Drinkers’ Facial Flushing May Indicate Cancer Risk


By Hugh C. McBride

The red-faced drinker is somewhat of a staple in comedies and cartoons (see: Fields, W.C.), but the condition may be less laugh-worthy than was once thought.

Researchers with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have revealed that facial flushing after the consumption of alcohol can indicate the presence of a genetic enzyme deficiency that puts the drinker at increased risk for developing esophageal cancer.

East Asians at Greatest Risk

According to a March 20, 2009 New York Times article by Nicholas Bakalar, NIAAA researchers report that the condition is prevalent among members of East Asian populations, though they are not the only ones who are susceptible to the disorder:

  • The flushing response, which may be accompanied by nausea and a rapid heartbeat, is caused mainly by an inherited deficiency in an enzyme called ALDH2, a trait shared by more than a third of people of East Asian ancestry – Japanese, Chinese or Koreans. As little as half a bottle of beer can trigger the reaction.
  • The deficiency results in problems in metabolizing alcohol, leading to an accumulation in the body of a toxin called acetaldehyde. People with two copies of the gene responsible have such unpleasant reactions that they are unable to consume large amounts of alcohol. This aversion actually protects them against the increased risk for cancer.
  • But those with only one copy can develop a tolerance to acetaldehyde and become heavy drinkers.

Dr. Philip J. Brooks, who authored a report on this particular alcohol-cancer connection that appeared on the website of the open-access journal PLoS Medicine, told the Times that the presence of the condition represents “a pretty serious risk” to those who are affected.

Increasing Awareness

In the introduction to the study, Dr. Brooks indicates that there is a bit of good news in his team’s findings – namely, that the intensity of the flushing symptoms can make it very easy to determine who is at risk for contracting alcohol-related esophageal cancer:

  • Our goal in writing this article is to inform doctors firstly that their ALDH2-deficient patients have an increased risk for esophageal cancer if they drink moderate amounts of alcohol, and secondly that the alcohol flushing response is a biomarker for ALDH2 deficiency.
  • Because of the intensity of the symptoms, most people who have the alcohol flushing response are aware of it. Therefore clinicians can determine ALDH2 deficiency simply by asking about previous episodes of alcohol-induced flushing. As a result, ALDH2-deficient patients can then be counseled to reduce alcohol consumption, and high-risk patients can be assessed for endoscopic cancer screening.

Later in the report, Dr. Brooks emphasizes the necessity of spreading awareness and acting quickly should a person develop this type of cancer:

  • When detected early, esophageal cancer can be treated by endoscopic mucosectomy, a standard and relatively non-invasive procedure. However, once the cancer has grown large enough to penetrate the submucosal layer, the likelihood of lymph node metastasis increases significantly.
  • Only about 20 percent of esophageal cancer patients survive three years after diagnosis, emphasizing the importance of disease prevention.

Living Healthier

Patients who report to their doctors that their faces flush when they drink can take a simple, painless test in which an ethanol-soaked pad is applied to their skin. If, after 10 or 15 minutes, the skin that was in contact with the pad becomes noticeably redder, then they are likely to have the enzyme deficiency.

Though they are at increased risk for developing a form of cancer that is often associated with smoking cigarettes, drinkers who experience facial flushing when they consume alcohol have the twin advantages of being aware of their condition and being able to reduce their risk by limiting or eliminating alcohol from their daily lives.

Some drinkers may be able to slow or stop their alcohol intake on their own, while others may require professional assistance such as outpatient therapy or in a residential alcohol rehabilitation program.

Of course, given the wide range of negative health effects that have been associated with alcohol abuse, anyone who is unable to control the amount or frequency with which they drink should contact their family physician or explore other alternatives for accessing alcoholism treatment.

Living a healthier and happier life is within the reach of anyone who is struggling to overcome a dependency upon alcohol or another drug. Learning as much as you can about your personal medical condition and educating yourself about the options that are available to you are important first steps to take.

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