The evidence that more than 3 drinks per week significantly increase a woman’s risk of breast cancer has become irrefutable. See our report on it here.
Considerable evidence is accumulating that links moderate drinking – especially when coupled with cigarette smoking – increases the risk of a variety of cancers for both men and women.
It is essential that physicians counsel patients that even moderate drinking can significantly increase the risk of cancer. For a woman with a familial risk of breast cancer or a man with familial risk of colorectal cancer, such counseling could save lives.
The Link Between Drinking and Cancer
According to the website of the National Cancer Institute, extensive reviews of research studies reveal a strong association between alcohol consumption and several types of cancer.1,2 In its Report on Carcinogens, the National Toxicology Program of the U.S. Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.
The research evidence indicates that the more alcohol a person drinks—particularly the more alcohol a person drinks regularly over time—the higher his or her risk of developing an alcohol-associated cancer. Based on data from 2009, an estimated 3.5% of all cancer deaths in the United States (about 19,500 deaths) were alcohol related.3
Clear patterns have emerged between alcohol consumption and the development of the following types of cancer:
- Head and neck cancer: Alcohol consumption is a major risk factor for certain head and neck cancers, particularly cancers of the oral cavity (excluding the lips), pharynx, and larynx.4 People who consume 50 or more grams of alcohol per day (approximately 3.5 or more drinks per day) have at least a 2-3 times greater risk of developing these cancers than do nondrinkers 4 Moreover, the risks of these cancers are substantially higher among persons who consume this amount of alcohol and also use tobacco.5 (See Figure 1.)
Figure 1. Histopathology of oral squamous cell carcinoma.
- Esophageal cancer: Alcohol consumption is a major risk factor for esophageal squamous cell carcinoma.2 In addition, people who inherit a deficiency in an enzyme that metabolizes alcohol have been found to have substantially increased risks of alcohol-related esophageal squamous cell carcinoma.
- Liver cancer: Alcohol consumption is an independent risk factor for, and a primary cause of hepatocellular carcinoma.6 (Chronic infection with the hepatitis B virus and the hepatitis C virus are the other major causes of liver cancer.) (See Figure 2.)
- Colorectal cancer: Alcohol consumption is associated with a modestly increased risk of cancers of the colon and rectum. A meta-analysis of 57 cohort and case-control studies examined the association between alcohol consumption and colorectal cancer risk. The results showed that people who regularly drank 50 or more grams of alcohol per day (approximately 3.5 drinks) had 1.5 times the risk of developing colorectal cancer as nondrinkers or occasional drinkers.9 For every 10 grams of alcohol consumed per day, there was a 7% increase in the risk of colorectal cancer.
Figure 2. Alcoholic hepatitis.
Alcohol Consumption May Reduce or Not Influence Risk of Other Cancers
Numerous studies have examined the association between alcohol consumption and the risk of other cancers, including cancers of the pancreas, ovary, prostate, stomach, uterus, and bladder. For these cancers, either no association with alcohol use has been found or the evidence for an association is inconsistent.
However, for 2 cancer typess—renal cell cancer and non-Hodgkin lymphoma (NHL)—multiple studies have shown that increased alcohol consumption is associated with a decreased risk of these cancers.10,11 A meta-analysis of the NHL studies (which included 18,759 people with NHL) found a 15% lower risk of NHL among alcohol drinkers compared with nondrinkers.11. The mechanisms by which alcohol consumption would decrease the risks of either renal cell cancer or NHL are not understood.
While only a few studies have been done on drinking alcohol and the risk of recurrence, a 2009 study found that drinking even a few alcoholic beverages per week (3 to 4 drinks) increased the risk of breast cancer recurring in women who had been diagnosed with early-stage disease.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Alcohol consumption and ethyl carbamate. IARC Monographs on the Evaluation of Carcinogenic Risks in Humans 2010;96:3-1383.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens. IARC Monographs on the Evaluation of Carcinogenic Risks in Humans 2012;100(Pt E):373-472.
- Nelson DE, Jarman DW, Rehm J, et al. Alcohol-attributable cancer deaths and years of potential life lost in the United States. American Journal of Public Health 2013;103(4):641-648.
- Baan R, Straif K, Grosse Y, et al. Carcinogenicity of alcoholic beverages. Lancet Oncology 2007;8(4):292-293.
- Hashibe M, Brennan P, Chuang SC, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiology, Biomarkers & Prevention 2009;18(2):541-550.
- Grewal P, Viswanathen VA. Liver cancer and alcohol. Clinics in Liver Disease 2012;16(4):839-850.
- Hamajima N, Hirose K, Tajima K, et al. Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. British Journal of Cancer 2002;87(11):1234-1245.
- Allen NE, Beral V, Casabonne D, et al. Moderate alcohol intake and cancer incidence in women. Journal of the National Cancer Institute 2009;101(5):296-305.
- Fedirko V, Tramacere I, Bagnardi V, et al. Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Annals of Oncology 2011;22(9):1958-1972.
- Bellocco R, Pasquali E, Rota M, et al. Alcohol drinking and risk of renal cell carcinoma: results of a meta-analysis. Annals of Oncology 2012;23(9):2235-2244.
- Tramacere I, Pelucchi C, Bonifazi M, et al. A meta-analysis on alcohol drinking and the risk of Hodgkin lymphoma. European Journal of Cancer Prevention 2012;21(3):268-273.