To address these unknowns, researchers from Oxford Population Health, Peking University and the Chinese Academy of Medical Sciences, Beijing, used a genetic approach by investigating gene variants linked to lower alcohol consumption in Asian populations. Nearly 4% of cancers diagnosed worldwide in 2020 can be attributed to alcohol consumption, according to the World Health Organization. In the United States alone, about 75,000 cancer cases and 19,000 cancer deaths are estimated to be linked to alcohol each year. Interpersonal influences, including interactions with family and friends, also shape knowledge and behaviors (42, 43).
- It was also unclear whether alcohol is linked to other types of cancer, including lung and stomach cancers.
- Greater collaboration with other specialties and clinicians who regularly interact with people with cancer, such as oncology nurses, to develop ways to reduce risky drinking behaviors will be needed moving forward, Dr. Agurs-Collins said.
- When the researchers analyzed moderate drinking further, they found that 41,300 of those cases could be attributed to light drinking, or consumption of 10 grams or less per day.
- Following epidemiological evidence of the link between alcohol use and risk of cancer at multiple sites, several pathways have been investigated to explain the carcinogenic effects of alcohol.
- Overall, about 12,000 people in this group reported that they drink alcohol, and nearly 40% reported engaging in hazardous drinking—that is, repeated excessive alcohol use.
- Some studies show that drinking three or more alcoholic drinks per day increases the risk of stomach and pancreatic cancers.
Hazard ratios (HRs) were adjusted for age, sex, socioeconomic position (income level and place of residence), smoking status, physical activity, comorbidities (hypertension, diabetes, dyslipidemia, chronic kidney disease, chronic obstructive pulmonary disease), and Charlson Comorbidity Index. In addition to its involvement in downstream ROS-producing pathways, it is hypothesised that IL-8 contributes to further accumulation of white blood cells (neutrophils, specifically) in the liver leading to acute inflammation. Elevated IL-8 levels have been found in patients with acute liver injury such as alcoholic hepatitis [34]. Additionally, the cytokine IL-6 stimulates production of the anti-apoptotic protein Mcl-1, thus avoiding cell death and exposing the cell to further DNA damage [35]. As it is highly reactive towards DNA, acetaldehyde may bind to DNA to form DNA adducts which alter its physical shape and potentially block DNA synthesis and repair [21]. These DNA adducts are particularly genotoxic as they can induce DNA point mutations, double-strand breaks, sister chromatid exchanges, and structural changes to chromosomes [21,22].
More than just light drinking
“It’s pretty clear there are no health benefits [from heavy drinking], and there’s lots of risk to health overall,” she said. Similarly, for esophageal cancer, the researchers zeroed in on a type called squamous cell carcinoma, which is the only type known to be triggered by alcohol consumption. “This may make the estimates of alcohol-related cancers lower than previous studies, but they’re more precise,” said Dr. Abnet. Evidence from Western countries already strongly indicates that alcohol is a direct cause of cancer in the head, neck, oesophagus, liver, colon and breast.
The IARC Monographs program aims to classify cancerous agents according to the strength of the available epidemiological and experimental evidence. The study also found that people who believed drinking alcohol increased the risk of heart disease were more aware of the alcohol–cancer risk than those who were unsure or believed drinking lowered the effect on heart risk. The December 2020 NCI Workshop highlighted existing evidence on the alcohol-cancer link, and revealed opportunities to strengthen relevant scientific knowledge. Additionally, the workshop panel recognized that the health, including cancer, impact of increases in alcohol consumption resulting from the coronavirus pandemic (60) will need to be carefully assessed, particularly if these behaviors are sustained long-term. Alcohol regulations are designed to ensure an orderly marketplace, and to minimize or reduce the health, social, and economic harms due to consumption. The U.S. Community Preventive Services Task Force’s (CPSTF) Guide to Community Preventive Services (54), and WHO’s 2010 Global Strategy to Reduce the Harmful Use of Alcohol(8) describe a range of evidence-based alcohol control policies.
New genetic study confirms that alcohol is a direct cause of cancer
Drinking alcohol even at lower levels of intake can increase the risk of cancer and we previously estimated that over 100,000 cases of cancer in 2020 were caused by light and moderate drinking of the equivalent of around one or two alcoholic drinks per day [1]. Despite this, there is low public awareness of the causal link between alcohol and cancer and alcohol use is growing in several regions of the world [2,3]. Cancers of the upper aerodigestive tract can also be characterised as having a more than multiplicative increased risk when alcohol and tobacco are consumed together. For oesophageal squamous cell carcinoma, a cohort study in the Netherlands observed an eight times risk among current smokers who drank 15 g alcohol or more per day, compared with never smokers who consumed less than 5 g alcohol per day [12].
“I think the perception often is, if you can fit it in a glass, it’s one drink,” Dr. LoConte said. But studies have shown that people pouring their own wine or spirits at home tend to underestimate the amount they’re actually consuming. “A lot of our surveys just estimate the total number of drinks per week and haven’t differentiated between the person who has one drink a day each week and someone who has 7 drinks just one day a week,” he said. The estimates of cancer cases attributed to alcohol may have been higher if past consumption had been accounted for, Dr. Abnet said. The breakdown of alcohol can also produce reactive oxygen species, also known as free radicals.
Because overt behaviors appear to be more susceptible to normative influence than clandestine behaviors (44), alcohol consumption behaviors in groups might be especially subject to social sanction. Increased awareness of the alcohol-cancer link might encourage some people to warn family and friends about consumption, although the efficacy of such communication on behavior is unclear. Greater collaboration with other specialties and clinicians who regularly interact with people with cancer, such as oncology nurses, to develop ways to reduce risky drinking behaviors will be needed moving forward, Dr. Agurs-Collins said. And although people who identified as Hispanic were less likely than White participants to report drinking alcohol, those who did drink were more likely to drink heavily. Overall, about 12,000 people in this group reported that they drink alcohol, and nearly 40% reported engaging in hazardous drinking—that is, repeated excessive alcohol use. Of those who may have been actively undergoing treatment for cancer, about 75% drank alcohol, many heavily.
The accumulation of acetaldehyde has such unpleasant effects (including facial flushing and heart palpitations) that most people who have inherited the ALDH2 variant are unable to consume large amounts of alcohol and therefore have a low risk of developing alcohol-related cancers. The future potential of MR studies is yet to be discovered but disclosing potential sources of biases and confounding in observational studies is necessary to obtain robust estimates of the causal relationship between alcohol consumption and cancer risk. The study had several limitations, including that it only looked at current alcohol consumption, not past drinking habits, said Dr. Abnet. Surveys worldwide often have not collected information about past alcohol use, “but for a lot of people, there’s a pattern where they drink more heavily when they’re young and moderately as they get older,” he explained.
For example, inflammation can result in oxidative stress, but inflammation is a reaction by the immune system which is itself compromised by alcohol use. Furthermore, DNA damage can occur through exposure to acetaldehyde and ROS which are both produced through CYP2E1 activity, with acetaldehyde also a product of ADH activity. Other potential pathways have been proposed including the dysregulation of carnitine metabolism [49]. We can you smoke moon rock straight have only covered carcinogenesis in this review, but alcohol likely alters, through these pathways and others, other functions in the body which render it more susceptible to other diseases and injuries, as discussed in other articles in this Special Issue. Alcohol can also have more subtle cancer-promoting effects, including impairing the body’s ability to metabolize and absorb a variety of nutrients it needs to prevent cancer.
Alcohol and cancer: Identifying evidence gaps and research challenges across the cancer continuum
The association between alcohol drinking and risk of other cancer types has been studied but without sufficient evidence to be classified in the IARC monographs or WCRF Continuous Update Project. Positive associations have been reported in some meta-analyses; for example, a 3% increase in lung cancer risk was observed per 10 g alcohol per day in the WCRF meta-analysis based on 28 studies (RR 1.03 (95% CI 1.01–1.04)) after excluding studies which did not control for smoking [7]. A positive association with lung cancer was only found for heavy drinkers in Bagnardi and colleagues’ meta-analysis, but this was probably due to residual confounding from smoking because alcohol use did not increase the risk of lung cancer among non-smokers [8].
But the potential threat it poses to people with cancer and longer-term survivors has largely been overlooked, explained Tanya Agurs-Collins, Ph.D., of the Behavioral Research Program in NCI’s Division of Cancer Control and Population Sciences. For example, one way the body metabolizes alcohol is through the activity of an enzyme called alcohol dehydrogenase, or ADH, which converts ethanol into the carcinogenic metabolite acetaldehyde, mainly in the https://sober-house.net/ liver. Recent evidence suggests that acetaldehyde production also occurs in the oral cavity and may be influenced by factors such as the oral microbiome (28, 29). There is a strong scientific consensus that alcohol drinking can cause several types of cancer (1, 2). In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.
The NCI Alcohol and Cancer Risk Fact Sheet provides a broad overview of alcohol as a risk factor for cancer, and three recent papers explore Division interest in alcohol awareness (7,8) and research needs related to alcohol and cancer prevention and control (9). According to the federal government’s Dietary Guidelines for Americans, 2020–2025, individuals who do not drink alcohol should not start drinking for any reason. The Dietary Guidelines also recommends that people who drink alcohol do so in moderation by limiting consumption to 2 drinks or less in a day for men and 1 drink or less in a day for women. Heavy alcohol drinking is defined as having 4 or more drinks on any day or 8 or more drinks per week for women and 5 or more drinks on any day or 15 or more drinks per week for men. We conducted a cohort study to investigate the association between the reduction, cessation, or increase of alcohol consumption and the development of alcohol-related cancers and all cancers.
Interestingly, there is evidence that higher folate intake among alcohol drinkers may attenuate the increased risk of liver cancer mortality compared with those with low folate intake [36]. This attenuation was also observed for risk of postmenopausal breast cancer among women who drink alcohol and have higher folate levels [37]. The effect of alcohol on one-carbon metabolism and folate might also be important in colorectal cancer development [20].