Stephen W. Rex, MD

A More Honest Look at Alcohol and Cancer Risk

(A Bayesian Rebuttal to “The Hidden Risk in Your Glass” by Dr. Wendy Walker)

The article by Dr. Wendy Walker correctly points out that alcohol can contribute to several forms of cancer. Where it falls short, however, is in how it presents the numbers. The statistics cited are conditional risks — percentages that describe how much more likely a cancer is among drinkers than nondrinkers — but they don’t account for the base probability of developing each cancer in the first place. That omission exaggerates the apparent danger and leads readers to misjudge the magnitude of the real risk.

A more rigorous way to look at this issue is through Bayesian analysis, which multiplies the prior probability (the baseline lifetime risk) by the likelihood ratio (the relative risk increase). Doing so preserves the real-world context.

1. Why Relative Risk Misleads

Saying a certain behavior “raises cancer risk by 46%” sounds alarming — until you realize it’s 46% of a small number. If a woman’s baseline lifetime risk of breast cancer is about 13%, a 46% increase doesn’t mean nearly half of drinkers will develop cancer. It raises her lifetime risk from 13% to about 19% — a 6-point increase, not 46.

That is not trivial, but it’s far less dramatic than the headline suggests. The same holds true for most other alcohol-related cancers.

2. The Bayesian Perspective

Using the same relative risks cited in the article, but applying them to U.S. baseline lifetime probabilities, the results look like this:

Cancer Type Baseline Risk Relative Risk (from article) Bayesian-Adjusted Lifetime Risk Absolute Increase
Breast (F) 13% ×1.32 (3–4 drinks/day) ≈ 17% +4 pts
×1.46 (>4/day) ≈ 19% +6 pts
Colorectal (M+F) 4.1% ×1.63 (AUD) ≈ 6.7% +2.6 pts
×2.67 (11 yrs AUD) ≈ 10.9% +6.8 pts
×0.92 (≤2 drinks/day) ≈ 3.8% –0.3 pts
Esophageal 0.5% ×1.3 (1–2 drinks/day) ≈ 0.65% +0.15 pts
×5.0 (>4/day) ≈ 2.5% +2 pts
Laryngeal 0.3% ×2 (moderate drinker) ≈ 0.6% +0.3 pts
×5 (heavy + smoke) ≈ 1.5% +1.2 pts
Liver 1.1% ×2 (heavy) ≈ 2.2% +1.1 pts
Mouth/Throat 0.7% ×30 (heavy + smoke) ≈ 21% +20 pts (synergy dominates)

Notice how most absolute increases are just a few percentage points.
The truly dangerous outlier is alcohol + smoking, which creates a synergistic jump — not a simple multiple.

3. Context Matters

Cancer risk from alcohol is real but must be seen in proportion.
Moderate drinking (one drink per day) slightly affects risk, while heavy and chronic consumption, especially with tobacco use or poor nutrition, produces substantial harm.

For most people:

A glass of wine at dinner adds fractions of a percent to lifetime risk.

A bottle of whiskey every week adds several percent.

Smoking while drinking multiplies the danger dramatically.

Without these distinctions, risk reporting becomes more fear-based than fact-based.

4. Why Bayesian Framing Is More Honest

It preserves priors — baseline probabilities grounded in population data.

It shows scale — the real difference between “relative” and “absolute” risk.

It respects causality — distinguishing correlation from confounding lifestyle factors (diet, obesity, smoking, genetics).

It avoids moralizing — empowering people with informed, quantitative understanding.

5. A Responsible Conclusion

There is no question that excessive alcohol harms the body, and moderation — or abstinence — is always a healthy choice. But scientific honesty requires that we distinguish between doubling a 1% risk and doubling a 20% risk.

Presenting conditional percentages without context makes small risks look large and undermines public trust in health communication.
A Bayesian approach restores that trust by showing how much risk actually changes in absolute terms — usually, by just a few points.

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