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Is Alcohol Consumption Linked To Cancer

Many Australians and New Zealanders are 'drinkers' and alcohol remains an integral part of many of their social activities and cultural events. While alcohol consumption remains one of the most challenging lifestyle factors to study, alcohol use has been associated with an increased risk for several types of cancer.

Did you know?


The National Drug Strategy Household Survey (NDSHS) 2016 found that slightly more than 3 in 4 (77%) Australians consumed alcohol in the previous 12 months.1,2


1 in 6 Australian adults had, on average, consumed more than 2 standard drinks per day in 2017/18, exceeding the lifetime alcohol risk guidelines.3 1 in 5 New Zealanders engaged in hazardous drinking in 2018/19.3


The International Agency for Research on Cancer (IARC) has given alcohol their highest classification, that of a Group 1 carcinogen, for cancers of the mouth, pharynx, larynx, oesophagus, bowel, liver, stomach and breast (in women). 4


Alcohol was estimated to be responsible for 4.5% of Australia's cancer disease burden in 2015, with similar results in New Zealand.5,6


Liver cancer caused the greatest cancer burden from alcohol use, followed by breast, mouth and pharyngeal cancers. Burden from colorectal, laryngeal and oesophageal cancers was also attributed to long-term alcohol use.7


Multiple studies have shown that cancer survivors continue to drink alcohol after their diagnosis. In the British Childhood Cancer Survivor study, involving 10,000 respondents8:

  • Admitted to drinking alcohol – 77 percent
  • Drank above weekly recommendations – 24 percent
  • Drank potentially harmful amounts – 4 percent

 

The Facts:


Overall health risk of alcohol

  • Weighing up other health effects, even though alcohol use is widely promoted for its protective effects for ischaemic heart disease and diabetes, these effects are offset when overall health risks are considered - especially because of the strong association between alcohol consumption and the risk of cancer, injuries, and communicable diseases.38
  • According to a recent publication by the prestigious journal, The Lancet, "the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and “the level of consumption that minimises health loss is zero.".38  

 


 [GM1]This seems to need a separate heading


Alcohol use has been associated with increased risk for several types of cancer, with heavy use associated with the highest risk.9,10


There is strong evidence that alcohol is a cause of seven types of cancers: breast, larynx, mouth, oesophagus, pharynx, colon-rectum and liver.11,12

 


In a meta-analysis of 572 studies, the risk of cancer with heavy alcohol use was greatest for cancers like oral, pharyngeal, oesophageal and laryngeal cancers. The increased risk from several other cancer types, like breast and colorectal cancers, was not as high.13


There is a dose-risk relationship between alcohol and cancer. The more alcohol you drink, the higher the risk of cancer.13


Even among light and moderate drinkers, some studies have found a trend toward an increased cancer risk, regardless of smoking history.14 In particular, among women who have never smoked, even one alcoholic drink per day has been associated with an increased risk of alcohol-related cancer (mainly breast cancer).14


Drinking alcohol has been identified by the American Society of Clinical Oncology as a proven risk factor for several malignancies and as a risk factor for cancer that can be modified.15


Breast cancer

  • There is consistent evidence that women who drink both low (<1 drink per day) and high (3 or more drinks per day) levels of alcohol have a higher risk of breast cancer than women who don’t drink alcohol at all.13,16–19 This risk increases significantly as more alcohol is consumed, starting from as low as three to six drinks per week.
  • A history of “binge” drinking, especially among moderate alcohol drinkers, also may increase risk among women who have a sister with a history of breast cancer.20
  • A large study examining the relationship between alcohol and breast cancer found a 10 percent increase in risk with every 10 grams per day of alcohol consumed.17
  • The Life After Cancer Epidemiology (LACE) study of 1897 female breast cancer survivors found that those who drank at least 6 grams of alcohol per day (at least 3 to 4 alcoholic drinks per week) had significantly higher rates of relapse and death from breast cancer than those who drank less than 0.5 grams per day. Women who were overweight and postmenopausal experienced the greatest harm from alcohol intake as measured by breast cancer recurrence risk.21

Gastrointestinal cancer

  • Several types of gastrointestinal cancers are linked to alcohol consumption, even at low levels of intake.
  • In a study of 226,000 men, the combined mortality rate for cancers of the mouth, larynx, pharynx, oesophagus, and liver was 40 percent higher in less-than-daily drinkers than in non-drinkers and rose progressively with heavier consumption.22
  • In the large European Prospective Investigation into Cancer and Nutrition (EPIC) study23, the cancer risk attributed to alcohol was, for men and women, respectively:
    • Upper gastrointestinal cancer - 44 and 25 percent
    • Hepatocellular cancer - 33 and 18 percent
    • Colorectal cancer - 17 and 4 percent

Oesophageal

  • The risk of squamous cell oesophageal cancer (cancer that starts in the cells that line the oesophagus) is related to alcohol use.24

 


Colorectal

  • Most studies report an association between moderate or heavy alcohol use and colorectal cancer.13,25 There is a weak association for limited alcohol use.18,22,26

Pancreatic

  • High alcohol intake was associated with an increased risk of pancreatic cancer.27

Liver cancer

  • Liver cancer (hepatocellular carcinoma) has been linked to alcohol use, particularly for heavy drinking. Much of this association may be brought about by alcoholic cirrhosis, the major risk factor for liver cancer.
  • For liver cancer, alcohol consumption is the strongest lifestyle risk factor, contributing to 26 percent of all cases, while smoking contributes to 13 percent and obesity to 9 percent.28
  • A meta-analysis indicates that the risk of liver cancer actually decreases by 6 to 7 percent a year after giving up alcohol. It takes an estimated 23 years after giving up drinking for the risk of liver cancer to become the same as people who have never drunk alcohol.29
  • Alcohol, possibly even at low levels of consumption, also further increases the risk of liver cancer in carriers of hepatitis B or hepatitis C.30

Lung cancer

  • There is limited evidence that alcohol intake alone increases the risk of lung cancer.31

Head and neck cancer

  • Alcohol consumption is a risk factor for head and neck cancer. Patients who smoke and drink are at greater risk than would be expected from either factor alone.32

Alcohol and tobacco

  • The individual effects of smoking and alcohol on the risk of upper gastrointestinal and aero-digestive cancers are much higher when used together.33 In fact, over 75 percent of cancers of the upper aero-digestive tract are estimated to be due to this fact.33
  • Compared to people who do not drink or smoke, the relative risks for developing mouth and throat cancers increase with intake. Relative risks are up to seven times greater for heavy users of  tobacco (at least 2 packs of cigarettes per day), up to six times greater for heavy drinkers (at least 4 alcoholic drinks per day), and 35 times greater for regular heavy users of both tobacco and alcohol.34
  • Accumulated data also suggests that alcohol intake (especially moderate to heavy use) increases cancer-related mortality in cancer survivors. A 2013 meta-analysis of 18 studies concluded that mortality from all cancers was highest in participants who regularly consumed 50 or more grams of alcohol (5 standard drinks).35
  • An Italian study showed that overall mortality from cancer and other diseases was five times higher for alcoholics than for those who did not drink alcohol.36

Non-melanoma skin cancers

  • Alcohol may also be associated with non-melanoma skin cancers.37

What can we do about it?


If you want to avoid cancer:

  • Avoid drinking alcohol
  • Choose non-alcoholic beverages

If you are a cancer survivor:

  • Avoid drinking alcohol to reduce your risk of recurrence

If you do drink alcohol and want to continue drinking:

  • The less alcohol you drink, the lower your risk of alcohol-related disease and injury.39
  • Cancer Council Australia recommends minimising alcohol to 2 standard drinks per day based on current NHMRC guidelines.40 New NHMRC draft guidelines have added a recommendation regarding binge drinking, recommending “no more than ten standard drinks per week and no more than 4 standard drinks on any one day.”39
  • Cancer Society NZ recommends minimizing alcohol intake to no more than 2 standard drinks per day for women or 3 standard drinks for men, in addition to 2 alcohol-free days per week.41  

 


Seek professional counselling and support to help you reduce and preferably avoid alcohol consumption

Summary:

Alcohol is a confirmed carcinogen that causes several types of cancer and should be completely avoided by those who want to reduce their risk of disease.

 

REFERENCES

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2.         Ministry of Health New Zealand. Annual Data Explorer - New Zealand Health Survey - Nov 2019. Ministry of Health, New Zealand; 2019. https://minhealthnz.shinyapps.io/nz-health-survey-2018-19-annual-data-explorer/_w_9440147c/#!/home May 4, 2020

3.         Australian Institute of Health and Welfare. Cancer data in Australia. 2019. https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/acim-books

4.         International Agency for Research on Cancer. Consumption of alcoholic beverages. 2012  [cited May 4, 2020]. In: IARC monographs on the evaluation of carcinogenic risks to humans [Internet]. Lyon, France: International Agency for Research on Cancer, [cited May 4, 2020]; [472]. Available from: https://monographs.iarc.fr/wp-content/uploads/2018/06/mono100E-11.pdf

5.         Australian Institute of Health Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. 2015. https://www.aihw.gov.au/reports/burden-of-disease/burden-disease-study-illness-death-2015-summary/contents/table-of-contents May 4, 2020

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9.         Xi B, Veeranki SP, Zhao M, Ma C, Yan Y, Mi J. Relationship of Alcohol Consumption to All-Cause, Cardiovascular, and Cancer-Related Mortality in U.S. Adults. Journal of the American College of Cardiology. 2017;70(8):913-22. doi:10.1016/j.jacc.2017.06.054

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11.       World Cancer Research Fund. Continuous Update Project (CUP) Matrix. London, UK: World Cancer Research Fund; 2018. https://www.wcrf.org/int/continuous-update-project May 04, 2020

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14.       Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: Results from two prospective US cohort studies. BMJ (Online). 2015;351. doi:10.1136/bmj.h4238

15.       LoConte NK, Brewster AM, Kaur JS, Merrill JK, Alberg AJ. Alcohol and cancer: A statement of the American society of clinical oncology. Journal of Clinical Oncology. 2018;36(1):83-93. doi:10.1200/JCO.2017.76.1155

16.       Singletary KW, Gapstur SM. Alcohol and breast cancer: Review of epidemiologic and experimental evidence and potential mechanisms. American Medical Association; 2001. p. 2143-51.

17.       Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA - Journal of the American Medical Association. 2011;306(17):1884-90. doi:10.1001/jama.2011.1590

18.       Allen NE, Beral V, Casabonne D, Kan SW, Reeves GK, Brown A, et al. Moderate Alcohol Intake and Cancer Incidence in Women. JNCI: Journal of the National Cancer Institute. 2009;101(5):296-305. doi:10.1093/jnci/djn514

19.       Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, et al. Light alcohol drinking and cancer: A meta-analysis. Annals of Oncology. 2013;24(2):301-8. doi:10.1093/annonc/mds337

20.       White AJ, DeRoo LA, Weinberg CR, Sandler DP. Lifetime Alcohol Intake, Binge Drinking Behaviors, and Breast Cancer Risk. American Journal of Epidemiology. 2017;186(5):541-9. doi:10.1093/aje/kwx118

21.       Kwan ML, Kushi LH, Weltzien E, Tam EK, Castillo A, Sweeney C, et al. Alcohol consumption and breast cancer recurrence and survival among women with early-stage breast cancer: The life after cancer epidemiology study. Journal of Clinical Oncology. 2010;28(29):4410-6. doi:10.1200/JCO.2010.29.2730

22.       Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ, Heath CW, et al. Alcohol Consumption and Mortality among Middle-Aged and Elderly U.S. Adults. New England Journal of Medicine. 1997;337(24):1705-14. doi:10.1056/NEJM199712113372401

23.       Schütze M, Boeing H, Pischon T, Rehm J, Kehoe T, Gmel G, et al. Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ (Clinical research ed). 2011;342. doi:10.1136/bmj.d1584

24.       Pandeya N, Williams G, Green AC, Webb PM, Whiteman DC. Alcohol Consumption and the Risks of Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus. Gastroenterology. 2009;136(4):1215-24. doi:10.1053/j.gastro.2008.12.052

25.       Zhu JZ, Wang YM, Zhou QY, Zhu KF, Yu CH, Li YM. Systematic review with meta-analysis: alcohol consumption and the risk of colorectal adenoma. Alimentary Pharmacology & Therapeutics. 2014;40(4):325-37. doi:10.1111/apt.12841

26.       Shimizu N, Nagata C, Shimizu H, Kametani M, Takeyama N, Ohnuma T, et al. Height, weight, and alcohol consumption in relation to the risk of colorectal cancer in Japan: A prospective study. British Journal of Cancer. 2003;88(7):1038-43. doi:10.1038/sj.bjc.6600845

27.       Wang YT, Gou YW, Jin WW, Xiao M, Fang HY. Association between alcohol intake and the risk of pancreatic cancer: A dose-response meta-analysis of cohort studies. BMC Cancer. 2016;16(1):212-. doi:10.1186/s12885-016-2241-1

28.       Baecker A, Liu X, La Vecchia C, Zhang Z-F. Worldwide incidence of hepatocellular carcinoma cases attributable to major risk factors. European Journal of Cancer Prevention. 2018;27(3):205-12. doi:10.1097/cej.0000000000000428

29.       Heckley GA, Jarl J, Asamoah BO, G-Gerdtham U. How the risk of liver cancer changes after alcohol cessation: A review and meta-analysis of the current literature. BMC Cancer. 2011;11(1):446-. doi:10.1186/1471-2407-11-446

30.       Donato F, Tagger A, Chiesa R, Ribero ML, Tomasoni V, Fasola M, et al. Hepatitis B and C virus infection, alcohol drinking, and hepatocellular carcinoma: A case-control study in Italy. Hepatology. 1997;26(3):579-84. doi:10.1002/hep.510260308

31.       World Cancer Research Fund. Summary of Conclusions - Full evidence Matrix. World Cancer Research Fund; 2018. https://www.wcrf.org/sites/default/files/Matrix-for-all-cancers-A3.pdf May 04, 2020

32.       Choi SY, Kahyo H. Effect of cigarette smoking and alcohol consumption in the aetiology of cancer of the oral cavity, pharynx and larynx. International Journal of Epidemiology. 1991;20(4):878-85. doi:10.1093/ije/20.4.878

33.       Mao Q, Lin Y, Zheng X, Qin J, Yang K, Xie L. A meta-analysis of alcohol intake and risk of bladder cancer. Cancer Causes and Control. 2010;21(11):1843-50. doi:10.1007/s10552-010-9611-9

34.       Blot WJ, McLaughlin JK, Winn DM, Austin DF, Greenberg RS, Susan S, et al. Smoking and Drinking in Relation to Oral and Pharyngeal Cancer. Cancer Research. 1988;48(11):3282-7.

35.       Jin M, Cai S, Guo J, Zhu Y, Li M, Yu Y, et al. Alcohol drinking and all cancer mortality: A meta-analysis. Annals of Oncology. 2013;24(3):807-16. doi:10.1093/annonc/mds508

36.       Saieva C, Bardazzi G, Masala G, Quartini A, Ceroti M, Iozzi A, et al. General and Cancer Mortality in a Large Cohort of Italian Alcoholics. Alcoholism: Clinical and Experimental Research. 2012;36(2):342-50. doi:10.1111/j.1530-0277.2011.01626.x

37.       Yen H, Dhana A, Okhovat JP, Qureshi A, Keum N, Cho E. Alcohol intake and risk of nonmelanoma skin cancer: a systematic review and dose–response meta‐analysis. British Journal of Dermatology. 2017;177(3):696-707. doi:10.1111/bjd.15647

38.       Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SRM, Tymeson HD, et al. Alcohol use and burden for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2018;392(10152):1015-35. doi:10.1016/S0140-6736(18)31310-2

39.       National Health Medical Research Council. Draft Australian guidelines to reduce health risks from drinking alcohol. Canberra, Australia; 2019. https://www.nhmrc.gov.au/health-advice/alcohol#download May 04, 2020

40.       Cancer Council Australia. Alcohol and cancer - Cancer Council Australia 2018. Available from: https://www.cancer.org.au/policy-and-advocacy/position-statements/alcohol-and-cancer/ May 04, 2020

41.       Cancer Society N. Z. Position Statement on Alcohol and Cancer Risk. Auckland/Northland; 2014. https://auckland-northland.cancernz.org.nz/reducing-cancer-risk/what-you-can-do/alcohol-and-cancer/ May 04, 2020

 

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Dr. Luiz Fernando SellaMD, MPH
Author
Medical Doctor at the Federal University of Santa Catarina, Brazil, a Certified Lifestyle Medicine Physician and Health and Wellness Coach.