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Published Online: [[December 13]] 2004 (DOI: 10.1002/cncr.20781) Print Issue Date: [[January 15]] 2005</ref>
Published Online: [[December 13]] 2004 (DOI: 10.1002/cncr.20781) Print Issue Date: [[January 15]] 2005</ref>


One study suggests that heavy drinking accelerates cancer growth by speeding up the loss of body fat and depressing immune activity - particularly that of 'killer t-cells'.<ref>BBC report [http://news.bbc.co.uk/1/hi/health/1990061.stm Alcohol 'speeds cancer growth']</ref>
One study suggests that very heavy drinking in rats accelerates cancer growth by speeding up the loss of body fat and depressing immune activity - particularly that of 'killer t-cells'.<ref>BBC report [http://news.bbc.co.uk/1/hi/health/1990061.stm Alcohol 'speeds cancer growth']</ref>


==Relative health risks==
==Relative health risks==

Revision as of 16:35, 5 June 2006

Research on the relationships between beverage alcohol and cancer is summarized by both level of consumption and type of malignancy. Although additional information is provided, this article does not provide medical advice and none should be inferrred.

The recommended maximum alcohol intake varies around the world. These take into account other factors than cancer risk. In the USA, it is commonly defined (Department of Agriculture and Department of Health & Human Services) as one daily drink for women and two daily drinks for men, where a drink is defined as 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. The U.S. National Institute of Alcohol Abuse and Alcoholism defines it, for a man, as not exceeding four drinks per day or 14 per week and , for a woman, not to exceed three drinks per day or seven per week (ICAP International Drinking Guidelines)

Daily maximum drinks

  • Italy 3 (men) 2 (women)
  • Netherlands 4 (men) 4 (women
  • Portugal 3 (men) 2 (women)
  • Spain (Basque) 5 (men) 5 (women)
  • Switzerland 2 (men) 2 (women) (ICAP)

Daily/weekly maximum drinks

  • Australia 4/day;28/week (men) 2/day;14/week (women)
  • Canada 2/day;14/week (men) 2/day;9/week (women)
  • Hong Kong 4/day;21/week (men) 3/day;14/week (women)
  • New Zealand 6/day;21/week (men) 4/day;14/week (women)
  • UK 4/day;21/week (men) 3/day;14/week (women) (ICAP)

The Cancer Council New South Wales page, Alcohol recommendations / guidelines by other organisations, also summarizes some recommendations by country.

One meta-analysis suggests that risks of cancers may start below the recommended levels. "Risk increased significantly for drinkers, compared with non-drinkers, beginning at an intake of 25 g (< 2 standard drinks) per day for the following: cancers of the oral cavity and pharynx (relative risk, RR, 1.9), esophagus (RR 1.4), larynx (RR 1.4), breast (RR 1.3), liver (RR 1.2), colon (RR 1.1), and rectum (RR 1.1)"[1][2]

Alternatively, the actual quantities of alcohol associated with negative effects may be substantially higher than generally reported because participants in medical research studies tend to underestimate and underreport their usual amounts of alcohol consumption (Purdue & Shoemaker).

When cancer is established, alcohol may affect its growth: see "Effect of alcohol on the progress of cancer" below. If you are a cancer patient, consult your doctor on whether you should drink alcohol.

Alcohol as a risk factor for cancers

This section reviews cancers roughly in the order in which alcohol is believed to be a risk factor.

Head and neck cancers

Head and neck cancers are a collective term for cancers of the:

The U.S. National Cancer Institute's (NCI) Cancer Trends Progress Report Alcohol Consumption states that drinking alcohol increases the risk of these cancers in both men and women. In general, these risks increase above the recommended maximum intake (see above). "Heavy alcohol use … leads to greater increases in risk for most of the alcohol-related cancers. … Also, using alcohol with tobacco is riskier than using either one alone, because it further increases the chances of getting cancers of the mouth, throat, and esophagus."

The International Head and Neck Cancer Epidemiology (INHANCE) Consortium co-ordinates research on this topic – see Pooled analysis investigating the effects of beer, wine and liquor consumption on the risk of head and neck cancers.

The American Cancer Society estimates that, as a proportion of all cancer deaths in the US in 2006, cancer of the mouth (oral cavity) will represent 1.3 percent, of the esophagus will be 2.4 percent, of the pharynx will constitute slightly under one-half of one percent, and of the larynx will be about six-tenths of one percent.[3]

Breast cancer

Alcohol generally appears to increase the risk of breast cancer in women. The U.K.s Review of Alcohol: Association with Breast Cancer concludes that "studies confirm previous observations that there appears to be an association between alcohol intake and increased risk of breast cancer in women. On balance, there was a weak association between the amount of alcohol consumed and the relative risk."

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) concludes that "Chronic alcohol consumption has been associated with a small (averaging 10 percent) increase in a woman's risk of breast cancer (Friedenreich et al.; Longnecker; Nasca)). According to these studies, the risk appears to increase as the quantity and duration of alcohol consumption increases. Other studies, however, have found no evidence of such a link (Chu et al. ; Schatzkin et al.; Webser et al)." Cite error: The <ref> tag has too many names (see the help page).

The Committee on Carcinogenicity of Chemicals in Food, Consumer Products Non-Technical Summary concludes, "The new research estimates that a woman drinking an average of two units of alcohol per day has a lifetime risk of developing breast cancer 8% higher than a woman who drinks an average of one unit of alcohol per day. The risk of breast cancer further increases with each additional drink consumed per day. … The research also concludes that approximately 6% (between 3.2% and 8.8%) of breast cancers reported in the U.K. each year could be prevented if drinking was reduced to a very low level (i.e. less than 1 unit/week)."

It has been reported that "Two drinks daily increase the risk of getting breast cancer by about 25 percent." (NCI) but the evidence is inconsistent. The Framingham study has carefully track individuals since the 1940s . Data from that research found that drinking alcohol moderately did not increase breast cancer risk (Wellness Facts). Similarly, research by the Danish National Institute for Public Health found that moderate drinking had virtually no effect on breast cancer risk [4].

Breast cancer constitutes about 7.3% of all cancers[3]. Among women, breast cancer comprises 60% of alcohol-attributable cancers.[5] One study suggests that women who frequently drink red wine may have an increased risk of developing breast cancer.[6]

"Folate intake counteracts breast cancer risk associated with alcohol consumption" [7] and "women who drink alcohol and have a high folate intake are not at increased risk of cancer" [8]. Those who have a high (200 micrograms or more per day) level of folate (folic acid or Vitamin B9) in their diet are not at increased risk of breast cancer compared to those who abstain from alcohol [9]. Foods rich in folate include citrus fruits, citrus juices, dark green leafy vegetables (such as spinach), dried beans, and peas. Vitamin B9 can also be taken in a multivitamin pill.

Liver cancer

The NIAAA reports that "Prolonged, heavy drinking has been associated in many cases with primary liver cancer. However, it is liver cirrhosis, whether caused by alcohol or another factor, that is thought to induce the cancer (Takada et al;Villa et al). In areas of Africa and Asia, liver cancer afflicts 50 or more people per 100,000 per year, usually associated with cirrhosis caused by hepatitis viruses. In the United States, liver cancer is relatively uncommon, afflicting approximately 2 people per 100,000, but excessive alcohol consumption is linked to as many as 36 percent of these cases by some investigators (Rothman;Dufy & Sharples)." [1]. It's been reported that "The chances of getting liver cancer increase markedly with five or more drinks per day" (NCI).

Liver and intrahepatic bile duct cancers combined account for about 2.8% of all cancers.[3]

Colorectal cancer

The NIAAA reports that "Epidemiologic studies have found a small but consistent dose-dependent association between alcohol consumption and colorectal cancer (Longnecker; Longneck et al.), even when controlling for fiber and other dietary factors (Longnecker; Kune & Watson; Potter & McMichael). Despite the large number of studies, however, causality cannot be determined from the available data." [2].

"Heavy alcohol use may also increase the risk of colorectal cancer" (NCI). One study found that "People who drink more 30 grams of alcohol per day (and especially those who drink more than 45 grams per day) appear to have a slightly higher risk for colorectal cancer." [3]. Another found that "The consumption of one or more alcoholic beverages a day at baseline was associated with approximately a 70% greater risk of colon cancer."[10][11]

One study found that "people who abstain from alcohol are more likely to develop colorectal cancer than people who drink moderate amounts of wine" [4].

Other research suggests that "to minimize your risk of developing colorectal cancer, it's best to drink in moderation" [5]

Colorectal cancer consitutes about 9.7% of all cancers.[3]

Leukemia

Leukemia (British spelling: leukaemia) in children may be associated with the mother's drinking of alcohol during pregnancy.[12][13]

There is no association between drinking alcohol and adult leukemia. Leukemia constitutes about 7.8% of all cancers[3].

Lung cancer

Lung cancer is a major cause of death, constituting about 28.8% of all cancers[3]. The NIAA reports that “A few studies have linked chronic heavy drinking with cancers of the stomach, pancreas, and lungs (International Agency for Research on cancer). However, the association is consistently weak and the majority of studies have found no association (International Agency for Research on Cancer).” [6].

Chronic heavy alcohol consumption possibly increases the risk of lung cancer, but the evidence is inadequate to date.[14] Commenting on a study by Freudenheim et al[15] R. Curtis Ellison MD writes, "This study, like others, suggests a weak, positive association between consuming larger amounts of alcohol (>2 drinks a day) and lung cancer risk."[16]

Endometrial cancer

"Thirteen studies to date have reported on the relationship between endometrial cancer and alcohol consumption. Only two of these studies have reported that endometrial cancer incidence is associated with consumption of alcohol; all the others have reported either no definite association, or an inverse association." (Six studies showed an inverse association.) "…if such an inverse association exists, it appears to be more pronounced in younger, or premenopausal, women."[17]

Endometrial plus all other uterine cancers account for about 1.9% of all cancers.[3]

Stomach cancer

As indicated above, the NIAA reports that “A few studies have linked chronic heavy drinking with cancers of the stomach, pancreas, and lungs (International Agency for Research on cancer). However, the association is consistently weak and the majority of studies have found no association (International Agency for Research on Cancer).” [7].

Alcohol consumption, even when chronic and heavy, probably does not affect the risk of stomach cancer.[14]

Cancers not associated with alcohol

The following cancers are not associated with alcohol:[14]

  • Bladder cancer: Bladder cancer represents about 2.3% of all cancers.
  • Prostate cancer: The Fred Hutchinson Cancer Research Center "found that men who consumed four or more glasses of red wine per week reduced their risk of prostate cancer by 50 percent". They "found no significant effects — positive nor negative — associated with the consumption of beer or hard liquor and no consistent risk reduction with white wine, which suggests that there must be a beneficial compound in red wine that other types of alcohol lack. That compound … may be an antioxidant called resveratrol, which is abundant in the skins of red grapes." [18]. (There are dietary sources of resveratrol other than red wine, such as red or purple grape juice.) Prostate cancer accounts for about 4.8% of all cancers.[3]

Other cancers

Moderate consumption either does not increase the risk, or actually reduces risk of the following common cancers (as listed by the National Cancer Institute in alphabetical order):

Alcohol as a carcinogen

The International Agency for Research on Cancer (Centre International de Recherche sur le Cancer) of the World Health Organization has classified alcohol as a Group 1 carcinogen.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that "Although there is no evidence that alcohol itself is a carcinogen, alcohol may act as a cocarcinogen by enhancing the carcinogenic effects of other chemicals. For example, studies indicate that alcohol enhances tobacco's ability to stimulate tumor formation in rats (Garro & Lieber). In humans, the risk for mouth, tracheal, and esophageal cancer is 35 times greater for people who both smoke and drink than for people who neither smoke nor drink (Blot et al.), implying a cocarcinogenic interaction between alcohol and tobacco-related carcinogens (Garro & Lieber)." [9]

The NIAAA emphasizes that "Although epidemiologic studies have found a clear association between alcohol consumption and development of certain types of cancer, study findings are often inconsistent and may vary by country and by type of cancer."

Some studies find that drinking in moderation significantly reduces the risk of some malignant tumors such as kidney cancer (Rashidkhani et al.), thyroid cancer in women (Rosing et al.) and non-Hodgkins lymphoma. A review of findings from nine international studies found that drinking of alcohol reduces the risk of non-Hodgkin’s lymphoma by 27%, report scientists at the National Cancer Institute. The cancer is the sixth most common in the U.S. Beer, wine and liquor were found to be equally effective in protecting against the disease (Morton et al.)

Chronic heavy abuse of alcohol increases risk. "Considerable evidence suggests a connection between heavy alcohol consumption and increased risk for cancer, with an estimated 2 to 4 percent of all cancer cases thought to be caused either directly or indirectly by alcohol (Rothman)" indicates the NIAAA. [10]

"Studies have suggested that high concentrations of acetaldehyde, which is produced as the body breaks down ethanol, could damage DNA in healthy cells. … Researchers at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland, have added weight to this idea by showing that the damage occurs at concentrations of acetaldehyde similar to those in saliva and the gastrointestinal tract while people drink alcohol. Acetaldehyde appears to react with polyamines - naturally occurring compounds essential for cell growth - to create a particularly dangerous type of mutagenic DNA base called a Cr-Pdg adduct…"[20]

Effect of alcohol on the progress of cancer

A study suggests that alcohol stimulates tumor growth by fueling the production of a growth factor that stimulates blood vessel development in tumors.[21][22]

One study suggests that very heavy drinking in rats accelerates cancer growth by speeding up the loss of body fat and depressing immune activity - particularly that of 'killer t-cells'.[23]

Relative health risks

It’s always important to balance relative health risks. About half of Americans die of heart attacks. Moderate drinking reduces the risk of heart attacks by up to 41% in men, 36% in women. An increase in risk of a cancer needs to viewed in relation to the benefits of moderate drinking on reducing a major threat to health and long life. See Alcohol and heart attacks for more. There are, of course, many ways of reducing your risk of a heart attack without drinking alcohol, such as controlling your weight and exercising. Balancing such risks is a personal decision that should be discussed with one’s own physician.

Notes

  1. ^ Alcohol and Serious Consequences: Risks Increase Even With “Moderate” Intake
  2. ^ Corrao G, Bagnardi V, Zambon A, et al. A meta-analysis of alcohol consumption and the risk of 15 diseases Prev Med. 2004;38(5):613–619
  3. ^ a b c d e f g h American Cancer Society. Statistics for 2006
  4. ^ Petri, A.L., et al. Alcohol intake, type of beverage, and risk of cancer in pre- and postmenopausal women. Alcoholism: Clinical & Experimental Research, 2004, 28(7), 1084-1090).
  5. ^ Boffetta P. et al. (2006-03-23) Int J Cancer. "The burden of cancer attributable to alcohol drinking".
  6. ^ Maggiolini M. et al. (2005) J Mol Endocrinol. "The red wine phenolics piceatannol and myricetin act as agonists for estrogen receptor alpha in human breast cancer cells"
  7. ^ Mayo Clinic news release June 26 2001 "Folate Intake Counteracts Breast Cancer Risk Associated with Alcohol Consumption"
  8. ^ Boston University "Folate, Alcohol, and Cancer Risk"
  9. ^ "A prospective study of folate intake and the risk of breast cancer"
  10. ^ Boston University "Alcohol May Increase the Risk of Colon Cancer"
  11. ^ Su LJ, Arab L. Alcohol consumption and risk of colon cancer: evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study. Nutr and Cancer. 2004;50(2):111–119.
  12. ^ Boston University Can Drinking During Pregnancy Raise the Risk of Childhood Leukemia?
  13. ^ Menegaux F, Steffen C, Bellec S, et al. Maternal coffee and alcohol consumption during pregnancy, parental smoking and risk of childhood acute leukemia. Cancer Detect and Prev. 2005;29(6):487–493.
  14. ^ a b c Cancer Council New South Wales Alcohol and Cancer
  15. ^ Freudenheim JL, Ritz J, Smith-Warner SA, et al. Alcohol consumption and risk of lung cancer: a pooled analysis of cohort studies. Am J Clin Nutr. 2005;82(3):657–667.
  16. ^ Boston University Alcohol Consumption and Lung Cancer: Are They Connected?
  17. ^ UK Department of Health Review of Alcohol: Association with Endometrial Cancer p8
  18. ^ Fred Hutchinson Cancer Research Center press release A Glass of Red Wine a Day May Keep Prostate Cancer Away
  19. ^ Rashidkhani, B., Åkesson, A., Lindblad, P, and Wolk, A. Alcohol consumption and risk of renal cell carcinoma: A prospective study of Swedish women International Journal of Cancer, 2005 (December 10), 117(5), 848-853.
  20. ^ New Scientist article "Alcohol's link to cancer explained"
  21. ^ Cancer news alert"Study Provides Clues to Alcohol's Cancer Connection"
  22. ^ Ethanol stimulates tumor progression and expression of vascular endothelial growth factor in chick embryos Jian-Wei Gu, Amelia Purser Bailey, Amanda Sartin, Ian Makey, Ann L. Brady Cancer Published Online: December 13 2004 (DOI: 10.1002/cncr.20781) Print Issue Date: January 15 2005
  23. ^ BBC report Alcohol 'speeds cancer growth'
  • Ahlgren, J. D., et al. Epidemiology and risk factors in pancreatic cancer. Seminars in Oncology, 1996, 23(2), 241-250.
  • Chu, S.Y.; Lee, N.C.; Wingo, P.A.; and Webster, L.A. Alcohol consumption and the risk of breast cancer. American Journal of Epidemiology 130(5):867-877, 1989.
  • Duffy, S.W., and Sharples, L.D. Alcohol and cancer risk. In: Duffy, J.L., ed. Alcohol and Illness: The Epidemiological Viewpoint. Edinburgh: Edinburgh University Press, 1992. pp. 64-127.'
  • Friedenreich, C.M.; Howe, G.R.; Miller, A.B.; and Jain, M.G. A cohort study of alcohol consumption and risk of breast cancer. American Journal of Edidemiology 137(5):512-520, 1993.
  • International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol. 44. United Kingdom: World Health Organization, 1988.
  • Kune, S.; Kune, G.A.; and Watson, L.F. Case-control study of alcoholic beverages as etiological factors: The Melbourne Colorectal Cancer Study Nutrition and Cancer 9(1):43-56, 1987.
  • Longnecker, M.P.; Berlin, J.A.; Orza, M.J.; and Chalmers, T.C. A meta-analysis of alcohol consumption in relation to risk of breast cancer. Journal of the American Medical Association 260(5):652-656, 1988.
  • Longnecker, M.P.; Orza, M.J.; Adams, M.E.; Vioque, J.; and Chalmers, T.C. A meta-analysis of alcoholic beverage consumption in relation to risk of colorectal cancer. Cancer Causes and Control 1(1):59-68, 1990.
  • Longnecker, M.P. Alcohol consumption in relation to risk of cancers of the breast and large bowel. Alcohol Health & Research World 16(3)':223-229, 1992.
  • Morton, L., et al. Alcohol consumption and risk of non-Hodgkin lymphoma: A pooled analysis. Lancet Oncology, June 8, 2005.
  • Nasca, P.C.; Baptiste, M.S.; Field, N.A.; Metzger, B.B.; Black, M.; Kwon, C.S.; and Jacobson, H. An epidemiological case-control study of breast cancer and alcohol consumption. International Journal of Epidemiology 19(3):532-538, 1990.
  • Purdue, L., and Shoemaker, W. The French Paradox and Beyond. Sonoma, CA: Renaissance Publishing, 1992, p. 57.
  • Potter, J.D., and McMichael, A.J. Diet and cancer of the colon and rectum: A case-control study. Journal of the National Cancer Institute 76(4):557-569, 1986.
  • Rossing, M.A., Cushing, K.L., Voight, L.F., and Wicklund, K.G. Risk of papillary thyroid cancer in women in relation to smoking and alcohol consumption Epidemiology, 2000, 11, 49-54.
  • Rothman, K.J. The proportion of cancer attributable to alcohol consumption. Preventive Medicine 9(2):174-179, 1980.
  • Schatzkin, A.; Piantadosi, S.; Miccozzi, M.; and Bartee, D. Alcohol consumption and breast cancer: A cross-national correlation study. International Journal of Epidemiology 18(1):28-31, 1989.
  • Takada, A.; Takase, S.; and Tsutsumi, M. Alcohol and hepatic carcinogenesis. In: Yirmiya, R., and Taylor, A.N., eds. Alcohol, Immunity, and Cancer. Boca Raton, FL: CRC Press, 1993. pp. 187-209.
  • Villa, E.; Melegari, M.; and Manenti, F. Alcohol, viral hepatitis, and hepatocellular carcinoma. In: Watson, R.R., ed. Alcohol and Cancer. Boca Raton, FL: CRC Press, 1992. pp. 151-165.
  • Webster, L.A.; Layde, P.M.; Wingo, P.A.; and Ory, H.W. Alcohol consumption and risk of breast cancer. Lancet 2(8352):724-726, 1983.
  • Wellness Facts. Wellness Letter (School of Public Health, University of California at Berkeley), 1999, 15(8), 1.


Government and international bodies

Cancer charities

Other sites

Science sites

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