to health are also harmful to faith – and the chief (of all such
harmful things) is alcohol.’[xlv]
Commenting that science will show concordance with the teachings of Islam, the Promised Messiah (as) further wrote:
‘I
say with gratitude that I have been bestowed the knowledge of Islam’s
superior powers. Through this knowledge I can say that Islam will not
only defend itself from the attacks from modern philosophy but will
prove the confronting knowledge to be no more than mere ignorance and
backwardness. The kingdom of Islam has no fear for these attacks from
science and philosophy.’[xlvi]
Conclusion
In
summary, 2018 has seen several large, robust and scientifically sound
studies confirming the negative impact of light or moderate alcohol
consumption on human health, specifically from the perspective of
cancer. As our understanding progresses, it becomes more and more
evident that the harmful effects of alcohol far outweigh its advantages.
The words of the reformer of our time are worth reflecting here:
‘Many
times it happens that if a certain thing is not widespread enough, then
its effects cannot be known. Take for instance the prevalence of
alcohol nowadays in places like Europe – if this prevalence did not
occur, then how could its negative effects become manifest, from which
the world today seeks refuge? And by its prevalence, the beauty of Islam
and the Messenger (sa) of Islam is revealed, who stopped this vice and
deemed it unlawful.”[xlvii]
Islam
acknowledged alcohol-related harm more than 1400 years ago and forbade
Muslims from taking part in any activities that produce and propagate
the use of this harmful substance. We conclude that robust scientific
evidence regarding the harmful effects of alcohol demonstrate an
incontrovertible concordance between Islam and the scientific
literature.
Acknowledgement
We are
immensely grateful for the helpful scientific critique of Professor
David Nutt. Professor David Nutt is the Edmond J. Safra Professor of
Neuropsychopharmacology and director of the Neuropsychopharmacology Unit
in the Division of Brain Sciences, Imperial College London. In 2010, The Times’ Eureka science magazine included Professor Nutt among the 100 most important figures in British science.
About the Authors:
Professor
AR Carmichael is a surgeon by profession and has an interest in the
philosophy of religion. She is widely published in peer-reviewed medical
literature and serves the Ahmadiyya Muslim Community in various
capacities. Aizaz Khan has completed a seven-year missionary training
course from Jamia Ahmadiyya Canada, the missionary training university
of the Ahmadiyya Muslim Community in Canada. He completed his
dissertation on the topic of “The Impact of Alcohol and Gambling on
Society.” He currently serves the community as a missionary at MTA
International Canada Studios.
[i] DJ Nutt, LA King and LD Phillips, “Drug Harms in the UK: A Multicriteria Decision Analysis,” The Lancet 376, 9752 (November 2010):1558-1565.
[ii] C Scoccianti, M Cecchini, AS Anderson et al., “European Code Against Cancer 4th Edition: Alcohol Drinking and Cancer,” Cancer Epidemiology 45 (December 2016):181-188.
[iii] D Praud, M Rota, J Rehm et al., “Cancer Incidence and Mortality Attributable to Alcohol Consumption,” International Journal of Cancer 138, 6 (March 2016):1380-1387.
[iv] SM Hartz, M Oehlert, AC Horton et al., “Daily Drinking Is Associated with Increased Mortality,” Alcoholism: Clinical and Experimental Research 42, 11 (November 2018):2246-2255.
[v] V
Bagnardi, M Rota, E Botteri et al., “Alcohol Consumption and
Site-Specific Cancer Risk: A Comprehensive Dose-Response
Meta-Analysis,” British Journal of Cancer 112, 3 (February 2015):580-593.
[vi] P van’t Veer and E Kampman, Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective (Washington, DC: World Cancer Research Fund/American Institute for Cancer Research), 2007.
[vii] PE
Molina, JD Gardner, FM Souza-Smith and AM Whitaker, “Alcohol Abuse:
Critical Pathophysiological Processes and Contribution to Disease
Burden,” Physiology 29, 3 (May 2014):203-215.
[viii] PE Molina, JB Hoek, S Nelson, DM Guidot, CH Lang, JR Wands and JM Crawford, “Mechanisms of Alcohol-induced Tissue Injury,” Alcoholism: Clinical and Experimental Research 27, 3 (2003): 563-575.
[ix] M Varela-Rey, A Woodhoo, ML Martinez-Chantar, JM Mato, SC Lu, “Alcohol, DNA Methylation, and Cancer,” Alcohol Research 35, 1(2013):25-35.
[x] A
Green, J Hauge, M Iachina et al., “The Mortality after Surgery in
Primary Lung Cancer: Results from the Danish Lung Cancer Registry,” European Journal of Cardiothoracic Surgery 49, 2 (2016):589-594.
[xi] DJ
Genther, CG Gourin, “The Effect of Alcohol Abuse and Alcohol Withdrawal
on Short-term Outcomes and Cost of Care after Head and Neck Cancer
Surgery,” Laryngoscope 122, 8 (2012):1739-1747.
[xii] R Jayadevappa, S Chhatre, “Association between Age, Substance Use, and Outcomes,” Journal of Geriatric Oncology 7, 6 (2016):444-452.
[xiii] R
O’Shea, H Byrne, J Tuckett et al. “Impact of Current Smoking and
Alcohol Consumption on Gastrostomy Duration in Patients with Head and
Neck Cancer Undergoing Definitive Chemoradiotherapy,” JAMA Otolaryngology – Head and Neck Surgery 141, 5 (2015):463-469.
[xiv] S
van Rooijen, F Carli, SO Dalton et al., “Preoperative Modifiable Risk
Factors in Colorectal Surgery: An Observational Cohort Study Identifying
the Possible Value of Prehabilitation,” Acta Oncologica 56, 2 (2017):329-334.
[xv] LT
Sørensen, T Jørgensen, LT Kirkeby et al., “Smoking and Alcohol Abuse
Are Major Risk Factors for Anastomotic Leakage in Colorectal Surgery, British Journal of Surgery 86, 7 (1999): 927-931.
[xvi] L
Glória, M Cravo, ME Camilo et al., “Nutritional Deficiencies in Chronic
Alcoholics: Relation to Dietary Intake and Alcohol Consumption.” The American Journal of Gastroenterology 92, 3(1997): 485-489.
[xvii] G Szabo, P Mandrekar, “A Recent Perspective on Alcohol, Immunity, and Host Defense,” Alcoholism: Clinical and Experimental Research 33, 2 (2009): 220-232.
[xviii] E
Mostofsky, H Chahal, K Mukamal et al., “Alcohol and immediate risk of
cardiovascular events: A systematic reviewand dose-response
meta-analysis,” Circulation 133, (2016): 979-987.
[xix] C
Schwedhelm, H Boeing, G Hoffmann, et al., “Effect of diet on mortality
and cancer recurrence among cancer survivors: A systematic review and
meta-analysis of cohort studies,” Nutrition Reviews 74, 12 (2016): 737-748.
[xx] Y
Li, Y Mao, Y Zhanget al., “Alcohol drinking and upper aerodigestive
tract cancer mortality: A systematic review and meta-analysis,” Oral Oncology 50, 4 (2014): 269-275.
[xxi] C
Li, J Daling, P Porter et al., “Relationship between potentially
modifiable lifestyle factors and risk of second primary contralateral
breast cancer among women diagnosed with estrogen receptor positive
invasive breast cancer,” Journal of Clinical Oncology 27, 32 (2009): 5312-5318.
[xxii] J
Knight, L Bernstein, J Largent et al., “Alcohol intake and cigarette
smoking and risk of a contralateral breast cancer: The Women’s
Environmental Cancer and Radiation Epidemiology Study” American Journal of Epidemiology 169, 8 (2009): 962-968.
[xxiii] M
Kwan, L Kushi, E Weltzien et al., “Alcohol consumption and breast
cancer recurrence and survival among women with early-stage breast
cancer: The life after cancer epidemiology study,” Journal of Clinical Oncology 28, 29 (2010): 4410-4416.
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