The head and neck cancer risk linked to being Catholic

In the early 1960’s, there were many papers in medical journals suggesting an association between alcohol and tobacco consumption and head and neck cancers. The most interesting study I could find was by Keller and Terris from 1965. They observed a statistically higher incidence of head and neck cancers associated with tobacco and alcohol consumption. They also observed a statistically significant higher rate of these cancers in Roman Catholics when compared to Protestant and Jews, but they did not comment on that. Science has a notorious habit of finding things you do not want to find. They recommended cessation of smoking and drinking but did not suggest religious conversion.

Cancer and tobacco use. No one can argue against this.

The year before the Keller and Terris study was published, the Surgeon General’s 1964 report was released which linked tobacco use with cancers of the larynx and lungs in men. This report reviewed 7,000 publish medical articles to reach their conclusion. This is a very large number of articles for the early 1960’s. This report also established a link between heart disease and chronic bronchitis with tobacco usage. They did not observe a link of between alcohol usage and cancer. Alcohol was not mentioned in this report. With public education and higher cigarette taxes, smoking has decreased and with it the rate of head and neck cancers. Unfortunately, the association between head and neck cancers and Catholic faith have never been challenged. Old prejudices are not easily erased.

After the 1960’s there was a demographic shift from the 50–60-year-old age group to younger people (20-35) being diagnosed with head and neck cancers.

Human Papilloma Virus and cancer

A report published in 2008 by Maura Gillison was the first to link Human Papilloma Virus (HPV) and head and neck cancers. Since that time this link has been confirmed by multiple other investigators. Prior to her article, only cervical cancer had been linked to HPV. Using her scientific approach to cancer and HPV, the link has been confirmed in most cancers of the genital-urinary system and anus in both men and women. In 2006 the first HPV vaccine was introduced to decrease the risk of cervical cancer and with widespread acceptance the rates of head and neck cancers should continue to fall. When asked why she thought there had been a shift in demographics, Dr Gillison suggested it was due to the ‘sexual revolution’ of the 1960-70’s.

In the WHO report Cancer, the authors offer 10 suggestions to prevent cancers, and alcohol avoidance is number 5. The recommendation to avoid alcohol is just above the recommendation for the treatment for hepatitis C and vaccinations for hepatitis B and HPV. As mentioned above, the association of HPV infections and head and neck cancers is clear. Hepatitis B and C infections are associated with the development of liver cancer. Hepatitis C is also associated with non-Hodgkins’s lymphoma. Vaccination programs are expensive and are the responsibility of the government. Programs for testing and treatment of hepatitis C are also expensive and that can be the responsibility of a government to implement. Instead of urging governments to implement these programs the WHO report Cancer blames the victims.

Where do they get this stuff?

The WHO has an agency called The International Agency for Research on Cancer (IARC). They are responsible to classify potentially carcinogenic chemicals and infections into 4 categories. Group 1 is the highest classification, ‘Carcinogenic to Humans’ 135 chemicals, radiation, or infections that they feel have been proven to cause cancer in humans. The consumption of alcoholic beverages is in Group 1 because the metabolism of alcohol results in the formation of acetaldehyde. Acetaldehyde has been linked to causing mutations in DNA. The enzyme Alcohol Dehydrogenase(ADH) breaks down alcohol to acetaldehyde, but this chemical is immediately broken down by Acetaldehyde Dehydrogenase(ALDH) into acetate which becomes a source of energy for the body. (This is a lot of science, but the background is important. Please bear with me.) We know that acetaldehyde is broken down immediately because we can block ALDH with the drug disulfiram. This drug is used in the treatment of Alcohol Use Disorder (A DSM-5 diagnosis). Blocking ALDH and consuming alcohol, even the smallest amount, results in immediate flushing of the skin, nausea, vomiting, headaches and a racing heartbeat. Very unpleasant and nothing I have ever experienced from a glass of wine.

“There is no form of (Insert 135 agents here) consumption that is risk-free.”

The IARC list is very inclusive and within the 4 categories there are 1,060 agents cataloged. There is a great deal of overlap between Group 1 agents. The best example is that of that acetaldehyde found in the metabolization of alcohol and in tobacco smoke. The first and only time I tried a cigarette, I experienced immediate flushing of the skin, nausea, vomiting, headache and racing heartbeat. (Sound familiar?) The list of Group 1 agents also includes sunlight, air pollution, acetaminophen (paracetamol), testosterone and estrogen. None of us are living a “risk-free” life.

So, Doc, give it to me straight

Based on this review, can I say that there is no link between alcohol consumption and cancer?

NO!

From a group of scientists and statisticians sponsored by the NIH comes this thorough review of the subject. In their 2025 report, National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Review of Evidence on Alcohol and Health (Now that is a big title!), found a 10% increase in breast cancer for women for moderate alcohol drinkers compared to non-drinkers (Conclusion, with moderate certainty). Within the moderate drinking group there was a 5% increase in breast cancer (Conclusion, with low certainty). When they looked at colon cancer, no conclusion could be made for an increased risk in moderate alcohol drinkers. Within the moderate alcohol consumer, moderate drinkers who reported higher amounts had an increased risk of colon cancer (Conclusion with low certainty). Additionally, they could find no increased risk of head and neck cancers for moderate alcohol drinkers. The authors chose not to evaluate liver cancers at this time. Finally, when they looked at all-cause mortality, the moderate drinkers had a 16% decreased risk of death when compared to non-drinkers (Conclusion of moderate certainty).

Moderate alcohol drinkers may be at a slight increased risk of developing breast cancer and colon cancer. But they live longer. Conclusions made with only moderate certainty.

The NASEM report is very different from the WHO reports, because they cited their methodology and the studies they used. These reports of the NASEM committee are updated every 5 years from data obtained since the last review. Essentially, this report will spur researchers to redefine and focus their next studies to better understand this question.

What I feel confident in saying is that everyone needs to stay up to date with their cancer screenings and vaccinations.

When it comes to alcohol drinking, I will give you the advice that I gave to all my patients,

“All things in moderation, my friend. All things in moderation.”

None of us are getting out of here live.

We cannot choose how we die,

but we can choose how we live.

1. Keller AZ, Terris M. The association of alcohol and tobacco with cancer of the mouth and pharynx. Am J Public Health Nations Health. 1965 Oct;55(10):1578-85. doi: 10.2105/ajph.55.10.1578. PMID: 5890556; PMCID: PMC1256548.

2. Vidal L, Gillison ML. Human papillomavirus in HNSCC: recognition of a distinct disease type. Hematol Oncol Clin North Am. 2008;22(6):1125–42.

3. https://www.mdanderson.org/cancerwise/hepatitis-c-and-cancer--what-to-know.h00-159779601.html

4. https://iris.who.int/server/api/core/bitstreams/1333236f-e51b-40aa-8d08-7975cc1201fb/content

5. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Review of Evidence on Alcohol and Health; Stone KB, Calonge BN, editors. Review of Evidence on Alcohol and Health. Washington (DC): National Academies Press (US); 2025 Apr 23. 5, Cancer. Available from: https://www.ncbi.nlm.nih.gov/books/NBK614681/

6. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Review of Evidence on Alcohol and Health; Stone KB, Calonge BN, editors. Review of Evidence on Alcohol and Health. Washington (DC): National Academies Press (US); 2025 Apr 23. 3, All-Cause Mortality. Available from: https://www.ncbi.nlm.nih.gov/books/NBK614689/

Before we discuss the events from forty years ago, we need to understand toxic alcohols. There are four types of alcohol that are commonly encountered. Ethanol is the most common naturally occurring form and is a product of the fermentation of simple sugars. Methanol is also a naturally occurring alcohol and is a product of the fermentation of cellulose found in wood. Both can be found in wine, but the limited pectin in grapes keeps the formation of methanol to a minimum. Isopropyl and diethylene glycol are not naturally occurring compounds. All of these forms of alcohols can cause differing levels of intoxication, but methanol and diethylene glycol ingestion can be lethal even in small quantities. Ethylene glycol is lethal in smaller quantities than methanol. The toxicity of methanol and diethylene glycol develops as the chemicals are digested by the enzyme, alcohol dehydrogenase. All alcohols are broken down by this enzyme. Alcohol dehydrogenase has a limited ability to breakdown alcohols over time which explains the increasing inebriation with increasing ethanol consumption. The toxic metabolite of methanol is formic acid and sublethal doses of methanol can cause permanent blindness. The treatment for toxic alcohol ingestion is intravenous ethanol to inhibit the breakdown of the toxic alcohol and removal of the toxic alcohol through hemodialysis. Before the nature of the methanol poisoning could be determined and all the tainted wines removed, an estimate of 22 people in Italy died and countless others where permanently blinded. In 1987, La Republica reported that there were victims of methanol tainted Italian wine outside of Italy but failed to identify the country of the victim.

By March 1986, the Italian authorities became convinced that there was menthol poisoning related to adulterated wine. The unknown alcohol identified in the blood of victims was determined to be methanol. They immediately informed neighboring European nations that there was a possibility that they may have been sent the tainted wines.  In the French ports of Sete and Marseille, 4.4 million gallons of methanol tainted bulk wine from Italy was discovered and destroyed. In Karlsruhe, Germany 1,600 tainted bottles were identified and destroyed. The wines were tainted with methanol to increase the alcohol content up to 12% therefore increased its value. It was estimated that 2.5 metric tons of methanol was used to taint the wine. Such a large amount of methanol could only have been secured after Italy deregulated the production and sales of methanol the year before. Italy began a testing program on all wine slated for export to ensure the purity of the product once the menthol tainting was recognized. The testing program ensured that no additional wines left Italy tainted with methanol. Germany was not confident with the Italian testing program, so they also tested for methanol but did not identify any additional tainted wine.

The first wine identified as tainted was Odore Barbera which was found to be 5.7% methanol. Other wines were subsequently identified and initially 31 wine merchants and 65 producers were investigated. All the wines had one thing in common, the father and son team of Giovanni and Daniele Ceravegna, who had bottled the tainted wine. This was not the first time the father and son team had come under suspicion. Their company had been investigated the year before in 1984 due an improper adulteration of wine with methanol which resulted in seizure of wine, but no criminal charges were brought. When the case of the 1985-86 poisoning was brought to trial in 1992, 19 defendants were present. The defendants included the distributors and the Cerevegna father son team who bottled all the wines. The primary responsibility for the poisoning was placed on Giovanni and Daniele and they were sentenced to prison for 14 and 4 years, respectively.

The methanol wine poisoning in Italy came on the heels of the diethylene glycol poisoning in Austria the year before. In 1984, it was recognized that small amounts diethylene glycol had been added to sweeten late harvest wine.  Even though diethylene glycol is toxic in smaller amounts than for methanol, the Austrian poisoning resulted in no reported deaths possibly because the sweet Austrian late harvest wines are consumed in small amount. Unfortunately, the effect on the Austrian wine industry was devastating. In spite of banning the export of sweet late harvest wine, Austrian wine sales fell 90% in the first year and struggled to return over the next 15 years. The Austrian ban on exporting sweet late harvest continues 40 years later.

In 1985, the Italian wine industry was the largest in the world and provided a significant portion of the Italian economy. A similar drop in wine exports would have devastated the Italian economy. This crisis was acutely felt in the Chianti producing region of Tuscany even though none of these wines were implicated. The growers of Sangiovese knew that the wine they produced were world-class and they wanted that consideration. Unfortunately, lax standards in the wine region resulted in inconsistent quality which limited its respect on the world wine market.

Well before the scandal, success in the Chianti region was based on quantity of wine produced and not the quality. A grower was profitable by how much wine they sold and not on the quality of their product. Prior to the methanol poisoning, wine makers of Tuscany had started a quest to improve the reputation of Chianti and raise its international reputation to a wine worth collecting and aging. The efforts to elevate Chianti were muti-pronged and included increased regulations and improved quality of Sangiovese grapes.  In the 1960’s the round basketed fiasco bottle was increasingly being replaced by the broad-shouldered Bordeaux bottle. Fearing a loss of cultural pride, in 1964 the fiasco bottle was limited to wines legally approved in Denominazione di Origine Controllata (D.O.C.) Chianti regions. The chianti region of Tuscany was granted D.O.C. status in 1967 which codified the allowable concertation of the primary Sangiovese and the allowable mixing grapes. In 1984, the year before the methanol poisoning, the Chianti region obtained D.O.C.G. (Denominazione di Origine Controllata e Garantita) status. This increased the limitations placed on Chianti wine produced from the region. The percentage of Sangiovese required in each bottle was increased and limited even further the number of mixing grapes. The new designation allowed for the addition of the recently introduced Bourdeaux grapes, Cabernet Sauvignon and Merlot to be used as mixing grapes.

Along with increased regulations within the region, a group of Sangiovese farmers began attempts to improve the grape through clonal identification and propagation throughout the 1970’s. The most successful study of Sangiovese began in 1982 when the bothers John and Harry Mariani of Castello Banfi partnered with the University of Milan to further focus the Sangiovese clones from the 650 previously identified clones. By 1996, the work had been successful in identifying the 6 clones Sangiovese best suited for Tuscany.

On the 40^th anniversary of the methanol wine scandal, Italy continues to be among the top two wine producing countries in the world. The quality of Italian wine is also among the best in the world. When asked to comment on the Chianti advancement since the methanol scandal Piero Antinori said, “In the last 40 years, Chianti Classico area has gone through a radical transformation. Vineyards planted at the end of the 60s’ have been gradually replanted with others, oriented more towards quality. The number of vines per hectare has increased considerably, the production of each vine has decreased. Progress has been made in both the vinification and the wine aging process which have improved the quality.
Even the regulations of the Chianti Classico production with the introduction of the additional specifications such as Gran Selezione, UGA (“Additional Geographical Units”, that is sub-areas) has improved the quality and style.”

The Chianti region was not alone in their focus on improving their processes, and the quality of Italian wines has improved across all regions in Italy.  The Italian wine producers took this crisis seriously and challenged themselves to make wine that made themselves proud.

The first evening was a welcome dinner at a local restaurant. It felt strange to be in civilian to clothes, in a restaurant in Iraq without a heavily armed unit in escort. When i got there i was shocked to see General Odierno also present in civilian clothes. He did not have his normal escort either. Seeing a 4-star is always a surprise even as an O-6. We ate at a big table. I sat next to one of the bosses aids, a hilarious Navy Captain. We were all good and did not take any of the offered wines. Odierno’s General Order #1 explicitly forbid the consumption of any alcohol in Iraq.

After dinner back at the hotel where we were all staying, we went to the bar to chat; still no booze. General O, as he was known, was on the other side of the room with his small staff. The Navy Captain left their table and walked over to the table that i shared with another Army Doctor who had decided to join the team. He sat down and said,

“Gentleman, the drinking lamp is lit.”

We looked at him in surprise, “But General O is sitting right over there?”

“I just ordered a bottle of wine for his table.” He said with great pride.

Our bottle arrived after the General’s bottle and we enjoyed it. We broke General Order #1 with the author. I wish i had registered the wine to look for it again but that was before i got serious about wine.

My guiding philosophy is that wine is central to the creation and maintenance of society. I do not say this to encourage everyone to drink alcohol. I wish to illustrate the place of wine and other fermentation beverages in the modern world, even if you choose not to consume it.

As a human physiologist i will attempt to explain how the human body responds to the consumption alcohols. I am going to present the topic honestly and not minimize the damage that alcohol can cause.

My goal is to be a content creator not an influencer on this site. Any research i present will be cited so viewers can do a deeper dive if they are interested. My opinions will be my own based on 5 decades of studying the human body and developing a philosophy. You cannot spend your days treating the actively dying without protecting yourself with a philosophy of life.

Finally, I will not ask you to pledge money to me on this site. What i say is important, so i will share equally. Please repost this article and encourage your friends to follow this page.

Here is my first presentation

Alcohol dehydrogenase is not a single enzyme but a group of enzymes in 5 different classes(1). Class 1 is the most important and is found in the liver. Class 4 is found in gastric secretions and actively metabolizes alcohol before it is absorbed(2).

1. Haseba, 2009: PMID:19489444

2. Parés, 1994: PMID: 8127901

To understand which taste is our favorite, answer these three questions:

1. What is our favorite candy?

   Chocolate A bitter flavor best balanced with sugar, salt and citrus

2. What drink do we start our day with?

   Coffee or Tea Both are very bitter

3. What do herbs bring to a dish?

   Herbs bring bitter flavors. Not all people can tolerate cilantro in a dish.

Bitterness balances out the other three flavors but it also distinguishes ripeness. As food spoils the chemicals in the food are broken down into urea and other bitter tasting compounds. The slight bitterness tells you to enjoy now because it will not last.

When bitterness is excessive in a food it is also a warning to not eat it. I like my coffee black, so i guess I’m living on the edge.

As wine lovers, we break a wine down into its scents and flavors. We look for the bitterness along with sweetness and acidity in a wine to lead us to a conclusion of style and quality. We can apply these practices to cooking to build a balanced dish. We measure the flavors in a dish, we eat to gain additional insight

Let’s begin with a discussion on how the taste perception of acidity or ‘sourness’ is occurring. The sour taste is appreciated on the sides of the tongue as well as under the tongue and the sides of the mouth. The area under the tongue is home to the sublingual and submandibular glands. These are two of the glands that keep your mouth moist. They are also responsible for neutralizing acids that we eat and drink. They produce a liquid that is very high in bicarbonate that neutralizes the acids. This fluid can have 3-times the concentration of bicarbonate when compared to the amount found in blood. These glands do not have reservoirs of fluid and can produce a fairly large volumes very quickly. The ‘pucker’ associated with sour or acidic foods is from the salivary glands becoming very metabolically active. Since an acid is an acid there should be similar responses to malic and lactic acids. The difference could be due to another mechanism.

Lactic acid normally forms in the body unlike malic acid. The more active a cell in the body is, the more lactic acid it produces. This byproduct is converted to pyruvate by an enzyme called lactate dehydrogenase (LDH). You may have seen this on the results of a blood sample. LDH is an enzyme that requires no energy to process the lactic acid into pyruvate and is not chemically altered either. So after converting one molecule of lactic acid it is ready to convert the next one.

Saliva in the mouth has 3-times the concentration of LDH than is found in the blood. The LDH is ready to neutralize the lactic acid in wine through enzyme conversion, while malic acid relies mostly on the bicarbonate from the salivary glands for neutralization. The more active the salivary glands are, the greater the ‘pucker’ sensation. The nearly immediate enzymatic breakdown of the lactic acid in the wine when it encounters the saliva in the mouth may decreases the workload of the salivary glands and the ‘pucker’ is softened.

In science a solution is first proposed and released for ‘peer review’. This is my proposal and I submit it for your consideration. Please comment I would like your feedback.

Respectfully submitted.