Alcohol-related cancer on the rise in US: What it means for drinkers in Singapore

Alcohol-related cancer on the rise in US: What it means for drinkers in Singapore

(For subscribers)

https://www.straitstimes.com/life/home-design/alcohol-related-cancer-on-the-rise-in-us-what-it-means-for-drinkers-in-singapore

2025-03-01

Chantal Sajan Senior Correspondent

The Straits Times

=========

SINGAPORE – On Jan 3, Dr Vivek Murthy, the then United States Surgeon-General, released a federal advisory that alcohol is a leading preventable cause of cancer and requested a warning label for drinks, similar to the advisory printed on cigarette packs.

He highlighted an urgent public health issue in the US that requires immediate awareness and action.

Alcohol-related deaths more than doubled among Americans between 1999 and 2020, according to recent research published in The American Journal of Medicine, which cited data from the Centers for Disease Control and Prevention.

Alcohol was linked to about 50,000 deaths among adults aged 25 to 85 in 2020, up from about 20,000 in 1999.

The report also stated that, overall, drinking contributes to 100,000 cancer cases every year. While the increases were in all age groups, the biggest uptick was in adults aged 25 to 34, whose fatality rate increased nearly four times between 1999 and 2020.

Women are less likely than men to die of an illness caused by alcohol, but the US report showed that they also experienced a spike over two decades from 4.8 per cent in 1999 to 12 per cent in 2020.

The federal advisory also highlighted that young adults are becoming a high-risk group.

In 2023, 10.2 per cent of Americans – about 28.9 million people – aged 12 or older were diagnosed with alcohol use disorder. This included 800,000 adolescents aged 12 to 17 (2.9 per cent of this age cohort).

In addition, 5.1 million young adults aged 18 to 25 (15.1 per cent) and 23 million adults aged 26 or older (80 per cent) were also diagnosed with alcohol use disorder.

Yet, in a 2019 national survey conducted by the American Institute for Cancer Research, less than half – 45 per cent – of Americans said they are aware of the dangers of alcohol consumption and increased cancer risk.

The Jan 3 statement cautions that alcohol induces cancerous changes in the body. After ingesting booze such as beer, wine or sake, enzymes in the body – mainly in the liver – are released to break down the ethanol in alcohol.

Ethanol then becomes acetaldehyde, a toxic chemical compound that binds to one’s DNA and causes harm, allowing cells to start growing uncontrollably to create a cancerous lesion or tumour.

On Feb 14, the World Health Organisation (WHO) released new findings on a lack of awareness about alcohol’s link to cancer in Europe, pushing for tobacco-style labelling in a region home to the world’s heaviest drinkers.

The global health agency has repeatedly warned over the last few years that alcohol causes cancer.

Although alcohol causes 800,000 deaths across Europe annually, WHO said only a fraction of the population is aware of the risks.

More On This Topic

It’s time to rethink how safe alcohol is

Party smart, drink safe: New South Wales teaches youth how to navigate nightlife

In Singapore, based on the Ministry of Health’s annual National Population Health Survey in 2023, the prevalence of regular alcohol consumption among residents has remained relatively low over the last few years. The prevalence of binge drinking has also remained stable.

Figures from the survey show that regular drinking, defined as consuming alcohol less than four times a week, and binge-drinking, defined as consuming at least five alcoholic drinks for males or at least four for females in a single drinking session, remained the same – at about 2 and 10 per cent of the population respectively – from 2019 to 2023.

The 2023 survey tracked the health, risk factors and lifestyle practices of Singapore residents aged 18 to 74 between July 2022 and June 2023.

According to an MOH spokesman, there are no plans to put mandatory labels on alcohol.

“We will continue to raise awareness of the risks of consuming alcohol through schools and other public education efforts,” he adds. “MOH will monitor consumption trends and evaluate the need for measures that are suited to our local context.”

According to experts and doctors here, while alcohol consumption has long been recognised as a risk factor for chronic diseases such as cardiovascular conditions and liver cirrhosis, the findings in the US Surgeon-General’s report highlight that even moderate drinking can contribute to health risks.

Dr Kyle Tan, adjunct assistant professor at the Saw Swee Hock School of Public Health at the National University of Singapore, who specialises in chronic disease prevention and management, says the report also pertains to Asian populations.

“The US findings are highly relevant in an Asian context, and are likely to be underestimated in terms of impact,” he says.

This is because many Asians have a genetic variant, aldehyde dehydrogenase 2 (ALDH2) deficiency, that affects alcohol metabolism, leading to higher accumulation of acetaldehyde.

ALDH2 deficiency causes the well-known Asian Flush Syndrome, which presents as facial flushing, increased heart rate, nausea and headaches after imbibing alcohol. It is one of the most common hereditary enzyme deficiencies and affects 35 to 40 per cent of Asians.

This makes Asians more susceptible to alcohol-related health risks, including an elevated risk of oesophageal and other cancers, Dr Tan says.

Another worrying trend is that alcohol consumption patterns in parts of Asia are changing, he adds, with increased social drinking among younger populations, raising long-term public health concerns.

Increasingly, he says the notion that moderate drinking is “healthy” is being widely debunked.

While past studies suggested it had benefits for heart health, more recent and rigorous research shows that the risks outweigh any potential benefits, and that the benefits seen for heart health may be due to selection biases in the studies in question.

“Scientific consensus is very clear. Acetaldehyde, the toxic by-product of alcohol metabolism, plays a significant role in alcohol-related cancer risk,” says Dr Tan, who is also co-founder of private practice Novi Health.

He and his medical team at Novi Health in Robinson Road focus on optimising longevity through preventive strategies, including education on alcohol’s impact on metabolic and cardiovascular health.

He notes that individuals who frequently consume alcohol often exhibit metabolic markers that suggest an increased risk of fatty liver disease, insulin resistance and excess weight, all of which contribute to chronic disease progression.

“Singapore’s public health policies may need to evolve to reflect these new findings, emphasising alcohol education and early intervention strategies, particularly in populations at higher genetic risk,” he adds.

More On This Topic

2.6 million die annually due to alcohol: WHO

How much alcohol does it take to raise your cancer risk?

According to other experts, alcohol consumption can also damage the brain.

Dr Saima Hilal, assistant professor at NUS’ Saw Swee Hock School of Public Health, says there is a strong link between alcohol consumption and cognitive decline, including alcohol-related dementia and an increased risk of other neurodegenerative conditions, such as Alzheimer’s disease and vascular dementia.

Vascular dementia is caused by a series of strokes. These cause restricted blood flow, which reduces oxygen and glucose delivery to the brain, leading to cell damage.

According to the Health Promotion Board, vascular dementia makes up almost half – 45.5 per cent – of dementia cases in Singapore.

While chronic heavy drinking has long been recognised as a leading cause of cognitive impairment, moderate alcohol consumption may also pose long-term risks to brain health by increasing the likelihood of hypertension, stroke and small vessel damage.

“Prolonged alcohol use can lead to brain atrophy and impaired neurotransmitter function, particularly affecting the frontal lobes, which are responsible for decision-making, impulse control and memory,” says Dr Hilal, whose approaches to treating neurological diseases such as Alzheimer’s have increased the impact of neurodegenerative and vascular research, opening new pathways in understanding complex neurological diseases.

She notes that Asians are at greater risk for alcohol-induced cognitive impairment and neurodegeneration than Western populations, due to the ALDH2 deficiency.

“Singapore has seen a rise in social drinking, particularly among younger adults, raising concerns about long-term neurocognitive consequences,” she warns.

Strengthening alcohol education programmes and highlighting neurological risks, alongside liver and cardiovascular dangers, are key to tackling this growing problem, she says.

For starters, implementing routine cognitive assessments for high-risk individuals, especially those with a history of alcohol dependence, is a must.

Dr Hilal adds: “Given the growing body of evidence linking alcohol consumption to cognitive decline, policymakers should consider targeted interventions such as nutritional supplementation with thiamine to prevent cognitive deterioration.

“These should also include re-evaluating alcohol guidelines, shifting from promoting ‘safe limits’ to minimising consumption wherever possible.”

Over at Alexandra Hospital, consultant gastroenterologist Margaret Teng routinely asks her patients, especially those with pre-existing liver conditions, about their usual alcohol intake.

She sees a small but significant percentage of patients with heavy alcohol consumption. In the past year, the hospital has diagnosed or treated such patients with alcohol-associated liver cirrhosis, liver cancer and oesophageal cancer.

Although the Jan 3 advisory was based on medical data obtained from American test subjects, Dr Teng says the findings are relevant to Asia.

“East Asians are more likely to have the inactive variant of the ALDH2 gene, which plays an important role in breaking down acetaldehyde (a toxic metabolite) into acetate, which is non-toxic,” she notes.

Dr Teng adds that research from China has found that alcohol intake among male regular drinkers has been associated with increased risks such as cancer of the oesophagus, mouth and throat, colorectal region and liver.

“In Singapore, previous studies have also found that binge drinking has been associated with mental health conditions – mood and anxiety disorders – as well as a lower quality of life.”

More On This Topic

US surgeon general calls for cancer warnings on alcohol

Why high-intensity drinking is riskier than binge drinking