Are Wine Critics, Winemakers and Somms at Increased Risk for Cancer?

In the past two years, two prominent wine writers died from cancer. Oregon wine writer and critic Cole Danehower died in 2015 from pancreatic cancer and Greg Walter of the Wine Spectator and Pinot Report passed away in 2016 from colon cancer. There have been several other wine professionals in the news who died in recent years as well including Willamette Valley Vineyards winemaker Forest Klaffke (throat cancer, 2012), Poetic Wines owner and winemaker Katy Lovell (pancreatic cancer, 2013), Barossa Valley Australia winemaker Bob McLean (liver cancer, 2015), Burgundy vintner Ann-Claude Leflaive (cancer, 2015) and Dry Creek Valley winemaker John Pedroncelli (cancer, 2015).

Of course, these isolated cases do not document a significantly increased risk of dying from cancer among wine professionals. In the United States alone in 2016, there is expected to be 595,690 cancer deaths reflecting the fact that cancer is a prevalent cause of death. However, the increased exposure to alcohol among wine critics, winemakers and sommeliers compared to many in the general population suggests that they may be at heightened risk of dying from cancer.

Since I taste wine almost daily, I wondered about the health risk. It has been well established since the 1980s that alcohol is a carcinogen at high levels of alcohol intake at several sites in the human body including the mouth, throat, larynx, esophagus, stomach, colon, rectum, pancreas, liver, lung and breast. There is a dose response curve, meaning that the risk increases the more alcohol people consume on a regular basis with smoking tobacco greatly adding to the risk for all cancers, particularly throat and mouth cancer. The quantity of alcohol consumed matters most for men’s cancer risk, the frequency of drinking is more important for women’s risk according to Dr. Arthur Klatsky, a renowned health and alcohol researcher.

I asked Curtis Ellison, M.D., Professor of Medicine and Public Health at Boston University and one of the country’s top authorities on the relationship of alcohol and health, if he knew of a study that showed an increased risk of cancer among wine writers and critics, and he did not. A.H. Finkel, M.D., who has written about alcohol and health, told me in good humor that assuming judicious spitting, the only two risks among wine tasters are (1) dissolution of dental enamel, presumably by acidic wine being held in the mouth for long periods of time (and exacerbated by fastidious individuals brushing their teeth soon after slurping and swishing), and (2) stained neckties (a declining risk since hardly anyone wears neckties any more). He also mentioned that like all critics, those of wine share the risk from enraged subjects of their trade.

Research published in 2015 in the Australian Dental Journal has shown that acid in wine can expose teeth to erosion. This study found that just 10 one-minute episodes of wine tasting normally experienced by wine tasters was enough to erode tooth enamel, with teeth becoming vulnerable within a few minutes of wine acid exposure. Dr. Sarbin Ranjitar of the University of Adelaide who conducted the study said, “With professional wine tasters and winemakers tasting anywhere from 20 to 150 wines per day, and wine judges tasting up to 200 wines per day during wine competitions, this represents a significant risk to their oral health. Our results reinforce the need for people working the profession to take early preventive measures, in consultation with their dentists, to minimize the risks to their teeth.” These measures include not brushing teeth the morning of a wine tasting or if brushing is required, use chewing gum to stimulate saliva which is naturally protective. After wine tasting, do not brush the teeth as that may damage the enamel, but rinse with water and when it is time to clean the teeth, put some toothpaste on a finger and gently clean the teeth.

I tested my own blood alcohol level on several occasions after tasting with spitting a series of 8 to 12 wines with multiple passes through each wine (my usual tasting regimen). My blood alcohol level was less than 0.08% on every occasion. However, I believe those critics who taste large numbers of wine at one sitting, even with judicious spitting, will exceed that blood alcohol level. Spitting does not insulate one from alcohol absorption for it is proven that there is some absorption of alcohol through the mucous membranes of the mouth (alcohol is soluble in both water and saliva and moves easily and quickly within 10 to 20 seconds across membranes), and some alcohol is absorbed as vapor through the lungs. Fortunately, alcohol dries the mucous membranes of the mouth, causing the secretion of mucous that protects against absorption.

The jury is out since their is no scientific research to implicate an increased risk of cancer among those who do extensive wine tasting appropriately. One thing is for sure, however, as Dr. Finkel noted, like all critics, those of wine share the risk from enraged subjects of their trade. This stress is undoubtedly unhealthy.

Did this short discourse pique your interest about the risks of cancer among wine drinkers? Read further if you are inquisitive.

There were several major studies published in 2015 regarding the association of alcohol consumption with the risk of cancer, and the papers were critically reviewed by the International Forum on Alcohol Research.

The first study was published in the British Medical Journal and titled “Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies.” This study involved 88,084 women and 47, 881 men participating in the Nurses’ Health Study and Health Professionals Follow-up Study, followed until 2010. The Forum considered this a well-done analysis of two very large cohort studies and felt that this was an important study presenting data that is of relevance to individuals and agencies providing advice regarding alcohol consumption. That said, the Forum pointed out that all dietary and lifestyle factors shown to increase the risk of cancer were not included in the report. The authors of the study concluded that light to moderate drinking (up to two drinks per day) is associated with a minimal increased risk of overall cancer. For men who have never smoked, risk of alcohol related cancers is not appreciably increased for light and moderate drinking. For women who have never smoked, risk of alcohol related cancers (mainly breast cancer) increases even within the range of up to one alcoholic drink a day. For both genders, there seemed to be a dose-response increase in risk of cancer with larger amounts of alcohol. Heavy drinking markedly increased the risk of upper airway and digestive tract cancers. Smoking was identified as an even more important risk factor than alcohol for cancers.

The second study was published in Permanente Journal by chief author Arthur Klatsky, M.D., titled “Alcohol intake, beverage choice, and cancer: A cohort study in a large Kaiser Permanente population.” The results of this very large study indicated that heavy drinking (equal to or greater than 3 drinks a day) was associated with an increased risk of upper airway/digestive tract, lung, female breast, colorectal and melanoma cancers, with light to moderate drinking related to all but lung cancer. No significantly increased risk was seen for 12 other cancer sites: stomach, pancreas, liver, brain, thyroid, kidney, bladder, prostate, ovary, uterine body, cervix, and hematologic system. For all cancers combined there was a progressive relationship with all levels of alcohol drinking. Alcoholic beverage choice played no major independent role.

A third study was published in the British Medical Journal, titled “Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis.” The authors of the study concluded that heavy drinking (the study defined one typical drink as 12.5 g or less per day) of >50 g/day of alcohol increased the risk for cancers of the upper airway/digestive tract, lung, female breast, and colon and rectum; for those neoplasms there was a clear dose-risk relationship. Significant increases were reported for heavy drinking for cancers of the stomach, liver, gallbladder, pancreas and lung, but the risk ratio for most of these were lower. There was an indication of a positive association between alcohol consumption and risk of melanoma and prostate cancer.

A fourth study was published in Cancer Causes Control titled “Incident cancers attributable to alcohol consumption in Germany, 2010.” The authors found that there was an apparent increase in the population attributable risk of cancer for men for upper airway/digestive tract and colon and rectum, but decreases from alcohol for liver cancer. For women, there was a decrease in colon and rectal and liver cancer from alcohol, but increases for breast and upper airway/digestive tract cancers.

As the Forum points out, all these studies describe an increased risk for many cancers among heavy drinkers, especially cancers of the upper airway and digestive tract. Even with the data from these studies, we still cannot state reliable threshold levels of drinking that increase the risk of cancer. Most reports on alcohol and cancer are flawed because they lack information on confounding, drinking patterns, beverage choice and the effects of under reporting of alcohol intake. The studies also omit a discussion of total mortality versus cancer mortality. One additional complicating factor is that published studies offer varying definitions of light, moderate and heavy drinking making results more difficult to compare and threshold levels to be determined.

One more interesting study bears mention. A report published in 2016 in the British Journal of Sports Medicine found that drinkers who exercised 150 minutes a week reduced their chances of dying due to any alcohol related illness. In physically active groups, only harmful levels of drinking (more than 39 standard drinks a week for men and 11-29 standard drinks a week for women) were associated with an increased risk of cancer death and death from any cause. So although the drinking of an average of 2.4 standard drinks a day for men and 1.6 standard drinks a day for women was associated with a 36% greater risk of death from cancer, the risk was substantially lessened or offset by physical activity.

In summary, the words of Dr. Klatsky should be noted, “For most persons older than age 50 years, the overall benefits of lighter drinking, especially the reduced risk of atherothrombotic disese, outweigh possible cancer risk. For young persons, the possible increased cancer risk at moderate intake should be part of an individual’s estimation of the overall risk-benefit equation for alcohol drinking.”