Facial Flushing After Alcohol Consumption a Risk Factor for Esophageal Cancer

People who experience facial flushing after drinking alcohol should be particularly wary of esophageal cancer, researchers warn.

About one third of East Asians (Chinese, Japanese and Koreans) – have an inherited deficiency in an enzyme called Aldehyde Dehydrogenase 2 (ALDH2) that causes their skin to flush when they drink alcohol.

Researchers from the National Institute on Alcohol Abuse and Alcoholism found that even moderate drinkers with this deficiency were more at risk of esophageal cancer, one of the deadliest forms of cancer worldwide.

Alcohol is broken down by the body into acetaldehyde which is normally metabolized by an enzyme, ALDH2. Asian drinkers who are missing this enzyme are unable to break down acetaldehyde, which is carcinogenic to human body and accumulates, causing facial flushing.

Esophageal cancer is more common in other parts of the world than the U.S. but because it is hard to detect, often goes unnoticed until it is too late. Esophageal cancer found early can be removed by an endoscopy procedure. However, if the cancer grows into the deeper tissue and spreads to the lymph nodes then only about 20 percent of esophageal cancer patients survive three years after diagnosis, according to a Public Library of Science (PLoS) research article.

Many Asians and health professionals are aware that some people experience this flushing response to alcohol but most are not aware that those individuals are at greater risk of developing esophageal cancer.

“People are fairly well aware of this physical characteristic, which is sometimes called Asian flush or Asian alcohol response, but I don’t think people are aware that it is a warning sign for being at risk of esophageal cancer when they drink alcohol. That is what we wanted to point out,” said Philip Brooks of the National Institute on Alcohol Abuse and Alcoholism, whose study appears in the Public Library of Science journal PLoS Medicine.

“We hope that, by raising awareness of this important public health problem, affected individuals who drink will reduce their cancer risk by limiting their alcohol consumption.”

He said doctors could determine ALDH2 deficiency simply by asking about previous episodes of alcohol-induced flushing. Then people with ALDH2-deficient can be counselled to reduce alcohol consumption, and those high-risk patients could be assessed for endoscopic cancer screening.

Brooks estimates that at least 540 million people have this alcohol-related increased risk for esophageal cancer.

They found individuals with one copy of the inactive gene causing ALDH2-deficiency were 6-10 times more likely to develop esophageal cancer than individuals with the fully active ALDH2 enzyme who drank comparable amounts of alcohol.

They said if moderate or heavy drinking people with this deficiency were to become light drinkers instead, 53 percent of esophageal cancers might be prevented among Japanese men.

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