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Use of Alcohol and Tobacco in medicine is undermining efforts to fight cancer in LMICs

The use of known carcinogens, such as alcohol and tobacco, in medical treatments and products can indeed pose significant challenges to cancer prevention, management, and control,

Alcohol as a Carcinogen:

Alcohol is classified as a known human carcinogen1.

The National Cancer Institute states that the risk of developing alcohol-associated cancers increases with the amount of alcohol consumed over time1.

The International Agency for Research on Cancer (IARC) has found that even moderate alcohol consumption can increase the risk of several types of cancer2.

The Centers for Disease Control and Prevention (CDC) also acknowledges that reducing alcohol use may reduce the risk of cancer3.

The utilization of alcohol in traditional medicine within low- and middle-income countries (LMICs) indeed exacerbates the challenges associated with cancer prevention. This is largely due to prevailing attitudes and misconceptions about cancer and its relationship with alcohol use. 

Alcohol Use in Traditional Medicine:

In LMICs, alcohol is often used in traditional medicine practices for its supposed therapeutic properties1.

These practices can include the use of alcohol as a solvent for herbal concoctions or as a standalone remedy believed to have health benefits1.

Impact on Cancer Prevention Efforts:

The World Health Organization (WHO) has identified alcohol consumption as a risk factor for several types of cancer, including breast, liver, and colorectal cancers2.

Despite this, the use of alcohol in traditional medicine can perpetuate the belief that alcohol has health-promoting qualities, which contradicts scientific evidence2.

Attitudes and Misconceptions:

Attitudes towards alcohol use in traditional medicine can influence public perceptions and behaviors related to cancer prevention3.

Misconceptions about the medicinal value of alcohol can lead to its increased consumption, thereby elevating the risk of developing alcohol-related cancers3.

Challenges in Changing Perceptions:

Addressing the deeply ingrained beliefs and practices related to the use of alcohol in traditional medicine requires a nuanced approach that respects cultural identities while promoting evidence-based health practices.

Understanding Cultural Context:

Traditional medicine is not merely a set of practices; it’s often a part of the cultural heritage and identity of a community.

Any attempt to change these practices must start with a deep understanding of their cultural significance and the reasons behind their persistence.

Culturally Sensitive Health Education:

Health education campaigns need to be designed with cultural sensitivity to ensure they are effective and respectful.

These campaigns should engage with community leaders and healers who hold influence and can act as bridges between modern medicine and traditional practices.

Collaborative Approach:

Collaboration between healthcare professionals and traditional medicine practitioners can create a platform for dialogue and knowledge exchange.

This collaborative approach can help integrate beneficial traditional practices with modern medical knowledge, leading to more holistic healthcare solutions.

Empowering Communities:

Empowerment involves providing communities with the information they need to make informed decisions about their health.

Educational initiatives should aim to empower rather than dictate, allowing individuals to choose healthier practices without feeling that their cultural practices are being undermined.

Tailored Messaging:

Messages should be tailored to address specific misconceptions and provide clear, evidence-based information about the risks associated with alcohol use in medicine.

The messaging should also highlight alternative practices that align with cultural values but do not pose health risks.

Policy Support:

Supportive policies that regulate the use of alcohol in traditional medicines can reinforce educational efforts.

These policies should be developed in consultation with the communities they affect to ensure they are culturally appropriate and effective.

Overall, changing deep-rooted beliefs and practices related to alcohol use in traditional medicine is a complex challenge that requires a respectful, informed, and community-centric approach. Culturally sensitive health education campaigns, collaborative efforts, and supportive policies are key to addressing misconceptions without dismissing the value of traditional medicine. This multifaceted strategy can contribute to more effective cancer prevention and control in low- and middle-income countries.

Educational Interventions:

Educational interventions that provide accurate information about the risks associated with alcohol use, including its carcinogenic potential, are essential1.

These interventions should aim to empower individuals with knowledge, enabling them to make informed decisions about their health.

Policy Implications:

Policymakers in LMICs face the task of integrating evidence-based cancer prevention strategies with respect for traditional practices1.

Regulations may be needed to control the use of alcohol in medicinal products, ensuring that public health is not compromised.

Generally, while traditional medicine is an integral part of healthcare in many LMICs, the inclusion of alcohol as a medicinal component poses significant challenges for cancer prevention. Addressing the attitudes and misconceptions about alcohol’s role in medicine requires a multifaceted approach that includes education, policy change, and cultural sensitivity.

 

 

Tobacco and Cancer in Low- and Middle-Income Countries:

Tobacco smoking is a well-recognized risk factor for the initiation and spread of several cancers4.

The burden of cancers attributable to tobacco smoking is found to be higher in males and is positively associated with the socio-economic development of countries4.

Patterns of tobacco use in low and middle-income countries vary by product and socio-demographic characteristics, with the highest prevalence often reported in men, those with lower education, less household wealth, living in rural areas, and higher age5.

The use of tobacco in traditional medicines, particularly in the form of snuff, is a practice that persists in various low- and middle-income countries (LMICs). This practice has significant implications for public health, especially concerning cancer morbidity and mortality.

Tobacco Use in Traditional Medicines:

In many LMICs, tobacco is not only consumed for pleasure but also used in traditional medicines, often in the form of snuff1.

Snuff can be either inhaled through the nose (nasal snuff) or placed in the mouth (oral snuff), where the nicotine is absorbed through the mucous membranes1.

Health Implications:

The World Health Organization (WHO) recognizes that smokeless tobacco products, including snuff, are associated with several health risks, including cancer2.

The Global Burden of Disease study estimates that smokeless tobacco use, such as chewing tobacco and snuff, caused approximately 349,000 deaths in 20191.

Cultural and Socioeconomic Factors:

The prevalence and patterns of tobacco use, including snuff, vary widely across countries, regions, and socioeconomic groups within LMICs1.

Men, individuals with lower education, less household wealth, those living in rural areas, and older age groups are often found to have higher prevalence rates of tobacco use1.

Challenges in Cancer Control:

The incorporation of tobacco in traditional medicines complicates efforts to reduce the cancer burden in LMICs.

Cultural acceptance and the perceived medicinal value of tobacco in these contexts can lead to normalization of its use, making public health interventions more challenging.

Policy and Education:

Effective tobacco control policies and educational campaigns are needed to address the use of tobacco in traditional medicines.

Policies should be culturally sensitive and consider the traditional uses of tobacco while educating about its risks.

Public health strategies must also focus on debunking myths about the medicinal benefits of tobacco and promoting healthier alternatives.

In general, the use of tobacco in traditional medicines, such as snuff, in LMICs contributes to the high burden of cancer morbidity and mortality. Efforts to combat cancer must address these cultural practices by implementing targeted policies and educational initiatives that consider the socioeconomic and cultural contexts of these communities.

 

 

 

Attitudes Towards Carcinogens in Medicine:

Attitudes towards addressing alcohol consumption in healthcare settings can influence individuals’ behaviors related to alcohol use and abuse6.

Awareness of the link between alcohol and different types of cancer is generally low, which may contribute to the continued use and abuse of alcohol7.

Implications for Cancer Control Efforts:

Efforts to combat cancer must consider the complex interplay between socio-economic factors, cultural attitudes, and the availability of carcinogenic substances in medical products.

Public health strategies should include education on the risks associated with alcohol and tobacco use, as well as policies to limit their inclusion in medicinal products.

Addressing these underpinnings is crucial for reducing the burden of cancer morbidity and mortality, particularly in low- and middle-income countries where the impact is amplified.

Therefore, the presence of carcinogens like alcohol and tobacco in medicines, especially in low- and middle-income countries, significantly contributes to the global cancer burden. Changing attitudes towards these substances and implementing robust prevention strategies are imperative for effective cancer control.

 

The combined impact of alcohol and tobacco use indeed has a multiplicative synergistic effect on carcinogenesis, making the battle against cancer even more complex. When these substances are used together, they significantly increase the risk of developing cancers, particularly those of the oral cavity, oropharynx, larynx, and esophagus1. For instance, individuals who consume both alcohol and tobacco are at a 5-fold increased risk of developing these cancers compared to those who use either substance alone2. For heavy users, this risk can be up to 30 times higher2.

This synergistic effect is due to several factors:

Given this synergy, efforts to combat just one carcinogen may indeed be less effective if used in isolation. A comprehensive approach that addresses both alcohol and tobacco use is necessary for effective cancer prevention.

Moreover, the cultural milieu and social drivers of tobacco and alcohol use demand focused attention. These include:

To address these challenges, a multi-faceted strategy is required:

  • Public Health Campaigns: These should aim to educate about the risks of combined alcohol and tobacco use and promote healthy behaviors.
  • Policy Interventions: Regulations that control advertising, pricing, and availability of alcohol and tobacco can help reduce consumption.
  • Community Engagement: Working with community leaders and members to understand cultural contexts and develop tailored interventions.
  • Healthcare Integration: Incorporating substance use screening and counseling into routine healthcare can help identify and address risky behaviors early.

Overall, the twin impact of alcohol and tobacco use on carcinogenesis is a public health concern that requires a concerted effort that spans education, policy, and community engagement to effectively mitigate the heightened risk of cancer associated with these substances.

 

 

Recommended Reading

 

1.       Global Burden of Disease [database] Washington, DC Institute of Health Metrics 2019. IHME, accessed 17 July 2021.

2.        WHO International, Health topics, Tobacco, Fact sheet Last updated on 26th July 2021.

 

3.        Tata Institute of Social Sciences (TISS), Mumbai and Ministry of Health and Family Welfare, GoI. GATS. GATS 2 India 2016-17.

 

4.        Tata Institute of Social Sciences (TISS), Mumbai and Ministry of Health and Family Welfare, GoI. GATS. GATS 2 Delhi. 2016-17.

 

5.        International Institute for Population Sciences (IIPS) and ICF. 2021. National Family Health Survey (NFHS-5), 2019-21: India: Volume I Mumbai IIPS.

6.       Balan B, Elazan S, Morillas M, Sandberg A Disease load in Aliganj, an urban village in New Delhi, India: a search for directions in risk reduction through urban planning. Project of knowledge community on children in India in collaboration with Department of Community Medicine, VMMC, New Delhi.

 

7.       World Health Organization. Noncommunicable disease surveillance, monitoring and reporting. Global Adult Tobacco Survey. Available from: https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/global-adult-tobacco-survey.

 

8.       Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO The Fagerström test for nicotine dependence: A revision of the Fagerström tolerance questionnaire. Br J Addict 1991;86:1119–27. doi: 10.1111/j. 1360-0443.1991.tb01879.x.

 

9.       Kumar R, Kant S, Chandra A, Krishnan A Tobacco use and nicotine dependence among newly diagnosed pulmonary tuberculosis patients in Ballabgarh tuberculosis unit, Haryana. J Family Med Prim Care 2020;9:2860–5.

 

10.   Mattingly DT, Hirschtick JL, Fleischer NL Unpacking the non-hispanic other category: Differences in patterns of tobacco product use among youth and adults in the United States, 2009-2018. J Immigr Minor Health 2020;22:1368–72.

 

11.   Kypriotakis G, Robinson JD, Green CE, Cinciripini PM Patterns of tobacco product use and correlates among adults in the population assessment of tobacco and health (PATH) study: A latent class analysis. Nicotine Tob Res 2018;20 suppl_1 S81–7.

 

12.    Johnson AL, Collins LK, Villanti AC, Pearson JL, Niaura RS Patterns of nicotine and tobacco product use in youth and young adults in the United States, 2011-2015. Nicotine Tob Res 2018;20 suppl_1 S48–54.

 

13.   Rath JM, Villanti AC, Abrams DB, Vallone DM Patterns of tobacco use and dual use in US young adults: The missing link between youth prevention and adult cessation. J Environ Public Health 2012 2012. 679134.

 

14.   Villanti AC, Pearson JL, Cantrell J, Vallone DM, Rath JM Patterns of combustible tobacco use in U. S. young adults and potential response to graphic cigarette health warning labels. Addict Behav 2015;42:119–25.

 

15.   Tan C, Lin L, Lim M, Ong SK, Wong ML, Lee JK Tobacco use patterns and attitudes in Singapore young male adults serving military national service: A qualitative study. BMJ Open 2020;10:e039367.

 

16.   Blazer DG, Wu LT Patterns of tobacco use and tobacco-related psychiatric morbidity and substance use among middle-aged and older adults in the United States. Aging Ment Health 2012;16:296–304.

 

17.   Kumar R, Kant S, Chandra A, Krishnan A Tobacco use and nicotine dependence among patients with diabetes and hypertension in Ballabgarh, India. Monaldi Arch Chest Dis 2021.

 

18.   Divinakumar KJ, Patra P, Prakash J, Daniel A Prevalence and patterns of tobacco use and nicotine dependence among males industrial workers. Ind Psychiatry J 2017;26:19–23.

 

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