Alcohol and cancer

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Alcohol and Health
Short-term effects of alcohol
Long-term effects of alcohol
Alcohol and cardiovascular disease
Alcoholic liver disease
Alcoholic hepatitis
Alcohol and cancer
Alcohol and weight
Fetal alcohol syndrome
Fetal Alcohol Spectrum Disorder
Alcoholism
Blackout (alcohol-related amnesia)
Wernicke-Korsakoff syndrome
Recommended maximum intake of alcoholic beverages

"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[1]" indicates the NIAAA.[2]" 3.6% of all cancer cases worldwide are related to alcohol drinking, resulting in 3.5% of all cancer deaths."[3]

Contents

[edit] Alcohol as a carcinogen and cocarcinogen

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. Its evaluation states, "There is sufficient evidence for the carcinogenicity of alcoholic beverages in humans.… Alcoholic beverages are carcinogenic to humans (Group 1)."[4]

The U.S. 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.[5] 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,[6] implying a cocarcinogenic interaction between alcohol and tobacco-related carcinogens."[2]

The NIAAA states 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."[2]

[edit] Possible mechanisms of alcohol as a carcinogen

In a review, Pöschl and Seitz list some possible mechanisms of alcohol as a carcinogen:

  • local effects of alcohol
  • acetaldehyde "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…"[7]
  • induction of CYP2E1
  • nutritional deficiencies
  • interactions with retinoids
  • alcohol and methylation
  • alcohol and immune surveillance[8]

Purohita et al propose an overlapping list:

  1. production of acetaldehyde, which is a weak mutagen and carcinogen
  2. induction of cytochrome P450 2E1 and associated oxidative stress and conversion of procarcinogens to carcinogens
  3. depletion of S-adenosylmethionine and, consequently, induction of global DNA hypomethylation;
  4. induction of increased production of inhibitory guanine nucleotide regulatory proteins and components of extracellular signal-regulated kinase–mitogen-activated protein kinase signaling
  5. accumulation of iron and associated oxidative stress
  6. inactivation of the tumor suppressor gene BRCA1 and increased estrogen responsiveness (primarily in breast)
  7. impairment of retinoic acid metabolism.[9]

[edit] Effect of alcohol on the progress of cancer when established

A study of the influence of alcohol intake on tumor growth of hepatocellular carcinoma (HCC) in patients with type C cirrhosis, found that alcohol influenced tumor volume doubling time (TVDT). "In conclusion we found that alcohol intake was closely related to the tumor growth of HCC in patients with type C cirrhosis."[10]

A study of chick embryos suggests that alcohol stimulates their tumor growth by fueling the production of a growth factor that stimulates blood vessel development in tumors.[11][12] A 2006 study in mice showed moderate drinking resulted in larger and more robust tumors.[13]

A study where high amounts of alcohol were given to mice suggests that it accelerates their cancer growth by speeding up the loss of body fat and depressing immune activity - particularly that of 'killer t-cells'.[14][15]

[edit] Genetic variation and cancer risk

A study found that "the ADH1C*1 allele and genotype ADH1C*1/1 were significantly more frequent in patients with alcohol-related cancers…"[16] A European study has found two gene variants which offer "significant" protection against mouth and throat cancers. [17] Alcohol is a known porphyrinogenic chemical. Several studies in Europe published on Pubmed have linked the inherited hepatic porphyrias with a predisposition to hepatocellular carcinoma. Typical risk factors for HCC need not be present with the acute hepatic porphyrias, specifically acute intermittent porphyria, variegate porphyria and hereditary coproporphyria. Porphyria cutanea tarda is also associated with HCC, but with typical risk factors including evidence of hepatotropic viruses, hemochromatosis and alcoholic cirrhosis. Tyrosinemia Type I, an inherited disorder in tyrosine metabolism impacting the second enzyme in the heme metabolic pathway is associated with a high risk of developing HCC in younger populations, including children.

[edit] Alcohol as a risk factor for specific cancers

[edit] Alcohol consumption is believed to increase risk

The WCRF panel report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective finds the evidence "convincing" that alcoholic drinks increase the risk of the following cancers: mouth, pharynx and larynx, oesophagus, colorectum (men), breast (pre- and postmenopause).[18]

[edit] Head and neck cancers

Endoscopic image of patient with esophageal adenocarcinoma seen at gastro-esophageal junction.
Endoscopic image of patient with esophageal adenocarcinoma seen at gastro-esophageal junction.

Head and neck cancers, as used in this article, mean cancers of the mouth, esophagus, pharynx and larynx. The U.S. National Cancer Institute states "Drinking alcohol increases the risk of cancers of the mouth, esophagus, pharynx, larynx, and liver in men and women, … In general, these risks increase after about one daily drink for women and two daily drinks for men. (A drink is defined as 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor.) … 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."[19]

The International Head and Neck Cancer Epidemiology (INHANCE) Consortium co-ordinates a meta-study on the issue.[20] A study looking at laryngeal cancer and beverage type concluded, "This study thus indicates that in the Italian population characterized by frequent wine consumption, wine is the beverage most strongly related to the risk of laryngeal cancer."[21]

The American Cancer Society estimates that in 2007, cancer of the oral cavity and pharynx represents 3% of new cancer cases and 7550 deaths. Cancer of the esophagus caused 13,940 deaths and cancer of the larynx 3,660 deaths.[22]

According to Centre for Addiction and Mental Health Principal Investigator Dr. Jürgen Rehm, existing research consistently shows a relationship between alcohol consumption and an increased risk for cancer of the esophagus, larynx and oral cavity. Dr. Rehm and his team analyzed epidemiological literature from 1966 to 2006 to further investigate this association and their results, published in the September issue of the International Journal of Cancer, showed that:

  • The risk of esophageal cancer nearly doubled in the first two years following alcohol cessation, a sharp increase that may be due to the fact that some people only stop drinking when they are already experiencing disease symptoms. However, risk then decreased rapidly and significantly after longer periods of abstention.
  • Risk of head and neck cancer only reduced significantly after 10 years of cessation.
  • After more than 20 years of alcohol cessation, the risks for both cancers were similar to those seen in people who never drank alcohol.[23][24]

Although they are also located in the head or neck, alcohol consumption is not a risk factor for brain cancer, eye cancer, pituitary gland cancer, thymus cancer, salivary gland cancer, thyroid cancer, nasal cavity and paranasal sinus cancer, or adenoid cancer (see below).

[edit] Breast cancer

Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma).
Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma).

Alcohol increases the risk of breast cancer in women. A review 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."[25]

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[26][27] .[28] 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[29][30][31] .[2] " The nature and inconsistency of the evidence has called into question the existence of any causal link between moderate alcohol consumption and breast cancer [1]

The Committee on Carcinogenicity of Chemicals in Food, Consumer Products 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 UK each year could be prevented if drinking was reduced to a very low level (i.e. less than 1 unit/week)."[32]

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 tracked individuals since the 1940s. Data from that research found that drinking alcohol moderately did not increase breast cancer risk.[33] Similarly, research by the Danish National Institute for Public Health found that moderate drinking had virtually no effect on breast cancer risk.[34] Breast cancer constitutes about 7.3% of all cancers.[22] Among women, breast cancer comprises 60% of alcohol-attributable cancers.[35] One study suggests that women who frequently drink red wine may have an increased risk of developing breast cancer.[36]

Alcohol consumption has been shown to increase the rate of breast cancer in women.[37]

A study of 17,647 nurses found that high drinking levels more than doubled risk of breast cancer. "The relative risk of breast cancer was 2.30 … for alcohol intake of 22–27 drinks per week, compared to 1–3 drinks per week. Among alcohol consumers, weekly alcohol intake increased the risk of breast cancer with 2% for each additional drink consumed. Weekend consumption increased the risk with 4% for each additional drink consumed Friday through Sunday." Binge drinking of 4–5 drinks on the last weekday increased risk by 55%.[38]

"The findings from this prospective study suggest that moderate alcohol consumption increases breast cancer risk."[39]

A study showed that one or two alcoholic drinks a day increases the risk of breast cancer by 10 per cent compared with light drinkers who drank less than one drink a day. Women who have three or more drinks a day increase their risk of breast cancer by 30 per cent. The type of drink was not a factor.[40] "A typical 50-year-old woman has a five-year breast cancer risk of about 3 percent. If her risk jumps by 30 percent, her individual risk is still only about 4 percent."[41]

One of the largest studies of its kind has found that alcohol is a substantial risk factor for development of the most common type of breast cancer - the 70% of tumors that are classified as positive for both the estrogen and progesterone receptors (ER+/PR+). Researchers report that even moderate alcohol consumption, defined as one or two drinks per day, increased risk of developing this kind of cancer, and the more a woman drank, the higher her risk. Compared to women who did not drink at all, women who had three or more glasses of alcohol daily had as much as a 51% increased risk of ER+/PR+ breast cancer.[42]

"Deaths from heart disease greatly exceed those caused by breast cancer. Each year more than 500,000 American women die of heart disease, compared with 43,500 who die from breast cancer. According to a large long-term study published in December by the American Cancer Society, having one drink a day raises a woman's risk of dying of breast cancer by 11 percent but diminishes overall mortality by 20 percent because of alcohol's protective effects on the heart. Dr. Smith-Warner and her colleagues noted, however, that there are ways other than drinking alcohol to reduce a woman's cardiac risk, including regular exercise, maintaining a normal body weight, controlling blood pressure and cholesterol, not smoking and taking aspirin."[43] However, this statement should not be taken to conclude that the 9 percent difference allows one to justify alcohol use solely because it is good for your heart. The American Institute for Cancer Research states that while evidence that drinking modest amounts of alcohol is associated with a lower risk for coronary heart disease in men, and perhaps women, drinking higher amounts of alcohol raises the risk of cancer along with risks for high blood pressure, stroke, heart disease, birth defects, inflammation of the pancreas, damage to the brain and heart, malnutrition, osteoporosis, accidents, violence and suicide. The American Institute for Cancer Research further states that there are better ways to decrease your heart disease risk, including exercising, reaching and maintaining a healthy weight, lowering saturated fats and trans fats in your diet, controlling blood pressure and not smoking.[44]

"Folate intake counteracts breast cancer risk associated with alcohol consumption"[45] and "women who drink alcohol and have a high folate intake are not at increased risk of breast cancer".[46] 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.[47] A study of over 17,000 Australian women aged 40-69 over a period of about ten years found that those who consumed 40 grams of alcohol (about three to four drinks) per day have a higher risk of breast cancer than do women who abstain from alcohol. However, in women who take 200 micrograms of folate or folic acid (Vitamin B9) every day, the risk of breast cancer drops below that of alcohol abstainers. [48] See Folic acid for more.

A study on mice suggests that, when breast cancer is established, drinking as little as two alcoholic drinks a day increases the growth rate of tumors. Alcohol causes cancer cells' blood vessels to grow which in turn fuels the growth of the tumor, a process known as angiogenesis.[49]

[edit] Breast cancer in men

Male breast cancer is uncommon and, in Western populations, the incidence is less than one case per 100,000 men.[50] There is no evidence to suggest that the effect of alcohol varies between genders.

"Heavy alcohol intake increases the risk of breast cancer in men."[51] "If you drink heavy amounts of alcohol, you have a greater risk of breast cancer."[52]

[edit] Colorectal cancer

Colectomy specimen containing an invasive colorectal carcinoma (the crater-like, reddish, irregularly-shaped tumor).
Colectomy specimen containing an invasive colorectal carcinoma (the crater-like, reddish, irregularly-shaped tumor).

Colorectal cancer refers to cancers of the colon or rectum. Colorectal cancer constitutes about 9.7% of all cancers.[22] The WCRF panel report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective finds the evidence "convincing" that alcoholic drinks increase the risk of colorectal cancer in men[18] The National Cancer Institute states, "Heavy alcohol use may also increase the risk of colorectal cancer" [53]

The NIAAA reports that, "Epidemiologic studies have found a small but consistent dose-dependent association between alcohol consumption and colorectal cancer[54][55]even when controlling for fiber and other dietary factors.[56][57] 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."[58][59] 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."[60][61][62]

One study found that "While there was a more than twofold increased risk of significant colorectal neoplasia in people who drink spirits and beer, people who drank wine had a lower risk. In our sample, people who drank more than eight servings of beer or spirits per week had at least a one in five chance of having significant colorectal neoplasia detected by screening colonoscopy.".[63]

Other research suggests that "to minimize your risk of developing colorectal cancer, it's best to drink in moderation"[2]

The EPIC study suggests that "people who drink 15 grams of alcohol a day - equivalent to about two units - have about a 10 percent increased risk of bowel cancer. Those who drank more than 30 grams of alcohol - equivalent to three to four units which is less than a couple of pints of strong lager - increased their bowel cancer risk by around 25 per cent." [64][65]

A study found, "The proportion of patients with adenomas was 29.6% in abstainers, 22.1% in moderate drinkers, and 36.7% in heavy drinkers." It concluded "Consumption of less than seven alcohol drinks per week does not increase the risk of having a colorectal adenoma. We found evidence in this study that moderate alcohol consumption among long-term smokers may potentially decrease the risk of an adenoma compared to abstainers."[66]

A Japanese study concluded, "One fourth of colorectal cancer cases in men were attributable to an alcohol intake of ≥23 g/day."[67]

Drinking may be a cause of earlier onset of colorectal cancer.[68]

[edit] Heavy alcohol consumption appears to increase risk

[edit] Liver cancer

Hepatocellular carcinoma in an individual that was hepatitis C positive. Autopsy specimen.
Hepatocellular carcinoma in an individual that was hepatitis C positive. Autopsy specimen.

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."[69][70]

"The chances of getting liver cancer increase markedly with five or more drinks per day" (NCI). (Drinking coffee may reduce the risk. "Coffee drinking was inversely associated with HCC regardless of its aetiology."[71] "These data support the hypothesis that there is an ingredient in coffee that protects against cirrhosis, especially alcoholic cirrhosis."[72])

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% of these cases by some investigators[1][73][2] "Mortality rates of hepatocellular carcinoma (HCC) are high in Italy compared with other Western countries. … Overall, 61% of HCC were attributable to HCV [hepatitis C virus], 13% to HBV [hepatitis B virus], and 18% to heavy alcohol drinking."[74] A study in the province of Brescia, northern Italy concluded, "On the basis of population attributable risks (AR), heavy alcohol intake seems to be the single most relevant cause of HCC in this area (AR: 45%), followed by HCV (AR: 36%), and HBV (AR: 22%) infection."[75]

Liver and intrahepatic bile duct cancers combined account for about 2.8% of all cancers.[22]

[edit] Ovarian cancer

"Associations were also found between alcohol consumption and cancers of the ovary …, but only for 50 g and 100 g a day."[76] "Thus, the results of this study suggest that relatively elevated alcohol intake (of the order of 40 g per day or more) may cause a modest increase of epithelial ovarian cancer risk."[77] "This pooled analysis does not support an association between moderate alcohol intake and ovarian cancer risk."[78]

[edit] Evidence is inconsistent and inconclusive

[edit] Endometrial cancer

An endometrial adenocarcinoma invading the uterine muscle.
An endometrial adenocarcinoma invading the uterine muscle.

"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; that is, drinking was associated with a lower risk of endometrial cancer) "…if such an inverse association exists, it appears to be more pronounced in younger, or premenopausal, women."[79] "Our results suggest that only alcohol consumption equivalent to 2 or more drinks per day increases risk of endometrial cancer in postmenopausal women."[80]

Endometrial plus all other uterine cancers account for about 1.9% of all cancers.[22]

[edit] Gallbladder cancer

"It is concluded that high intake of alcoholic beverages is associated with the development of liver and gall bladder cancers among workers."[81].

A study of female gallbladder cancer patients in Kerala, India found that 10% consumed alcohol.[82] Another study found no relationship between alcohol consumption and the disease.[83]

"There was no clear association between alcohol consumption and the risk. … Drinking may pose an elevated risk among men, but that seems to be less true among women."[84]

[edit] Leukemia

Leukemia (British spelling: leukaemia). There is no association between drinking alcohol and adult leukemia.

“Results from the few studies that have examined the association between alcohol use during pregnancy and childhood leukemia are conflicting,” reported a study that found an association."[85] A review published by the National Cancer Institute placed maternal alcohol consumption during pregnancy in the category of “suggestive” and asserts that it is “unlikely to be an important risk factor.” [86]

Leukemia constitutes about 7.8% of all cancers.[22]

[edit] Lung cancer

"Globally, lung cancer is the most frequent malignancy in males, while it is the fifth most common cancer in females." [2] It is a major cause of death, constituting about 28.8% of all cancers.[22] 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).”[2]

Chronic heavy alcohol consumption possibly increases the risk of lung cancer, but the evidence is inadequate to date.[87] Commenting on a study by Freudenheim et al[88] 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."[89]

[edit] Malignant melanoma

"In interview data from the U.S.A.'s Third National Cancer Survey, alcohol ingestion was associated with a higher occurrence of cancers of the breast, thyroid, and malignant melanoma. Data from other studies support the first two associations."[90] "High alcohol consumption was associated with an increased risk for melanoma, which remained after adjustment for confounders…".[91] Other studies suggest there is no association for melanoma. "The risk of malignant melanoma was not influenced by alcohol consumption or smoking habits."[92] "There was no evidence that … alcohol or polyunsaturated fats were associated with an increased risk."[93]

There is no association between alcohol and Nonmelanoma skin cancer.

[edit] Non-Hodgkin lymphoma (NHL)

Some studies find no association between alcohol and NHL. "Alcohol does not appear to be a major etiologic factor for overall NHL, nor its common subtypes."[94] "NHL was not associated with smoking or alcohol, but collaborative studies could further investigate the risks of rarer WHO subtypes following these exposures."[95]

Some studies suggest a higher risk of NHL from alcohol. "…beer drinkers showed an increased OR of 5.5 (95% 1.1-26.7) in men. It could be concluded that … beer and 'mate' drinking are risk factors for NHL in the Uruguayan population."[96]

Other studies have suggested a protective effect in some groups. "The results of this large-scale European study … did not support an association between tobacco and NHL and suggested a protective effect of alcohol on development of NHL for men and in non-Mediterranean countries."[97] "These data suggest that moderate alcohol consumption is inversely associated with the risk of NHL in older women and the amount of alcohol consumed, rather than the type of alcoholic beverages, appears to be the main effect determinant."[98] In contrast, another study concluded, "These data show that consumption of wine, but not of beer or spirits, is associated with a reduced NHL risk."[99]

A meta-review concluded, "People who drink alcoholic beverages might have a lower risk of NHL than those who do not, and this risk might vary by NHL subtype. Further study designs are needed to determine whether confounding lifestyle factors or immunomodulatory effects of alcohol explain this association."[100]

"In the present study, heavy tobacco smoking, and particularly, heavy alcohol drinking were associated with poor survival in NHL patients. Our findings strongly encourage physicians to advice NHL patients to stop smoking and diminish alcohol consumption to obtain improvements in the course of NHL."[101]

The cancer is the sixth most common in the USA.

[edit] Prostate cancer

"Associations were also found between alcohol consumption and cancers of the ovary and prostate, but only for 50 g and 100 g a day."[76] However, one study concludes, "In contrast to the majority of previous studies, we found a positive association between moderate alcohol consumption and the risk of prostate cancer. Liquor, but not wine or beer, consumption was positively associated with prostate cancer."[102]

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.".[103][104]

Prostate cancer accounts for about 4.8% of all cancers.[22]

[edit] Thyroid cancer

"In interview data from the U.S.A.'s Third National Cancer Survey, alcohol ingestion was associated with a higher occurrence of cancers of the breast, thyroid, and malignant melanoma. Data from other studies support the first two associations."[90] Another study suggests that drinking in moderation significantly reduces the risk of some malignant tumors such as thyroid cancer in women.[105] However, another study concludes, "A reduced risk associated with alcohol was eliminated after adjustment for smoking…".[106]

[edit] Alcohol consumption is not suspected to increase risk

[edit] Bile duct cancer

"The use of alcohol and coffee was not related to risk of extrahepatic bile duct cancer."[107] "We found limited evidence for an excess risk of intrahepatic, but not for extrahepatic, biliary duct cancer."[108]

[edit] Bladder cancer

"Our data suggest that total and beverage-specific alcohol consumption are not associated with an increased risk of bladder cancer."[109] A Dutch study concludes, "The results of this study do not suggest an important association between alcohol consumption and bladder cancer risk."[110] Bladder cancer represents about 2.3% of all cancers.

[edit] Pancreatic cancer

"A few studies have linked chronic heavy drinking with cancers of the stomach, pancreas, and lungs. However, the association is consistently weak and the majority of studies have found no association", write the NIAAA,[2] citing the International Agency for Research on Cancer..[111] Alcohol has been reported as a possible risks in some (but not in most) studies.[112] Drinking alcohol excessively is a cause of acute pancreatitis and chronic pancreatitis. "About 7 out of 10 cases of chronic pancreatitis are due to long term heavy drinking. Chronic pancreatitis is a known risk factor for cancer of the pancreas. But chronic pancreatitis that is due to alcohol doesn't increase risk as much as other types of chronic pancreatitis. So if there is a link with alcohol and pancreatic cancer risk, it is only very slight."[113]

Pancreatic cancer constitutes about 5.7% of all cancers.

[edit] 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).”[2]

Alcohol consumption, even when chronic and heavy, probably does not affect the risk of stomach cancer.[87]

[edit] Vulvar cancer

"No consistent association emerged between milk, meat, liver, alcohol and coffee consumption and risk of vulvar cancer."[114]

[edit] Alcohol consumption might reduce risk

[edit] Hodgkin's lymphoma (HL)

One study concluded, "Our study indicates a protective effect of alcohol consumption for nonsmoking HL cases."[115]

[edit] Kidney cancer (Renal cell carcinoma) (RCC)

"Moderate alcohol consumption was associated with a lower risk of renal cell cancer among both women and men in this pooled analysis."[116] "This pooled analysis found an inverse association between alcohol drinking and RCC. Risks continued to decrease even above eight drinks per day (i.e. >100 g/day) of alcohol intake, with no apparent levelling in risk."[117]

"Results from our prospective cohort study of middle-aged and elderly women indicate that moderate alcohol consumption may be associated with decreased risk of RCC."[118]

A small study concluded that its "findings suggest an inverse association of alcohol consumption and RCC development among women but not among men."[119] Another small study concluded that "No significant relationship emerged, nor any differences between the sexes."[120]

[edit] Alcohol not listed as a risk factor

[edit] Recommended maximum alcohol intake

Main article: Recommended maximum intake of alcoholic beverages

As outlined above, there is no recommended alcohol intake with respect to cancer risk alone as it varies with each individual cancer. See Recommended maximum intake of alcoholic beverages for a list of governments' guidances on alcohol intake which, for a man, range from 140–280g per week.

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)"[122][123]

[edit] Relative health risks

An increase in risk of a particular cancer through drinking needs to balanced against the benefits of moderate drinking on reducing heart attacks. See Alcohol and cardiovascular disease for more. There are, of course, many ways of reducing your risk of a heart attack either without, or in addition to, drinking alcohol, such as controlling your weight, eating an appropriate diet, and exercising. Balancing such risks is a personal decision that should be discussed with one’s own physician.

[edit] References

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  2. ^ a b c d e f g h i j National Institute on Alcohol Abuse and Alcoholism Alcohol and Cancer - Alcohol Alert No. 21-1993
  3. ^ Burden of alcohol-related cancer substantial
  4. ^ IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Volume 44 Alcohol Drinking: Summary of Data Reported and Evaluation
  5. ^ Garro, A.J., and Lieber, C.S. Alcohol and cancer. Annual Review of Pharmacology and Toxicology 30:219-249, 1990
  6. ^ Blot, W.J.; McLaughlin, J.K.; Winn, D.M.; Austin, D.F.; Greenberg, R.S.; Preston-Martin, S.; Bernstein, L.; Schoenberg, J.B.; Stemhagen, A.; and Fraumeni, J.F. Smoking and drinking in relation to oral and pharyngeal cancer Cancer Research 48(11):3282-3287, 1988
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  9. ^ Vishnudutt Purohita, Jag Khalsab, Jose Serranoc Mechanisms of alcohol-associated cancers: introduction and summary of the symposium Alcohol Volume 35, Issue 3, Pages 155-160 (April 2005)
  10. ^ Matsuhashi T, Yamada N, Shinzawa H, Takahashi T Effect of alcohol on tumor growth of hepatocellular carcinoma with type C cirrhosis Intern Med. 1996 Jun;35(6):443-8
  11. ^ Cancer news alert"Study Provides Clues to Alcohol's Cancer Connection"
  12. ^ 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
  13. ^ Wei Tan, Megan Shparago, Amelia P. Bailey and Jian-Wei Gu Equivalent Of 2-4 Drinks Daily Fuels Blood Vessel Growth, Encourages Cancer Tumors In Mice
  14. ^ BBC report Alcohol 'speeds cancer growth'
  15. ^ WSU Researcher’s Work Indicates Alcohol May Hasten Progression of Cancer
  16. ^ Nils Homann, Felix Stickel, Inke R. König, Arne Jacobs, Klaus Junghanns, Monika Benesova, Detlef Schuppan, Susanne Himsel, Ina Zuber-Jerger, Claus Hellerbrand, Dieter Ludwig, Wolfgang H. Caselmann, Helmut K. Seitz Alcohol dehydrogenase 1C*1 allele is a genetic marker for alcohol-associated cancer in heavy drinkers International Journal of Cancer Volume 118, Issue 8, Pages 1998 - 2002
  17. ^ Clues to alcohol cancer mystery 25 May 2008
  18. ^ a b WCRF Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective
  19. ^ Cancer Trends Progress Report - Alcohol Consumption
  20. ^ The International Head and Neck Cancer Epidemiology (INHANCE) Consortium
  21. ^ Garavello W, Bosetti C, Gallus S, Maso LD, Negri E, Franceschi S, La Vecchia C Type of alcoholic beverage and the risk of laryngeal cancer Eur J Cancer Prev 2006 Feb;15(1):69-73.
  22. ^ a b c d e f g h American Cancer Society. Cancer Facts & Figures 2007
  23. ^ Centre for Addiction and Mental Health Alcohol and cancer: is drinking the new smoking?
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