Well Wisconsin Radio

Interviewer: The information in this podcast does not provide medical advice, diagnosis, or treatment. It should not be used as a substitution for healthcare from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.

Hello, and welcome to Well Wisconsin Radio, a podcast discussing health and wellbeing topics with experts from all around the state of Wisconsin. I’m your host Alexis Krause, and today my guest is Dr. Noelle Laconte. Dr. Laconte is a faculty member in the division of hematology, medical oncology and palliative care in the Department of Medicine at UW Medicine.

She leads outreach for the UW Carbon Cancer Center, and she’s a fellow of the American Cancer Society Clinical Oncology, ASCO, Dr. Latis, many regional and National Committee memberships include the Wisconsin Cancer Council Steering Committee, the National Comprehensive Cancer Network Treatment Guidelines Committee for Pancreatic Adenocarcinoma, the Big 10 Cancer Research Consortium Gastrointestinal Cancer Committee, and the ASCO Primary Care Provider Engagement Work Group and Cancer Ling Discovery and Research Publications Committee and Alcohol Policy Work Group, the letter of which she chairs. She is also a reviewer of over a dozen medical journals and has received a John A. Hartford Foundation American Cancer Society of Clinical Oncology Foundational Young Investigator Award, and a Wisconsin Cancer Center Certification of Appreciation Award.

Dr. LA County. That is quite a comprehensive list there. You very accomplished! I’m so happy to have you on the podcast today.

Guest: Yeah, thanks for having me.

Interviewer: I’m excited to talk with you today about a sobering look at alcohol and just kind of wanna lay the groundwork with our first question here. So what is research showing regarding the link between alcohol and cancer?

Guest: Yeah, I mean, this has been pretty well established. Kind of high-level message is that alcohol is a, is a class one carcinogen. The World Health Organization and other bodies, um, lump carcinogens into different classes; that alcohol is in the same group with things like UV light, uh, cigarette smoking, hepatitis B, hepatitis C, human papillomavirus. So these are not controversial, radon, asbestos, you know, that’s the kind of thing that alcohol is lumped with.

Uh, we’ve known. For quite some time about this association. Uh, it’s not all cancers. It’s, uh, seven different kinds of cancer. May, maybe increasing to nine or 10, which we can get into later, but for right now, it’s seven. And it’s really about the more you drink and for the longer period of time, the higher your risk of those cancers.

Interviewer: Okay. So it’s not, not something that is controversial. It is very well established at this point, point in the research.

Guest: Yes.

Interviewer: How does alcohol biologically contribute to cancer development?

Guest: If we can go through the types of cancer, each one is a slightly different cause by alcohol. So the types of cancer are, um, oral and pharynx and we sometimes we go, people say oropharyngeal, larynx, which is your voice box esophageal, o the tube that connects your mouth to your stomach, liver cancer, colorectal cancer, so large intestine cancer and breast cancer. We think that the next time they update that list, pancreas cancer and stomach cancer are likely to be added to that. Lung cancer and prostate cancer are a little bit less clear, but might also be added to that list.

So starting with the ones that are already on that list. When you drink alcohol, the main component of that is ethanol. Ethanol is the same thing that’s like in gasoline, right? Ethanol is broken down in your body to acid aldehyde. The enzyme that does that breakdown lives in your mouth and the lining of your esophagus in your stomach.

So basically the ethanol and then that carcinogenic metabolite sort of coat the surfaces of those organs, and that’s how it causes that cancer. We know that this is true because people that have a less active form of that enzyme that breaks that down have higher rates of cancer, even when they drink the same amount so that it’s more carcinogenic for them the longer they’re exposed to that compound.

For breast cancer, alcohol raises the blood levels of the female hormone estrogen, and that is sort of fuel on breast cancer’s fire, so to speak. Uh, for liver cancer, it’s that alcohol causes cirrhosis and it’s actually the cirrhosis that contributes to the liver cancer. And then for colorectal cancer, it’s not entirely clear, but we think it has something to do with folate, metabolism or absorption that is interrupted or disrupted in some way by alcohol consumption.

Interviewer: Okay. Thanks for providing all of that. That gives me a clearer picture of kind of what’s happening there. And is there a safe amount of alcohol when it comes to cancer?

Guest: Yeah. I mean, for cancer, if you, if you think only about cancer, which to be clear, most people are not oncologist thinking about cancer, you know, 24/7. So take this with a grain of salt. But the recommendations from cancer bodies like the American Cancer Society, um, and other organizations is there is no safe amount of alcohol consumption. If you look at bodies that think about health more holistically, so all areas of risk, cardiovascular, et cetera, stroke, those recommendations are up to one drink a day for women and two drinks a day for men. And you can’t batch it. You can’t not drink Monday to Friday to have six on Saturday kind of thing. Um, so it’s zero to one per day and there’s a daily and a weekly limit.

Interviewer: And how do different types of alcohol, you know, whether that’s, wine, beer or spirits compare in terms of the cancer risks that’s associated with drinking those, is there any?

Guest: I mean, the, the difference is the volume. So one drink, when we think about the recommendations for up, you know, up to one or up to two drinks a day. One drink of spirits or hard liquor is a shot. One drink of wine is a five ounce pour. And then one drink of beer is a bottle of beer, so the volumes are different, but the amount of ethanol in each of those volumes is the same. But it’s, you can imagine it’s easier to drink multiple shots than it is to drink multiple, you know, bottles of beer, and that’s really just a volume issue. But they’re all equally carcinogenic.

Interviewer: Yeah, and five ounces of wine, if you think about it. That’s not what you see an average poor looking like, is it?

Guest: Right. No. Yeah, no, usually it’s definitely not. Yeah. Yeah. From many patients. You know, the, the assumption is that one drink is whatever fits in a glass. But you could have many, many shots in one, one glass, for example. So, yeah, part of that is just explaining to patients what, what is one drink? Mm-hmm.

Interviewer: Mm-hmm. Yeah, absolutely. And then you have some places that you’ll go out to eat and they’ll call it like a double. But they may not be measuring, it’s more like a count that they’re doing, and so you may not even realize how much you’re having.

Guest: Right, right.

Interviewer: Are there certain populations that you have seen within the research that are more vulnerable to this alcohol-related cancer risk?

Guest: That’s a great question. Yeah. I mean, it looks like for people that have a very strong genetic risk for cancer, so for example carriers of a gene called BRCA, uh, which some people sometimes call brca, um, also known as the Angelina Jolie gene. If you have that, alcohol does not seem to really adjust your risk. Your risk is so high, you’re sort of, it’s a ceiling effect, right? Your risk of breast cancer. But if we take that aside, so assuming you don’t have a known genetic risk factor, there is a window theory for breast cancer. So hang with me. This is a little bit complex, but in women, uh, our breasts are not fully mature until we’ve gone through a full pregnancy and lactation cycle.

At that point, our, our breast cells are what are called terminally matured, meaning they’ve fully grown into their end cell. Up until that point, those cells are still not fully developed. If you drink alcohol before that time, so before your first pregnancy and lactation that alcohol may be more carcinogenic, may cause more risk of breast cancer than if you drink after. And then when you think about, you know, when are women. Most likely to binge drink or heavy drink. It’s like college age. So like late teens, early twenties, kind of mid twenties. And when are women having their first child now? I think the age now is like 29 or 30. It’s older. So we really think that targeting college age women might be a good strategy because we might get more benefit in, in terms of helping them reduce their consumption. As far as other populations, we know that there’s some predictors about who’s more likely to have heavy drinking behaviors. The ones that come to mind are men, people that smoke, people that are L-G-B-T-Q, and people that have a family history of alcohol use disorder, and people that drank as children.

So that all sets up, uh, you know, areas where we could do targeted outreach, for example, really focusing on youth drinking would be a good strategy to reduce adult drinking later in life.

Interviewer: Yeah. Looking more upstream with a lot of these approaches, it sounds like, are there any misconceptions about alcohol that you’d like to correct? For example, you know, should people have that glass of wine a day for that heart health that used to kind of be that ‘myth recommendation’ that was talked about for a while.

Guest: Yeah, I think it’s still pretty pervasive actually. Um, yeah, that would be the one, if I could only pick one. Um, that all started, uh, around a concept called the French Paradox. Made very popular by the show, 60 Minutes. Uh, it was kind of a, a pivot point in culture where maybe a little bit of wine was good for your health. It was so important I can remember as a child watching that segment with my parents, that tells you how old I am. But like, it really, it really caught on. Um, but the, the theory, the theory went that, you know, French people drink a lot. Per capita, but yet they seem to have pretty good health outcomes, especially cardiovascular outcomes. And so that’s why they called it the, the French paradox. And so the, the hypothesis went that there must be something in wine that’s protective to your heart.

And indeed, when we look at people that are currently light drinkers, which depends on the study you look at, but it’s usually something around one to two drinks per day. Compared to people that currently do not drink or people that drink more than that, those, those light drinkers do look to have less mortality.

Really it’s driven by cardiovascular mortality and that’s how it’s called the JHA curve. ’cause you’ll see it sort of dipped down at light drinkers and then go back up. What we know now is that that’s actually what’s called an abstain or bias, meaning that people that don’t drink now, so where their risk is a little bit higher, that’s made up of two groups of people, people that never drink and that, for example, there are like people that are um, Mormon. Like for religious reasons, they don’t drink any alcohol. Mm-hmm. Versus people that don’t drink now because something happened to them to make them have a sober life. Now usually that’s harms from alcohol and usually those, whatever that was, that’s what’s driving their health, not the fact that they’re not drinking. It’s that they had high risk drinking in the past. Higher, um, and that’s called abstainer bias. And that study finally showing that, which is what we all suspected for some time, but could never really prove because it’s, we’re never gonna have a randomized trial in this space. We finally have proven it.

There’s a study that came out that showed indeed the never drinkers are the healthiest group overall. The people that drink a little bit now do indeed look healthier than the people who are sober now for whatever reason. Again, probably because they have alcohol use disorder or something like that. Um, but we’ve been able to show that, that basically if you wanna live the healthiest possible life, you ne you should never drink.

So the cardiovascular myth has really, really hung on, you know, it’s, it’s. You don’t hear that often in the health space of like this thing that people really enjoy is actually really good for your health. Uh, also, doctors tend to be very, very high consumers of alcohol and we know that doctors that drink don’t talk to their patients about it. So there’s a number of reasons why that’s been pervasive.

Interviewer: Yeah, I mean, it’s something that I still hear about people just saying, well, I’m having this with dinner for my health, and they’re very excited to say that.

Guest: Yeah.

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Interviewer: How can individuals, you know, balance this, drinking that? Usually I feel like heavier drinking happens in social settings. Right? How can people kind of start to think about balancing that, that social situation with wanting to drink less? Do you have any ideas or recommendations that you talk with people about?

Guest: I mean, if you’re hosting, I think thinking about is alcohol really necessary in this event? I mean, I’m. My kids are older now, but I’ve certainly been to two, 3-year-old birthday parties where there’s alcohol served. Is that really necessary? I think if you’re going to an event where you feel like, I really can’t avoid it, what you can do is cycle in a non-alcoholic beverage, every other, or every, you know, do two non-alcoholic for everyone that you drink. Water’s a great option. ’cause a alcohol can also dehydrate you a little bit. If you’re hosting for like a major event for your employer or like you know, a fundraiser, think about giving drink tickets so people can never get above that one or two servings a day, at least under your, you know, your event. Eating does slow down the metabolism of alcohol, so not drinking on an empty stomach is great. Supporting alcohol free spaces, I think we were all a little bit disappointed that, you know Camp Randall now is serving alcohol, for example. So getting involved in those kind of local policies is a good strategy too.

Interviewer: It’s a perfect segue into what I’d like to talk about next is how is alcohol and cancer risk linked with being communicated to the public? Is there any upcoming or pending legislation regarding this issue? I know think about the work that’s been done with tobacco use and is there anything similar happening within that space?

Guest: There is the Alcohol Policy Project. It’s out of the Medical College of Wisconsin. They’re quite active in this space. It’s, uh, led by Maureen Busalacchi. I think more nationally, we’re seeing other states leading the way here. Alaska being front and center. They just passed a law to require signage at the point of sale that says alcohol causes colon and breast cancer. Um, you know. We don’t have warning labels required in states right now. There’s actually a very small warning on the back of alcoholic beverages. I would encourage your readers to look at a, at a bottle the next time. I didn’t even realize it was there. It’s so small, it’s so subtle, like you would really have to look for it. But there’s a movement to make that more prominent, dynamic changing, you know, have more impactful language. We are definitely looking to tobacco as a possible model, but they’re not the same, right? There’s, there’s not a doctor on this planet probably who’s gonna tell you to smoke. Um, that is, that is a habit where we can tell you with absolute certainty, you should never smoke. I think alcohol’s a little more complex and that there probably is an amount that doesn’t dramatically increase your risk of cancer.

Um, so it’s a much more nuanced message, which can make messaging like labels much harder. But yeah. The main policy space right now is in either signage or labeling on the bottles. I think in Wisconsin, we’re trying to empower local communities to take control of alcohol legislation and policy in their communities.

For example, your listeners may not know there are many states where they don’t sell alcohol at the grocery store, you actually have to go to a liquor store to get it, or they don’t sell alcohol on Sundays. Uh, I think a lot of that has gotten normalized in our state in a way that can make it very, very challenging not to drink.

Um, so, you know, for every little bit that we make it a tiny bit harder. What you tend to see is less children drinking and just less overall consumption. I think we can all agree things like. That happened with COVID, where they would deliver alcohol to your home. We should probably wind that back. Right? That doesn’t serve any good fundamental purpose anymore. The thought at the time was to prevent people from going into alcohol withdrawal when everything was shut down. But we’re past that now. We can wind that back. Same thing with drive through liquor stores make that go away. So yeah, that’s just some examples. Raising the price per sale, that would help too. But these are all, you know, there’s, there’s. Uh, health effects to this, but there’s also like business effects that might be counter to what we want and might also negatively impact communities. So we have to be very thoughtful and careful about what we suggest and recommend.

Interviewer: That’s all really interesting. As we start to wrap up our conversation today, I was wondering if you could share, I know we touched on this a little bit, but some additional ideas for people who are interested in either going alcohol free or tampering down their alcohol use to hopefully lower their cancer risks.So are there any things that you’re seeing that could be useful for people? I know you talked about the hosting piece of it, if you’re hosting events, things like that. Um, but other, other ideas.

Guest: Um, well, one is you can withdraw from alcohol. So if you are drinking daily, uh, talk to your doctor or your primary care provider about what’s a safe way for you to cut down. A rule of thumb is you reduce by one unit or one drink per day, per week. So if you’re drinking four a day. Go down to three a day for a week and then two a day, and then one a day, and then every other day. Uh, but some people need medically supervised, um, alcohol withdrawal. And so I think really partnering with primary care. There’s also really great recoveries resources out in the community if people fall into that. But most of the people that get alcohol associated cancer are not alcoholics. I think that’s a common misconception. Um, also a word on language. We’re really trying to get away from that word alcoholic and more use, um, people who drink alcohol or alcohol use disorder because it’s less stigmatizing.

So to your original question though, let’s say I am not in that category. I drink, you know, socially when I go out to dinner out with my friends or Packer game days or whatever, how can I think about, um, being mindful of my consumption? And I think just asking that question tells me that you’re probably primed to reduce all on your own. But it can be things like, first of all, count how much you drink. When you get to that limit, whether it’s one a day or two a day, depending on if you’re male or female, um. You’re gonna have to have something else to drink, bring it with you, or ask the host if they’re gonna have something. Um, I think taking advantage of mocktails, which is really a growing area in the restaurant industry, uh, that you buying those encourages them to provide more. And mocktails can be very friendly to adults. It’s not like the kitty cocktail that a lot of us grew up with, or you don’t have to just drink like a diet Coke, like you can actually have like an adult sophisticated beverage with your meal. And the more we drink those, the more demand there is for these restaurants to keep providing them.

Having something to eat. Having a buddy being accountable, stating what you’re hoping your goals are so that somebody else can help you stay within those goals. Those are all good strategies. And then avoiding trigger areas. So if you know Badger Game Day is like not great for you for alcohol consumption. Don’t come early, just come right at the time of the game and you know, leave right afterwards kind of thing.

Interviewer: I think those are all really good ideas and things that are attainable. Like they seem like, you know, small steps for someone who is just thinking about lowering their alcohol use, you know, not at that phase of having an alcohol use disorder, but really just being more mindful. Starting out with, being mindful is huge for, um, changing some of those wellbeing behaviors.

Guest: People can also try things like dry January. That’s another concept that they can try that might. It might be successful for them where you just take a month off, kind of see how you feel. Most people find I’m actually sleeping better. I’m not overeating as much. I generally have more energy, like they feel a little better, and that’s sort of self-sustaining after that.

Interviewer: Oh, I love that idea. And then you start to think like, oh, maybe I could do this a little longer than a month. So just to wrap things up here, um, what resources are available for those who are looking to quit or cut down? I know you talked about there’s a ton of resources within the community Yeah. With your PCP, that kind of thing. But what else could you leave us with today?

Guest: Yeah, and I might have it here with me. Of course, this is not on video, but I’ll uh, see if I can find it. But there’s a really wonderful book called Quit Like A Woman, and it was about, this is for your female woman, uh, listeners. It’s about a woman that went to Alcoholics Anonymous and just. She, she had a real problem with alcohol, but AA was never the right fit for her. For some, AA is absolutely wonderful, but it’s not gonna be the right fit for everybody. And so this is about her kind of finding her own way, and she found it through a connection to spirituality, yoga, you know, meditation, other things. It’s a really great book, even if it doesn’t, like it wasn’t a great fit for me personally, but I loved her perspective on like normalizing that AA is not the only way out of this. We also know that it takes many attempts. Most people are not successful the first time through, so if you try to cut down and you relapse, that’s okay. Keep at it. Get back on the horse, so to speak. There’s many wonderful podcasts, um, people can, can listen to. There’s recovery resources in the community. You probably would just Google whatever community you’re in, just like alcohol reduction and whatever your city name is.

Social workers, mental health providers can be helpful here too. It’s just there’s, there’s a lot. Sober living communities on Facebook, social media, Instagram, TikTok. I mean, however you like to get information, almost certainly you’re gonna be able to find somebody that can help you along the way. But I would start with books. For me, that’s my kind of hobby. That’s what I really love to do. So. Quit like a woman was a really good one.

Interviewer: Amazing. And I’ll make sure those are all linked in the show notes for this episode for people to check back on

Guest: Life Kit did a really, life Kit’s a podcast from NPR. They did a really great one on dry January.So that’d be a good one to link into your show notes.

Interviewer: Okay. Awesome. Well, thank you so much for your time today. I know this is valuable information for many and they might share it with a friend or a family member that they think might benefit from this as well. So thank you so much.

Guest: Awesome. Yeah, no problem! Thanks for the interest.

Interviewer: Thanks for listening to Wall Wisconsin Radio. I hope you enjoyed this show. You can find our survey in the wall, Wisconsin portal, and our transcripts and previous episodes, all at www.webmdhealthservices.com/wellwisconsinradio. If you’re listening to this podcast on your platform of choice, be sure to subscribe so you can never miss an episode.

In this episode of Well Wisconsin Radio, we explore the often overlooked link between alcohol and cancer and discuss the latest research on how even moderate drinking can impact cancer risk. Noelle LoConte, MD breaks down the biological mechanisms behind alcohol-related cancers, practical steps for reducing alcohol consumption, and the rising popularity of mocktails.

Episode Resources:

Wisconsin Alcohol Policy Project (WisAPP)

Quit Like a Woman: The Radical Choice to Not Drink in a Culture Obsessed with Alcohol by Holly Whitaker

Finding Local Resources: Google ‘alcohol reduction’ and whatever your city name is.

Life Kit Podcast: 6 strategies to help you take a break from drinking alcohol

Well Wisconsin Satisfaction Survey

The information in this podcast does not provide medical advice, diagnosis, or treatment. It should not be used as a substitution for healthcare from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.