Clear Definitions Exist

Rauschert et al. in their article (1) report on problematic versus non-problematic consumption of alcohol and tobacco.

Addiction medicine has clear definitions in this context. In somatic medicine, however, the borderline between problematic and non-problematic alcohol consumption is not supported by a generally accepted definition. Often, a dose–response relation exists between the volume consumed and the probability of disease (2).

In addition to genetic predisposition, risk factors such as overweight, diabetes, an unbalanced diet, and chronic infections can determine the timing and extent of the somatic pathologies caused by alcohol or tobacco (2, 3). As regards the alcohol related risk of breast cancer, no threshold exists—even very small amounts of alcohol can increase the risk of breast cancer in women.

Synergies between several risk factors can also result in even tiny amounts of alcohol increasing the disease risk. In patients with diabetes, even modest alcohol consumption increases the risk for cancers of the bile duct (4).

The risks of smoking tobacco are not adequately defined in somatic medicine by means of existing or lacking tobacco dependence.

In Germany, some 11% of adults are exposed to passive tobacco smoke. 40% of children up to age 17 have a parent who smokes, and in 14% of adolescents, both parents smoke.

Passive smoking in childhood is associated with an increased risk of cancer (of the pancreas and the lung) in adulthood.

In somatic medicine, a clear demarcation between problematic and non-problematic consumption of alcohol or tobacco is therefore difficult.

Regardless of the terminology, however, preventive tumor medicine and addiction medicine are in pursuit of the same objective: to restrict exposure to alcohol and tobacco, especially in children, adolescents, and young adults.

Persons with tobacco and/or alcohol dependence have a significantly increased risk for cancers and should therefore participate regularly in screening.