Link between alcohol and cancer

From National Cancer Control Policy
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Link between alcohol and cancer


The International Agency for Research on Cancer has classed alcohol as a Group 1 carcinogen (the highest IARC classification) for cancers of the mouth, pharynx, larynx, oesophagus, bowel, liver, stomach and breast (in women)[1][2]. There is accumulating evidence that drinking alcohol may also be associated with cancers of the lung[2], pancreas[3][2], prostate[3], melanoma[3][2] and basal cell carcinoma[2].

Cancer risk is increased because of the ethanol in alcohol, irrespective of the type of alcoholic beverage[4]. Ethanol, the chemical in alcoholic beverages that induces the physical and mental responses experienced with alcohol use, is also a Group 1 carcinogen[5]. Alcohol has been attributed to 2.8% of all cancers diagnosed in 2010, with mouth and pharynx cancers having the highest number of cases attributable to cancer[6].

There is convincing evidence that alcohol is a cause of seven cancers types and probable evidence linking alcohol to three others (see Table 2)[2]. Recent research has also found people high-risk drinking have a significantly higher risk of cancers of the stomach, pancreas, and prostate[3]. The overall evidence to date suggests that alcohol is not a risk factor for kidney cancer[4][5], Hodgkin's and non-Hodgkin's lymphoma[3]. For lung cancer, the studies generally cannot adequately control for the effects of smoking[5]. For other cancers, evidence of an association between alcohol use and cancer risk is generally limited or inconsistent[5].

Although alcohol use probably decreases the risk of kidney cancer[2], there is no evidence for recommending alcohol use protects against cancer[4]. Even low levels of alcohol use can increase cancer risk[4]. Alcohol use and cancer have a dose-response relationship meaning the more alcohol used over time, the greater the risk of developing alcohol-related cancers[4][7][8][9]. The relationship is not a straight line, but shows upward curvature at higher drinking levels over time; the relationship appears to be consistent for women and men[10].


Table 2. Evidence of a link between alcohol and cancer type[2]

Type of cancer Level of evidence
Any amount of alcohol increases risk
Breast (postmenopausal) Convincing
Larynx Convincing
Mouth Convincing
Oesophagus Convincing
Pharynx Convincing
Breast (premenopausal) Probable
Skin Limited - suggestive
Lung Limited - suggestive
Pancreas Limited - suggestive
Two or more alcoholic drinks a day (30 grams) increases
Colon-rectum Convincing
Three or more alcoholic drinks a day (45 grams) increases
Liver Convincing
Stomach Probable
Three or more alcoholic drinks a day (45 grams) decreases
Kidney Probable

Smoking and alcohol: synergies for high risk

Smoking and alcohol together have a synergistic effect on upper gastrointestinal and aero-digestive cancer risk, meaning the combined effects greatly exceed the risk from either one alone[11]. It has been estimated that over 75% of cancers of the upper aero-digestive tract in developed countries can be attributed to this effect. For example, compared to non-smoking non-drinkers, the approximate relative risks for developing mouth and throat cancer are up to seven times greater for those who use tobacco, up to six times greater for those who use alcohol, and 35 times greater for those who are regular heavy users of both tobacco and alcohol[12].

Alcohol has an independent effect on the risk of oral, pharyngeal, laryngeal and oesophageal cancers, but it is its synergistic effect with smoking that is most significant[13].

See the Tobacco control chapter of the National Cancer Prevention Policy for more information.

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Alcohol and hepatitis B infection

Alcohol and hepatitis B virus infection may exert a joint effect on cancer of the liver[14][15]. This is of particular concern in Aboriginal and Torres Strait Islander populations where hepatitis B is endemic, with data suggesting that liver cancer incidence and mortality rates are 3.5 to 3.6 times higher for Aboriginal and Torres Strait Islander males than for other Australian males[16]. It highlights an important area for further investigation and action.

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Alcohol and weight gain

As well as being a direct cause of several cancers, alcohol use may indirectly increase cancer risk by contributing to obesity and overweight, which are linked by convincing evidence to cancers of the oesophagus, pancreas, liver, bowel, breast (in post-menopausal women), endometrium and kidney[4]. There is also probable evidence that body fatness is a cause of cancers of the mouth, pharynx, larynx, stomach, ovary, prostate and gallbladder cancer[2]. (Convincing and probable are the highest levels of evidence as determined by the World Cancer Research Fund and American Institute for Cancer Research and denote that the relationship is causal or probably causal in nature.)

The relationship between alcohol use and body weight and fat is complex and appears to vary with sex and drinking pattern[17]. From a nutritional viewpoint, alcoholic drinks represent ‘empty kilojoules’ - meaning they are high in kilojoules but low in nutritional value, especially when added to sugary mixer drinks. Alcohol itself has a comparatively high energy content (29 kilojoules per gram) compared with other macronutrients.

If people drink alcohol in addition to their normal dietary intake – that is, without a compensatory reduction in energy intake – they are at risk of gaining weight. Alcohol provides extra kilojoules, and slows fat and carbohydrate oxidation. On the other hand, if drinking replaces healthy eating patterns, it can lead to nutritional deficiencies and serious illness[17][18].

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Perceived health benefits of alcohol: the evidence

Evidence shows there is no threshold (or safe limit) of alcohol use and cancer risk and that the more alcohol is used over a lifetime, the greater the risk of developing alcohol-related cancers. There is only evidence that low use of alcohol is protective for kidney cancer[2] but not any other form of cancer[7][8][9].

The potential benefit of light to moderate alcohol use on cardiovascular disease is the subject of ongoing scientific debate. A 2011 systematic review suggested that light to moderate alcohol consumption may reduce the risk of cardiovascular disease[19], however more recent evidence suggests alcohol use does not have a significant protective effect on all-cause mortality or cardiovascular disease[20][21][22]. Although some alcohol use appears to benefit cardiovascular health, when assessed with other health risks including cancer, injuries and communicable diseases, alcohol consumption leads to health loss across populations[23]. Neither the World Health Organization nor the National Heart Foundation of Australia recommend drinking red wine or any other alcoholic beverage to prevent cardiovascular disease[24][25].


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References

  1. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans, volume 100E. Consumption of Alcoholic Beverages. Lyon, France: IARC; 2012 [cited 2019 Jul 25] Available from: https://monographs.iarc.fr/wp-content/uploads/2018/06/mono100E-11.pdf.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 World Cancer Research Fund. Continuous Update Project (CUP) Matrix. London, UK: World Cancer Research Fund; 2018 May Available from: https://www.wcrf.org/sites/default/files/Matrix-for-all-cancers-A3.pdf.
  3. 3.0 3.1 3.2 3.3 3.4 Bagnardi V, Rota M, Botteri E, et al.. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015 Feb 3 [cited 2019 Jul 25];112(3): 580–593 Abstract available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453639/.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007.
  5. 5.0 5.1 5.2 5.3 International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans, volume 96. Alcohol consumption and ethyl carbamate. Lyon, France: IARC; 2010 Available from: http://monographs.iarc.fr/ENG/Monographs/vol96/mono96.pdf.
  6. Pandeya N, Wilson LF, Webb PM, Neale RE, Bain CJ, Whiteman DC. Cancers in Australia in 2010 attributable to the consumption of alcohol. Aust N Z J Public Health 2015 Oct;39(5):408-13 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26437723.
  7. 7.0 7.1 Million Women Study Collaborators, Allen NE, Beral V, Casabonne D, Kan SW, Reeves GK, et al. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst 2009 Mar 4;101(5):296-305 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19244173.
  8. 8.0 8.1 Collaborative Group on Hormonal Factors in Breast Cancer, Hamajima N, Hirose K, Tajima K, Rohan T, Calle EE, 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. Br J Cancer 2002 Nov 18;87(11):1234-45 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12439712.
  9. 9.0 9.1 Corrao G, Bagnardi V, Zambon A, La Vecchia C. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med 2004 May;38(5):613-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15066364.
  10. Ridolfo B, Stevenson C. The quantification of drug-caused morbidity and mortality in Australia. Canberra: AIHW; 2001 Feb 23. Report No.: Cat. no. PHE 29.. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459309.
  11. 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 Control 2010 Nov;21(11):1843-50 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20617375.
  12. Doll R, Forman D, La Vecchia C, Wouterson R. Alcoholic beverages and cancers of the digestive tract and larynx. Oxford: Blackwell Science Ltd; 1999.
  13. Blot WJ. Alcohol and cancer. Cancer Res 1992 Apr 1;52(7 Suppl):2119s-2123s Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1544150.
  14. Boyle P, Levin B. World cancer report 2008. Lyon: International Agency for Research on Cancer; 2008 Available from: http://www.iarc.fr/en/publications/pdfs-online/wcr/2008/wcr_2008.pdf.
  15. Brechot C, Nalpas B, Feitelson MA. Interactions between alcohol and hepatitis viruses in the liver. Clin Lab Med 1996 Jun;16(2):273-87 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8792072.
  16. Schiff ER. Hepatitis C and alcohol. Hepatology 1997 Sep;26(3 Suppl 1):39S-42S Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9305662.
  17. 17.0 17.1 Thompson N, Irvine JA. Review of cancer among Aboriginal people in Western Australia 2000. Cancer Foundation of Western Australia; 2001.
  18. World Cancer Research Fund International. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective - The Third Expert Report. [homepage on the internet] London, UK: World Cancer Research Fund International; 2018 Available from: https://www.wcrf.org/dietandcancer.
  19. Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 2011 Feb 22;342:d671 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21343207.
  20. Holmes MV, Dale CE, Zuccolo L, et al.. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ 2014 Jul 10 [cited 2019 Jul 25];349: g4164. Abstract available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091648/.
  21. Knott CS, Coombs N, Stamatakis E, Biddulph JP. All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ 2015 Feb 10 [cited 2019 Jul 25];350: h384 Abstract available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353285/.
  22. Stockwell T, Zhao J, Panwar S, Roemer A, Naimi T, Chikritzhs T. Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality. J Stud Alcohol Drugs 2016 Mar 16 [cited 2019 Jul 25];77(2): 185–198 Abstract available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803651/.
  23. GBD 2016 Alcohol Collaborators.. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018 Sep 22;392(10152):1015-1035 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/30146330.
  24. World Health Organization. Prevention of cardiovascular disease: guidelines for assessment and management of cardiovascular risk. Geneva, Switzerland: WHO; 2007 Available from: http://www.who.int/cardiovascular_diseases/guidelines/Full%20text.pdf.
  25. National Heart Foundation of Australia. Position statement: antioxidants in food, drinks and supplements for cardiovascular health. Canberra: NHFA; 2010 Aug Available from: http://www.heartfoundation.org.au/SiteCollectionDocuments/Antioxidants-Position-Statement.pdf.

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