A Sober Message for Iowans
Less is Better
Alcohol kills. I'm not talking about the fatal drinking-and-driving statistics drummed into me as a kid. Or the bachelor brothers in my small hometown who unwittingly served as object lessons to the dire consequences of cirrhosis of the liver. And I'm not pointing to the tragic combination of alcohol and firearms that snuffed out the life of my childhood farm neighbor and school classmate. . . although all of these are true.
No, there's more. The 2024 Cancer in Iowa report by the Iowa Cancer Registry is a sober reminder that alcohol also kills slowly, quietly, and perniciously. It's not the fearful bogeyman lurking on a dark street corner one night, but the familiar guest we invite into our homes for life's celebrations or to help us relax . . . it's the cumulative, cancer-causing impact of binge-drinking.
Alcohol is a toxin. Like other toxins, it isn't conducive to good health. Unlike other toxins, however, alcohol is available everywhere today ---from small-town gas stations to grocery stores, and even most of Iowa's county fairs. I'm old enough to remember when it was sold only at state-owned liquor stores.
I admit I was surprised when the 2024 Iowa Cancer Registry research drew a through line between Iowa's #4 rank in the U.S. for adult binge drinking and Iowa's #4 incidence of alcohol-related cancers.
But I'm not alone. A 2023 National Institutes of Health study revealed that "only 40% of the general public even knew that alcohol could contribute or cause cancer," says Mary Charlton, professor of epidemiology and director of the Iowa Cancer Registry at the University of Iowa.
The rate of alcohol-related cancers in 2019 was almost 10% higher in Iowa than the U.S. average. lowa was the only state reporting a significant increase in cancer incidence from 2015 to 2019, according to the 2023 Cancer in Iowa report. The incidence in other states decreased or remained static.
Rite of Passage
Drinking often is referred to as a rite of passage for youth. In my rural high school, there were rumors of under-age drinking parties in the rugged timber-covered hills. When I taught in rural Nebraska, the high school boys would talk casually about getting "wasted" over the weekend. By the time my own kids attended a rural high school, underage drinking parties were an open secret. Sometimes parents protested it was a safer alternative to allow their teen to host parties on their property. Occasionally a star athlete was barred from playing the remainder of the season.
Of course, I knew binge drinking wasn't a good habit at any age. I wrote a Rural Health page in Successful Farming magazine for 26 years. I cautioned that the earlier youth begin to drink, the greater the risk of hard wiring their developing brains for a pattern of adult substance abuse.
Pick Your Poison
In 2022, 22% of Iowa adults reported binge drinking, compared to the national average of 17%. Binge drinking is defined as five or more drinks at one sitting for men, and four or more for women. Beer, wine, hard liquor, it doesn't matter. The amount consumed and the frequency are the causative factors for cancer.
Beyond these statistics, Iowa's 2024 cancer report offers a few surprises. For instance, Iowans who earn more than $100,000 per year binge drink at "significantly higher rates" than Iowans who earn $50,000 or less. And the highest rate of binge-drinking occurs among Iowans ages 25 to 34. However, 23% of youth ages 12 to 20 also had consumed one drink in the past 30 days: 15% reported binge drinking in 2019-2020. Regardless of sex, age, race education or income, Iowans binge drink above the U.S. average.
"The geographic distribution for each specific cancer site is different, and there are no parts of the state that are at uniformly low risk of cancer across various cancer sites or types," Charlton points out.
How Does Alcohol Cause Cancer?
Alcohol is metabolized into acetaldehyde, a toxic chemical that damages DNA and other molecules, and hampers the body's capacity to repair the damage. This contributes to mutations. It's less well known that drinking alcohol in excess also can produce inflammation and impair immune system functioning.
The most common alcohol-related cancers are head and neck (oral cavity, pharynx, and larynx), esophageal, prostate, and colon and rectum. In women, it's breast cancer. Breast and esophageal cancer have been linked even to smaller amounts of alcohol consumption, but drinking in excess is tied to liver and colorectal cancer. Lung, colorectal, prostate and breast cancers total about half of all cancer cases in Iowa.
No one factor causes cancer. Genetics, environment, lifestyle behaviors, and other factors interact. But alcohol use can exacerbate it.
"Understanding what exposures the population of Iowa has, including in both urban and rural communities, is an important step in trying to figure out what is driving increases," Charlton says. "This includes understanding tobacco and alcohol consumption, other behaviors, and things in the environment, such as radon, air pollution, water contaminants and agricultural exposures. We try to carefully balance our activities and increase awareness about known or modifiable risk [controllable] factors at every opportunity."
An estimated 21,000 cancers will be diagnosed among Iowans in 2024. A total of 6,100 Iowans are expected to die from cancer this year. However, if there's any good news, it's that Iowa's cancer mortality rate has been declining. More Iowans are surviving, thanks to advances in screening and treatment.
What Are We Doing About it?
The pandemic spurred record levels of alcohol sales in Iowa, but Iowans can't blame Covid-19 for their elevated alcohol ranking. The upward trend in alcohol consumption was noted as far back as 2007 in a State of Iowa report. Iowans also have been spending more on liquor since 2012, from $255 million to $446 million in 2023. A budding industry of breweries and wineries is on the leading edge of economic development in Iowa. Although the University of Iowa no longer ranks in the top 10 list for party schools, it still is #18 in 2024
Depending upon individual health factors, even moderate drinking may be risky. But no one is advocating complete abstinence from alcohol in adulthood. "Reducing the amount we drink could significantly lower the risk of cancer," Charlton says.
A greater awareness is sorely needed. Binge drinking is a public health problem in Iowa, and it needs to be recognized by state leaders as such. Yet our legislators and the Reynolds administration continue their efforts to stigmatize LGBTQ youth in schools; never mind that research shows their rates of substance abuse are two to four times higher than their heterosexual peers.
Where are the new programs to address behavioral health and equip school counselors with the tools to help students adopt healthy options for coping with setbacks, challenges, and traumatic school shootings?
Young Iowans have the most to gain from pressing the re-set button on binge drinking. This adolescent rite of passage shouldn't put them on a trajectory toward a premature cancer diagnosis and final last rites. Iowa needs to find ways to reduce teen access to unhealthy choices. Parents need to push back on the normalization of teenage drinking and focus on modeling healthy behaviors. Clearly, more efforts are needed to discourage Iowans' reliance on alcohol as a social driver as well as a coping mechanism for undiagnosed behavioral health issues.
Finally, as individuals, we're also culpable. Iowa has the fourth highest rate of alcohol-related cancers in the U.S., and ranks #4 in adult binge drinking. Let that sink in. We can address the known associations with alcohol cited in the 2024 report, Â or we can choose to focus on the risks of polyfluoroalkyl substances (pfas), genetically modified foods, artificial sweeteners, and other less binge-worthy substances. Perhaps it's only human nature to obsess about uncontrollable risk factors instead of our daily choices that ignore the known risks.
It's too late to put the genie back in the alcohol bottle. But we hold the solution to cancer-causing binge drinking in the palm of our hands.
Thanks, Cathy. That is a subject that merits its own column. The Cancer Registry is focusing on alcohol because the connection is very well supported by research. I wrote about the research from the Agricultural Health Study of the National Cancer Institute for many years. Farmers and pesticide applicators are on the front lines of these exposures. Thanks again!
Thanks, Jim. Yes, I identify with the Methodist upbringing reference, although my grandpa enjoyed a little Mogen David "wine" from time to time. Yes, it is ubiquitous! And we do need to consider hitting the pause button.