Meta-analyses of different observational studies show that drinking alcohol causes undesirable outcomes such as increase in the risk of different types of cancers like head and neck cancer including oral and pharyngeal cancer, esophageal cancer, thyroid cancer and cancer of the larynx, as well as colorectal, liver and breast cancers.
Cancer is one of the leading causes of deaths worldwide. The risk of developing cancer is dependent on many factors which are not under our control including genetic mutations, age, family history of cancer and environmental factors such as exposure to radiation. However, there are many other factors which contribute significantly to the development of a variety of cancers but are under our control, such as dietary habits including alcohol consumption, tobacco use , eating red meat, processed meat and ultra-processed foods as well as life-style factors such as lack of physical activity and exercise and increased weight/obesity.
Alcohol has always been considered as an important part of celebrations, parties and social engagements. While many consume alcohol in moderate amounts as part of “social drinking”, a significant number of people consume high amounts of alcohol regularly, which ultimately results in undesirable outcomes including different life-threatening diseases and road accidents. Many premature deaths (relatively early in life) may be attributed to alcohol consumption, leading to approximately 13.5 % deaths in the age group between 20 to 39 years. (World Health Organization)
Can Alcohol Consumption cause Cancer?
According to the World health Organization, approximately 1 in 20 deaths (around 5.3% of global deaths) are due to the consumption of alcohol and 1 in 6 deaths are due to cancer worldwide. Hence, different studies have been conducted by researchers across the world to evaluate the association between alcohol and cancer. Examples of some meta-analyses which studied whether alcohol can cause different types of cancers are collated in this blog.
Alcohol Consumption may cause Head and Neck Cancer
- An analysis carried out on the demographics, pre-diagnosis lifestyle habits and clinical data from five studies within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium, which included 4759 head and neck cancer (HNC) patients found that, pre-diagnosis alcohol drinking is a prognostic factor of overall survival and HNC-specific survival for patients with cancer of the larynx.(L (Giraldi et al, Ann Oncol., 2017)
- In a study published in 2017, researchers used the alcohol consumption data of 811 head and neck cancer (HNC) patients and 940 controls from Taiwan to evaluate the association between alcohol and HNC by specific sites and found that alcohol consumption dose-dependently increased HNC risk with the highest risk observed for hypopharyngeal cancer, followed by oropharyngeal and laryngeal cancers. The risk was also found to be higher for individuals with slow ethanol metabolism. (Cheng-Chih Huang et al, Sci Rep., 2017)
- Meta-analysis of data obtained from Pubmed search till September 2009 which included 43 case-control and two cohort studies including a total of 17,085 oral and pharyngeal cancer (OPC) cases found that heavy alcohol drinkers were associated with a very high risk of cancer and the risk increased in a dose-dependent manner. The study also found that a moderate dose of >r=1 drink or 10g ethanol/day may also be associated with an increased risk of OPC. (Irene Tramacere et al, Oral Oncol., 2010)
- Analysis of data obtained from literature search in databases including Embase, Latin American and Caribbean Health Sciences (LILACS), PubMed, Science Direct, and Web of Science) till July 2018, which included 15 articles, found that consumption of alcohol and tobacco synergistically increased the risk of oral squamous cell carcinoma. (Fernanda Weber Mello et al, Clin Oral Investig., 2019)
- A systematic review and meta-analysis of data obtained from literature search in PubMed and Embase databases till July 2012 which included 8 cohort/population based and 11 case-control studies found that alcohol drinking in patients with upper aerodigestive tract (oral cavity, pharynx, larynx, and esophagus) cancer is associated with an increased risk of second primary cancers. (Nathalie Druesne-Pecollo et al, Cancer Epidemiol Biomarkers Prev. 2014)
The above studies suggest that a high intake of alcohol can cause head and neck cancers such as oral/mouth cancer, pharyngeal cancer and cancer of the larynx. (Harindra Jayasekara, Alcohol Alcohol., 2016; V Bagnardi, Br J Cancer., 2015)
Alcohol Consumption may cause Thyroid cancer
In a study published in 2016, the researchers from China analyzed data obtained from PubMed and EMBASE databases which included 24 studies with 9,990 thyroid cancer cases and found that high consumption of alcohol may be associated with an increase in the risk of Thyroid cancer.(Xiaofei Wang et al, Oncotarget. 2016)
The study suggests that high alcohol intake may cause thyroid cancer.
Alcohol Consumption may cause Esophageal Cancer
- In a study published in 2014, the researchers from the University of Michigan Medical School, Michigan analyzed data obtained from literature search in databases including MEDLINE, EBM reviews,EMBASE, ISI Web of Knowledge and BIOSIS which included 5 citations and found that alcohol and tobacco intake synergistically increased the risk of esophageal cancer. ( Anoop Prabhu et al, Am J Gastroenterol., 2014)
- A systematic review and meta‐analysis using 40 case‐control and 13 cohort/population studies which included 17 studies from America, 22 from Asia, 1 from Australia and 13 from Europe, found that moderate and high alcohol intake may be associated with an increased risk of esophageal cancer. The study also found that light alcohol intake may also be associated with esophageal cancer in Asia, suggesting a possible role of genetic susceptibility factors. (Farhad Islami et al, Int J Cancer. 2011)
These studies indicate that high alcohol intake may cause esophageal cancer.(V Bagnardi, Br J Cancer., 2015)
Alcohol Consumption may cause Breast Cancer
- A meta-analysis done by the researchers of Lanzhou University, China using 25 cohort studies found that there is a dose-response relationship between alcohol consumption and breast cancer mortality and recurrence. They also found that alcohol consumption exceeding 20 g/day may be associated with an increased risk of breast cancer mortality. (Yun-Jiu Gou et al, Asian Pac J Cancer Prev., 2013)
- A meta-analysis which included food frequency questionnaire based data from 6 prospective studies with 200 incident breast cancer cases from Canada, the Netherlands, Sweden, and the United States found that alcohol consumption may be associated with a linear increase in the breast cancer incidence in women. The study also suggested that among women who consumed alcohol regularly, reducing alcohol consumption may help in reducing the breast cancer risk. (S A Smith-Warner et al, JAMA,1998)
These studies suggest that high alcohol intake may cause breast cancer.(V Bagnardi, Br J Cancer., 2015)
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Alcohol Consumption may cause Colorectal Cancer
- A meta-analysis done by the researchers of Zhejiang University School of Public Health, China using data obtained from literature search in the PubMed and Web of Science from January 1966 to June 2013 which included 9 cohort studies found that heavy alcohol drinking corresponding to ≥50 g/day of ethanol may increase the risk of colorectal cancer deaths. (Shaofang Cai et al, Eur J Cancer Prev., 2014)
- Another similar meta-analysis of data from 27 cohort and 34 case-control studies identified through Pubmed literature search found that alcohol drinking of >1 drink/day may be associated with an increased risk of colorectal cancer. (V Fedirko et al, Ann Oncol., 2011)
- Meta-analysis of 16 studies which included 14,276 colorectal cancer cases and 15,802 controls from 5 case-control and 11 nested case-control studies found that very heavy drinking (more than 3 drinks/day) may be associated with a significant increase in the risk of colorectal cancer. (Sarah McNabb, Int J Cancer., 2020)
These studies suggest that high intake of alcohol may cause colorectal cancer.(Harindra Jayasekara, Alcohol Alcohol. 2016; V Bagnardi, Br J Cancer., 2015)
Alcohol Consumption may cause Liver Cancer
- A meta analysis done using data obtained from literature search in PubMed till May 2014 which included 112 publications found that one alcoholic drink per day (~12 g/day) may be associated with a 1.1 times higher risk of liver cancer. The analysis also suggested synergistic effects of alcohol consumption with hepatitis and with diabetes on the risk of liver cancer, however, they have suggested for more studies to establish the same. (Shu-Chun Chuang et al, Cancer Causes Control., 2015)
- A similar meta-analysis done using data obtained from literature search in the PubMed and EMBASE till April 2013 which included 16 articles (19 cohorts) with 4445 incident cases and 5550 deaths from liver cancer, found a 46% estimated excess risk of liver cancer for 50 g of ethanol per day and 66% for 100 g per day. This review suggested a moderate detrimental role of heavy drinking (consumption of 3 or more alcoholic drinks per day) on liver cancer, and a lack of association with moderate drinking.
In any case, these studies also suggest that a high intake of alcohol may cause liver cancer. (V Bagnardi, Br J Cancer., 2015)
Alcohol Consumption may cause Gastric Cancer
- A systematic meta-analysis done using data obtained from Medline search including 10 studies found that high alcohol consumption may be associated with an elevated risk of gastric cancer. The study also confirmed that both moderate drinking and heavy drinking of alcohol may be associated with an increased risk of gastric cancer. ( Ke Ma et al, Med Sci Monit., 2017)
- Meta-analysis of 11 cohort studies obtained from PUBMED and Ichushi database searches along with manual search on Japanese population found that in 9 out of 11 studies there was no association between alcohol drinking and gastric cancer, however, one study showed a high risk of gastric cancer in men with high intake of alcohol. The researchers suggested more studies on Japanese population to confirm the same.( Taichi Shimazu et al, Jpn J Clin Oncol., 2008)
Heavy drinking which include consumption of 3 or more alcoholic drinks per day may cause gastric cancer.
Alcohol Consumption and Kidney, Prostate and Lung Cancer Risk
- Meta-analysis of data obtained from PubMed, EMBASE, and MEDLINE databases till August 2011 which included 20 case-control studies, 3 cohort studies, and 1 pooled analysis of cohort studies found that, surprisingly, alcohol intake may be associated with a lower risk of renal cell cancer, with moderate consumption conferring the protection and higher consumption conferring no additional benefits. (D Y Song et al, Br J Cancer. 2012) The study suggested that moderate drinking of alcohol may help in decreasing the risk of renal cell cancer.
- However, another meta-analysis of data which included 20 observational studies (4 cohort, 1 pooled and 15 case-control) obtained from literature search in PubMed and EMBASE databases till November 2010 found that moderate and heavy drinking of alcohol may be associated with an increased risk of renal cell cancer.
Overall, the association between alcohol consumption and kidney cancer is inconclusive.
Similar contradictions were also found in studies related to association between alcohol consumption and prostate cancer risk (Jinhui Zhao et al, BMC Cancer., 2016; Christine M Velicer et al, Nutr Cancer., 2006; Matteo Rota et al, Eur J Cancer Prev., 2012).
The association between alcohol consumption and lung cancer risk is also inconclusive. While one study suggested that “a slightly greater risk of lung cancer was associated with the consumption of > or = 30 g alcohol/day compared to no alcohol consumption” (Jo L Freudenheim et al, Am J Clin Nutr., 2005), a second study suggested no association between alcohol intake and lung cancer risk in “never” smokers. (V Bagnardi et al, Ann Oncol., 2011)
Alcohol Consumption and Risk of Endometrial and Ovarian Cancers
Multiple meta-analyses studies have evaluated the association between alcohol consumption and endometrial cancer. However, the studies found no significant associations between the two. Many of these studies also suggested that the results were the same irrespective of the type of alcoholic beverage. (Quan Zhou et al, Arch Gynecol Obstet., 2017; Qingmin Sun et al, Asia Pac J Clin Nutr. 2011)
Meta-analysis of data obtained from literature search in PubMed till September 2011 which included 27 observational studies, of which 23 were case-control studies, 3 cohort studies and one pooled analysis of prospective cohort studies, including a total of 16,554 epithelial ovarian cancer cases, found no association between alcohol consumption and ovarian cancer risk.
Multiple studies and meta-analyses show that drinking alcohol elevates the risk of different types of cancers such as head and neck cancer including oral and pharyngeal cancer, esophageal cancer, thyroid cancer, cancer of the larynx; colorectal cancer; liver cancer and breast cancer. However, meta-analysis of different studies suggested that alcohol consumption may not be associated with cancers such as endometrial and ovarian cancers. For other cancers such as lung and prostate cancer, the studies are inconclusive.
Above studies and scientific evidence clearly suggest a need to reduce or if possible, stop/avoid alcohol consumption to reduce one’s cancer risk. The lesser alcohol we drink, the better for a healthy future!
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