Ramon Estruch

Professor Ramón Estruch is Senior Consultant of the Department of Internal Medicine at the Hospital Clínic (Barcelona, Spain), Professor of Medicine in the School of Medicine at the University of Barcelona, Member of the Steering Committee of the CIBER of Obesity and Nutrition at the Instituto de Salud Carlos III, Government of Spain and Scientific Director of the Mediterranean Diet Foundation, Barcelona, Spain.

He has published more than 650 manuscripts in high impact Journals, including ‘The New England Journal of Medicine’, ‘JAMA’, ‘The Lancet’, ‘Annals of Internal Medicine’, ‘Archives of Internal Medicine’, ‘Circulation’ and ‘American Journal of Nutrition’, among others. In this context, it should be underlined the results of the study “Effects of the Mediterranean Diet on the primary prevention of cardiovascular disease” (PREDIMED study), published in ‘The New England Journal of Medicine’, that was the second original article more read in the year 2013, and that has been the basis of the dietary guidelines recommended by several governments and scientific societies around the world. Finally, the years 2018, 2019, 2020 y 2021 has been recognized as a ‘Highly Cited Researcher’ by Claryvate Analytics, USA.

Do wine drinkers have an increased cancer risk? Epidemiological and clinical aspects.

Ramon Estruch, MD, PhD. University of Barcelona, Barcelona, and CIBERobn, Instituto de Salud Carlos III, Madrid, Spain

The relationship between wine consumption and cancer risk is complex, as it depends on several factors, including the amount and type of wine consumed, overall lifestyle and genetic predisposition. Wine, particularly red wine, contains several antioxidants, which have been suggested to have potential health benefits, including anti-inflammatory and anti-carcinogenic properties. Some studies have explored the possibility that moderate wine consumption might offer protective effects against certain types of cancer due to these compounds. However, the evidence remains inconclusive, and potential benefits must be weighed against known risks. Nevertheless, according to the results of the latest studies, the most important issue is to consider wine consumption in the correct context: it should be consumed in moderation, always with meals, and as part of a healthy diet, such as the Mediterranean diet.

Despite the presence of beneficial compounds, wine—like all alcoholic beverages—contains ethanol, which is classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC). Regular alcohol consumption has been linked to an increased risk of several cancers, including breast, liver, esophageal, colorectal, and head and neck cancers. Ethanol is metabolized into acetaldehyde, a toxic compound that can damage DNA and interfere with cellular repair processes, thereby contributing to cancer development. The risk of alcohol is dose-dependent, meaning that the more alcohol one consumes, the greater the likelihood of developing cancer. However, the main question to answer is whether all alcoholic beverages exert the same effect on cancer development or if some beverages, like red wine, contain relatively high amounts of anti-carcinogenic substances that counteract the effects of ethanol itself.

In this context, several epidemiological studies have associated alcohol consumption with cancer development, but many of them may have methodological issues, mainly related to the reference group (controls) and, more importantly, the monitoring of key confounding factors related to the assessed outcome, particularly the type of alcoholic beverage consumed, drinking patterns, and mainly overall diet.

Public health recommendations generally advise limiting alcohol intake to reduce cancer risk. However, governments and scientific entities should analyze the effects of moderate wine consumption in the context of a healthy lifestyle, such as the Mediterranean diet. The latest evidence suggests that wine consumption within a Mediterranean diet may even reduce the incidence of several cancers, including breast cancer in women.

In conclusion, despite the well-known carcinogenic effect of ethanol, moderate red wine in the setting of a healthy dietary pattern (i.e. Mediterranean pattern) may be associated with a reduced incidence of cancer, including breast cancer in postmenopausal women.