Why, as a top oncologist, I hardly ever drink

From enjoying a beer with colleagues at the end of a stressful day, to dawdling over a chilled glass of white at a family get-together, there’s no doubt that having a drink can be both relaxing and restorative.

After all, as the cliche goes, doesn’t a bit of what you fancy do you good?

Unfortunately, though the value on a social level is clear, as an oncologist when I see drink flowing, I can’t block out what advancing scientific research continues to make clear – that having any type of alcohol, even in moderate amounts, raises the risk for developing cancer.

And not just, as might be expected, liver cancer, but several others – including breast cancer, head and neck cancers, oesophageal, colorectal and stomach cancers.

In a major report published last month, the National Cancer Institute (NCI) in the US found drinking just one drink – defined as one bottle of beer, a regular glass of wine or shot of spirits - per day, raised the risk of developing oral cancers.

The NCI also found that if you’re a woman who has seven drinks per week, or a man who has 14 drinks per week – which is classed as being a moderate drinker by the NHS - then your risk of developing mouth and throat cancers is 1.8 times higher than those who don’t drink.

Only recently a hard-hitting report by the American Association for Cancer Research estimated that 40 per cent of all cancer cases are associated with lifestyle factors we can change – and that alcohol was likely to be the most prominent.

For those of us working in this area of medicine, it doesn`t come as a surprise.

In 2019, more than one in 20 cancer diagnoses in the West were attributed to alcohol consumption, according to the World Health Organisation. Again that was due to drinking at levels not necessarily classed as excessive by most people.

What is of particular concern, amid this emerging picture, is the rising incidence of cancer among younger adults, i.e. under 50.

Between 2011 and 2019 the rates of colorectal cancer in this group increased by 1.9 per cent a year in this country.

To put that figure into context, the average age of diagnosis for bowel cancer in the UK is 71 years old.

As an oncologist, I’m seeing an increasing number of people under 50 with bowel and other cancers – and the balance of evidence is that heavy social drinking is connected with an increased risk of getting the disease.

The link between drinking and increased risk of any cancer is specific to a substance known as ethanol – essentially the alcohol in your drink.

The body breaks down ethanol into a compound called acetaldehyde, which can damage DNA, the blueprint of our cells – and it’s this DNA damage that leads to cancer.

It also doesn’t matter whether you opt for wine, spirits or beer, it’s the breakdown of the ethanol itself that can cause cancer.

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That’s why drinking should be regarded as a bleak inversion of doing the lottery.

The more tickets you buy, the more likely you’ll get the big win.

With alcohol, the more you drink the more likely your cells will become cancerous.

Alcohol can also make it harder for the body to absorb nutrients such as vitamins that protect our cells and help reduce cancer risk.

It can affect hormone levels and good bacteria in the gut too, all of which may lead to a raise in cancer risk.

Then there is the socio-economic picture: drinking excessively is associated with a sedentary, unhealthy lifestyle – as well as smoking and obesity, which are themselves major risk factors for the disease.

Cancer can, of course, be arbitrary and occur without the risk factors we traditionally understand.

I’ve treated countless patients who developed the disease despite being slim, fit, non-smokers – and non-drinkers without a family history. Sometimes, hard as it is to process, cancer is just down to bad luck. That’s why it`s so important to raise awareness of the things which may increase risk.

And what’s clear from the data is that no amount of alcohol is entirely safe – despite the frequent pedalling of promises about a glass or red wine being generally ‘good’ for you.

Also, the more you drink, the worse the harm is, so heavy drinkers have a higher risk.

But even as a cancer doctor I understand that we do need to enjoy life (not least given the fact that I treat people forced to confront their mortality). I’m also aware that alcohol helps us to bond, laugh, and firms up the social fabric of society.

Personally, I don’t drink much because I don’t happen to like it. To be sociable I have the occasional drink and have a talent for making one beer last a very long time.

But I do think it important that we spread the message about the NHS recommendations, which state that men and women should drink no more than 14 units of alcohol per week, spread out over at least three days.

Granted, it at least gives people an idea of a sensible limit. Yet according to research by Drinkaware last year, 82 per cent of adults in the UK don’t know about the specific guideline at all.

Meanwhile, the number of British binge drinkers was up by 13 per cent in 2023, according to a report this year by the World Health Organisation.

We can’t spend our whole lives wringing our hands wondering how to avoid cancer – life is for living. But we should be aware of the direction of travel, at least when it comes to drinking.

And especially in younger adults. Unlike many risk factors for cancer, alcohol consumption is one we can control, whether it’s having a low-alcohol drink, drinking less or simply not drinking at all.

• Justin Stebbing is an oncologist and Professor of Biomedical Sciences at Anglia Ruskin University

• Interview by ANGELA EPSTEIN