Link between alcohol and cancer

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Link between alcohol and cancer


In 1988 the International Agency for Research on Cancer classed alcohol as a Group 1 carcinogen (the highest IARC classification) for cancers of the mouth, pharynx, larynx, oesophagus and liver[1].

Cancer risk is increased because of the ethanol in alcohol, irrespective of the type of alcoholic beverage[2]. Ethanol, the chemical in alcoholic beverages that induces the physical and mental responses experienced with alcohol use, is also a Group 1 carcinogen[3].

Alcohol use and cancer have a dose-response relationship; the more alcohol consumed over time, the higher the risk. 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[4].

Although alcohol consumption probably decreases the risk of kidney cancer, there is no evidence for recommending alcohol consumption to protect against cancer[2]. Even low levels of alcohol consumption can increase cancer risk[2]. Evidence shows there is no threshold (or safe limit) of alcohol consumption and cancer risk, and that the more alcohol is consumed over a lifetime, the greater the risk of developing alcohol-related cancers[2][5][6][7].

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Biological mechanisms

There are a number of plausible biological mechanisms linking alcohol to cancer, such as:

  • damaged DNA due to the acetaldehyde produced when alcohol is metabolised;
  • increased oestrogen levels, which are associated with breast cancer;
  • alcohol acting as a solvent for other carcinogens; and
  • altered folate metabolism, affecting cell function[2].

There is convincing evidence that alcohol is a cause of five cancers types and probable evidence linking alcohol to two others (Table 2)[8].

There is also evidence that heavy alcohol consumption may be associated with a higher risk of prostate cancer[9][10] and pancreatic cancer[11].

The overall evidence to date suggests that alcohol is not a risk factor for kidney cancer[2][3], non-Hodgkin's lymphoma[3] and bladder cancer[12]. For lung cancer, the evidence is inconsistent or insufficient to conclude causality and the studies generally do not adequately control for the effects of smoking[3]. For other cancers, evidence of an association between alcohol consumption and cancer risk is generally limited or inconsistent[3].

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

Type of cancer Association with alcohol Level of risk of causality
Breast (postmenopausal) Increases risk Convincing
Larynx Increases risk Convincing
Mouth Increases risk Convincing
Oesophagus Increases risk Convincing
Pharynx Increases risk Convincing
Colon-rectum Increases risk Convincing
Liver Increases risk Convincing
Breast (premenopausal) Increases risk Probable
Stomach Increases risk Probable
Lung Potential risk Insufficient
Pancreas Potential risk Insufficient
Prostate Potential risk Insufficient
Bladder Insufficient evidence of relationship
Kidney Decreases risk Probable

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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[13]. 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 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[14].

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[15].

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[16][17]. 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[18]. 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 consumption 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[19]. There is also probable evidence that body fatness is a cause of cancers of the mouth, pharynx, larynx, stomach, gallbladder, ovary and prostate[19]. (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 consumption and body weight and fat is complex and appears to vary with sex and drinking pattern[20]. 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 liable to gain 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[20][21].

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Perceived health benefits of alcohol: the evidence

Evidence shows there is no threshold (or safe limit) of alcohol consumption and cancer risk and that the more alcohol is consumed over a lifetime, the greater the risk of developing alcohol-related cancers. There is evidence that alcohol is probably protective for kidney cancer[2] and very moderate consumption (no more than one standard drink a day) may help to protect against pancreatic cancer[22].

The potential benefit of light to moderate alcohol consumption on cardiovascular disease is the subject of ongoing scientific debate. A number of population studies, including a 2011 systematic review[23] have suggested light to moderate alcohol consumption may reduce the risk of cardiovascular disease. However, other reviews have suggested unmeasured confounding in epidemiological studies on alcohol and heart disease is widespread and that randomised controlled trials may be the only way to obtain more consistent evidence about the effects of moderate alcohol consumption on cardiovascular disease risk[24].

Conclusive evidence shows higher levels of alcohol consumption confer no cardiovascular health benefits[24]. The 2011 review that suggested moderate alcohol consumption may reduce cardiovascular disease risk also linked higher alcohol consumption levels with an increased risk of stroke[23]. Neither the World Health Organization nor the National Heart Foundation of Australia recommend consuming 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 44: alcohol drinking. Lyon: IARC; 1988 Available from: http://monographs.iarc.fr/ENG/Monographs/vol44/volume44.pdf.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 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.
  3. 3.0 3.1 3.2 3.3 3.4 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. World Cancer Research Fund. Summary of global evidence on cancer prevention. London: WCRF; 2017 Sep Available from: http://www.wcrf.org/sites/default/files/CUP_Summary_Report_Sept17.pdf.
  9. Middleton Fillmore K, Chikritzhs T, Stockwell T, Bostrom A, Pascal R. Alcohol use and prostate cancer: a meta-analysis. Mol Nutr Food Res 2009 Feb;53(2):240-55 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19156715.
  10. Gong Z, Kristal AR, Schenk JM, Tangen CM, Goodman PJ, Thompson IM. Alcohol consumption, finasteride, and prostate cancer risk: results from the Prostate Cancer Prevention Trial. Cancer 2009 Aug 15;115(16):3661-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19598210.
  11. Tramacere I, Scotti L, Jenab M, Bagnardi V, Bellocco R, Rota M, et al. Alcohol drinking and pancreatic cancer risk: a meta-analysis of the dose-risk relation. Int J Cancer 2010 Mar 15;126(6):1474-86 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19816941.
  12. 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.
  13. Doll R, Forman D, La Vecchia C, Wouterson R. Alcoholic beverages and cancers of the digestive tract and larynx. Oxford: Blackwell Science Ltd; 1999.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. Thompson N, Irvine JA. Review of cancer among Aboriginal people in Western Australia 2000. Cancer Foundation of Western Australia; 2001.
  19. 19.0 19.1 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.
  20. 20.0 20.1 Tolstrup JS, Halkjaer J, Heitmann BL, Tjønneland AM, Overvad K, Sørensen TI, et al. Alcohol drinking frequency in relation to subsequent changes in waist circumference. Am J Clin Nutr 2008 Apr;87(4):957-63 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18400719.
  21. Wannamethee SG, Shaper AG, Whincup PH. Alcohol and adiposity: effects of quantity and type of drink and time relation with meals. Int J Obes (Lond) 2005 Dec;29(12):1436-44 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16077718.
  22. Pelucchi C, Tramacere I, Boffetta P, Negri E, La Vecchia C. Alcohol consumption and cancer risk. Nutr Cancer 2011;63(7):983-90 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21864055.
  23. 23.0 23.1 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.
  24. 24.0 24.1 24.2 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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