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Dr Amtul Razzaq Carmichael, UK, and Aizaz Khan, Canada
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.
But while the harms associated with high and frequent alcohol consumption have been well-understood, recently emerging evidence demonstrates that even light-to-moderate alcohol consumption is associated with physical, psychological and social harm to individuals and society.[i] In 2010, members of the Independent Scientific Committee on Drugs applied ‘multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK’ and subsequently published the results of the analysis in The Lancet. Using 16 criteria, they calculated a comprehensive “harm-score” which took into consideration harm caused by drug-specific mortality, drug-related mortality, damage and mental impairment, dependence, loss of tangibles (such as income, housing, job), loss of relationships, injury, crime, environmental damage, family adversities, international damage, economic cost and cost to the community. Using these parameters, alcohol with an overall score of 72 (out of 100), was judged to be the most harmful substance followed by heroin at 55, then crack cocaine with a score of 54. Authors of the report concluded that aggressively targeting harm caused by alcohol is a valid and necessary public health strategy.
Though the harms of alcohol are generally known, one particularly 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.[x] 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.[xi],[xii],[xiii],[xiv],[xv] 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.[xvi] [xvii] [xviii]
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.
End Notes
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[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.
[xxiv] M Holm, A Olsen, J Christensen et al., “Pre-diagnostic alcohol consumption and breast cancer recurrence and mortality: Results from a prospective cohort with a wide range of variation in alcohol intake,” International Journal of Cancer 132, 3 (2013): 686-694.
[xxv] V Walter, L Jansen, A Ulrich et al., “Alcohol consumption and survival of colorectal cancer patients: A population-based study from Germany,” The American Journal of Clinical Nutrition 103, 6 (2016): 1497-1506.
[xxvi] A Phipps, J Baron, P Newcomb, “Prediagnostic smoking history, alcohol consumption, and colorectal cancer survival: The Seattle Colon Cancer Family Registry,” Cancer 117, 21 (2011): 4948-4957.
[xxvii] H Danker, J Keszte J, S Singer et al., “Alcohol consumption after laryngectomy,” Clinical Otolaryngology 36, 4 (2011): 336-344.
[xxviii] S Sehlen, H Hollenhorst, M Lenk et al., “Only sociodemographic variables predict quality of life after radiography in patients with head-and-neck,” International Journal of Radiation Oncology, Biology, Physics 1, 52(2002): 779-83.
[xxix] J Jarl, U Gerdtham, “Time pattern of reduction in risk of oesophageal cancer following alcohol cessation: A meta-analysis” Addiction 107 (2012): 1234-1243.
[xxx] J Rehm, J Patra, S Popova, “Alcohol drinking cessation and its effect on esophageal and head and neck cancers: A pooled analysis,” International Journal of Cancer 121, 5(2007): 1132-1137.
[xxxi] M Marron, P Boffetta, Z Zhang et al, “Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk,” International Journal Epidemiology 39, 1(2010): 182-196.
[xxxii] L Ng, N Shelton, N Cable, “Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England,” BMC Public Health 18, 1(2018): 1090.
[xxxiii] The Holy Qur’an, 91:8-11.
[xxxiv] Hazrat Mirza Ghulam Ahmad (as), The Philosophy of the Teachings of Islam (Tilford, Surrey: Islam International Publications Ltd., 2017), 121.
[xxxv] The Holy Qur’an, 2:287.
[xxxvi] The Holy Qur’an, 76:4.
[xxxvii] Hazrat Hafiz Mirza Nasir Ahmad (rh), Tafsir Anwar-ul-Qur’an, 562.
[xxxviii] The Holy Qur’an, 2:220.
[xxxix] Hazrat Mirza Bashiruddin Mahmud Ahmad (ra). Tafsir-e-Kabir. 2:220, Vol 2, 480.
[xl] Sunan Ibn Majah, Kitab-ul-Ashribah, Book 30, No. 3392.
[xli] Sunan Abi Dawud, Kitab-ul-Ashribah, Book 27, No. 6.
[xlii] Jami’ At-Tirmidhi, Abwab-uz-Zuhd An Rasoolillah SA, Book 36 No. 14.
[xliii] https://www.alislam.org/library/book/noahs-ark/our-teaching-3/
[xliv] The Holy Qur’an, 5:91-92.
[xlv] Hazrat Mirza Ghulam Ahmad (as), Malfuzat Vol. 3, (Old Woking, Surrey: The Gresham Press, 1984), 292.
[xlvi] Hazrat Mirza Ghulam Ahmad (as), Aina Kamalat-e-Islam, Ruhani Khazain, (Tilford: Islam International Publications Ltd,) 254-255, footnotes.
[xlvii] Hazrat Mirza Ghulam Ahmad (as), Malfuzat Vol. 3, (London, 1984), 405.
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