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HomeNewsAlcohol and Cancer Risk: Clinical and Research Implications

Alcohol and Cancer Risk: Clinical and Research Implications

2021-04-01

Ample evidence has been available for some time indicating that alcohol use is a preventable risk factor for cancer, and the World Health Organization deemed alcohol a carcinogen more than 30 years ago. In the United States, it is estimated that 5.6% of incident cancer cases (approximately 87 000 each year) are associated with alcohol, including cancers of the oral cavity, pharynx, larynx, liver, esophagus (squamous cell carcinoma), female breast, and colorectum.1 Type of alcohol does not appear to matter; all alcoholic beverages include ethanol, which increases levels of acetaldehyde and in turn promotes DNA damage. Moreover, even moderate levels of consumption (often defined as approximately 14-28 g/d, the equivalent of about 1-2 drinks) appear to be associated with higher risk of some cancers, including cancers of the female breast.2 A protective association has emerged for some cancers, with the most evidence for kidney, Hodgkin lymphoma, and non-Hodgkin lymphoma.2 Nonetheless, the overall cancer burden associated with alcohol use is substantial and comparable with that of other preventable risk factors such as UV exposure and excess body weight.

Ecological studies examining trends in alcohol consumption along with cancer incidence and mortality rates suggest that decreases in alcohol intake may reduce cancer risk. One analysis of data from 17 countries showed that changes in cancer mortality rates for alcohol-related cancers tended to parallel changes in per capita annual alcohol sales 7 to 9 years earlier (controlling for tobacco use).3 For example, alcohol consumption has steadily decreased in France since 1961, mirroring reductions in mortality rates for lip, oral cavity, and pharyngeal (LOCP) cancers starting in 1971; in Romania, however, both alcohol consumption and LOCP cancer mortality rates have increased during those time frames. In countries where alcohol consumption has been fairly stable (eg, Denmark, United States, United Kingdom), LOCP cancer mortality rates have been similarly stable.

Even stronger evidence is provided by case-control studies. For example, a meta-analysis of 9 case-control studies found that 5 years of alcohol cessation was associated with a reduction of 15% in risk of laryngeal and pharyngeal cancers.4 This body of evidence, along with the consistent epidemiologic evidence suggesting a causal association between alcohol consumption and many cancers, substantiates the potential value of reducing consumption as a method of cancer control. Correspondingly, the American Society of Clinical Oncology published an important statement on the need for the cancer community to promote public education on this issue, support policy efforts to reduce alcohol use, educate clinicians about the state of the evidence, and identify research gaps.5

HomeNewsAlcohol and Cancer Risk: Clinical and Research Implications

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