These amounts are used by public health experts in developing health guidelines about alcohol consumption and to provide a way for people to compare the amounts of alcohol they consume. However, they may not reflect the typical serving sizes people may encounter in daily life. Nearly 4% of cancers diagnosed worldwide in 2020 can be attributed to alcohol consumption, according to the World Health Organization. In the United States alone, about 75,000 cancer cases and 19,000 cancer deaths are estimated to be linked to alcohol each year. Researchers and health professionals can do more to help break down these misconceptions, Dr. LoConte added. “We need to really make sure that we reinforce the message that all alcohol increases cancer risk,” she said.
- Ethanol’s metabolite acetaldehyde can cause DNA damage and block DNA synthesis and repair, whilst both ethanol and acetaldehyde can disrupt DNA methylation.
- And because of the study’s nature, it can also create certain “biases” in the data that may affect its accuracy or how relevant it is to the larger population of people with cancer and long-term survivors.
- Epidemiologic studies have shown that such individuals have a higher risk of alcohol-related esophageal cancer, as well as of head and neck cancers, than individuals with the fully active enzyme who drink comparable amounts of alcohol (31).
- Significant knowledge gaps on the impact of alcohol use (and cessation) among cancer patients and survivors remain.
- The oxidative metabolism of ethanol to acetaldehyde by alcohol dehydrogenase (ADH), and at high blood alcohol concentrations by ethanol-inducible cytochrome P4502E1 (CYP2E1) and catalase, also appears to play a role in carcinogenesis (10).
The study confirmed that most American adults aren’t aware of the link between alcohol consumption and cancer. It also found that, even among those who are aware, there’s a belief that it varies by the type of alcohol. For example, more participants were aware of the cancer risks from hard liquor and beer than about the risk from wine, with some participants believing wine lowers your cancer risk. The study also found that people who believed drinking alcohol increased the risk of heart disease were more aware of the alcohol–cancer risk than those who were unsure or believed drinking lowered the effect on heart risk.
Report Details Alcohol’s Global Cancer Burden
The mechanisms by which alcohol consumption may decrease the risks of some cancers are not understood and may be indirect. The results remained the same when the data were adjusted for other cancer risk factors, such as smoking, diet, physical activity, body mass and family history of cancer. Dr. LoConte said that she has direct conversations with her patients about drinking and other behaviors that could affect their treatment.
But the potential threat it poses to people with cancer and longer-term survivors has largely been overlooked, explained Tanya Agurs-Collins, Ph.D., of the Behavioral Research Program in NCI’s Division of Cancer Control and Population Sciences. Overall, about 12,000 people in this group reported that they drink alcohol, and nearly 40% reported engaging in hazardous drinking—that is, repeated excessive alcohol use. Of those who may have been actively undergoing treatment for cancer, about 75% drank alcohol, many heavily.
Despite substantial epidemiological and mechanistic evidence on alcohol and cancer, several knowledge gaps remain that if filled could improve estimates of the burden of alcohol-attributable cancers, and inform tailord interventions to reduce consumption. The researchers categorized alcohol use based on responses to several alcohol-specific questions. They also used an assessment tool, called AUDIT-C, that was developed to study drinking behavior. Using the data from All of Us does come with some limitations, they acknowledged, including that cancer diagnoses were self-reported and couldn’t be verified in every case. And because of the study’s nature, it can also create certain “biases” in the data that may affect its accuracy or how relevant it is to the larger population of people with cancer and long-term survivors. The fact that drinking alcohol can cause cancer has received increasing attention in the past few years.
The accumulation of acetaldehyde has such unpleasant effects (including facial flushing and heart palpitations) that most people who have inherited the ALDH2 variant are unable to consume large amounts of alcohol and therefore have a low risk of developing alcohol-related cancers. People who said they had searched for cancer information were more likely to know about the cancer risks posed by drinking beer and by drinking liquor than those who did not. But awareness of the risk from drinking wine was similar in both those who had and hadn’t sought cancer information. Participants in the survey are a nationally representative sample of adults aged 18 and older. The nearly 4,000 people who took part in the survey were asked how much does drinking several types of alcohol (wine, beer, and liquor) affect the risk of getting cancer. Alcoholic drinks contain ethanol, which is a known carcinogen, and there are several ways in which it may cause cancer.
Increasing awareness through different approaches
However, the federal government retained power to regulate alcohol through control of foreign and inter-state commerce, federal taxes, federal property, and financial incentives. Binge drinking was most common among men, people under the age of 50, and former and current smokers. Among those who drank, binge and hazardous drinking was also much more common in those diagnosed and treated for cancer before the age of 18. For example, one way the body metabolizes alcohol is through the activity of an enzyme called alcohol dehydrogenase, or ADH, which converts ethanol into the carcinogenic metabolite acetaldehyde, mainly in the liver. Recent evidence suggests that acetaldehyde production also occurs in the oral cavity and may be influenced by factors such as the oral microbiome (28, 29).
For example, a Canadian container label intervention demonstrated a 10% greater increase in knowledge of alcohol as a carcinogen in the intervention vs. the comparison group two months post-intervention (40). Another study found that using multiple and diverse information sources can reduce alcohol use intentions as compared to reliance on a single source (41). A high proportion of American adults, both drinkers and non-drinkers (35), are unaware of the association 11 natural remedies for erectile dysfunction ed between alcohol consumption and cancer risk. However, the fact that most Americans are unaware of the association suggests effective evidence-based strategies are needed to increase awareness, encourage informed decision making, modify health behavior, and develop policies to reduce consumption. In the study, many people being treated for cancer and longer-term cancer survivors reported regularly drinking alcohol—many moderately, but some also heavily and often.
Participants can also allow access to their electronic health records (with all identifying information removed), providing important insights on treatments received and other relevant health information. To conduct the study, the researchers used data from more than 15,000 people with a history of cancer who were participating in the National Institutes of Health All of Us Research Program. A person’s risk of alcohol-related cancers is influenced by their genes, specifically the genes that encode enzymes involved in metabolizing (breaking down) alcohol (27). The first mutation is a loss-of-function mutation in the gene for the enzyme aldehyde dehydrogenase 2 (ALDH2). The oxidative metabolism of ethanol to acetaldehyde by alcohol dehydrogenase (ADH), and at high blood alcohol concentrations by ethanol-inducible cytochrome P4502E1 (CYP2E1) and catalase, also appears to play a role in carcinogenesis (10).
Susan M. Gapstur
In this review, we summarise the epidemiological evidence on alcohol and cancer risk and the mechanistic evidence of alcohol-mediated carcinogenesis. There are several mechanistic pathways by which the consumption of alcohol, as ethanol, is known to cause cancer, though some are still not fully understood. Ethanol’s metabolite acetaldehyde can cause DNA damage and block DNA synthesis and repair, whilst both ethanol and acetaldehyde can disrupt DNA methylation. Ethanol can also induce inflammation and oxidative stress leading to lipid peroxidation and further DNA damage. Further understanding of the carcinogenic properties of alcohol and its metabolites will inform future research, but there is already a need for comprehensive alcohol control and cancer prevention strategies to reduce the burden of cancer attributable to alcohol. Interactions with clinicians could affect alcohol consumption behavior, as they are relatively trusted sources of health information (45).
Studies have shown that “high-risk behaviors are higher in [AYA] survivors,” Dr. DuVall said. The results, the study team argued, should be a wake-up call for all those involved in cancer care. But results from a new study suggest that this information may not be reaching faqs what are fentanyl test strips people who fall into either of these two categories. More research is needed to understand some of the disparities seen in this study, such as with age, Dr. LoConte said. “We need to better understand these root causes and how best to address them,” she said.
Effects of alcohol consumption before, during, and after treatment on cancer outcomes
The induction of CYP2E1 can activate procarcinogens, leading to the formation of reactive oxygen species which react with cellular lipids to form mutagenic DNA adducts, and DNA damage (10). Acetaldehyde can interfere with DNA synthesis and repair, form DNA-adducts, and cause cytotoxicity and mutagenicity (10). “I try to normalize asking [patients] things like, if they’re drinking, how much and how they feel it affects them,” she explained.
Increased awareness of the alcohol-cancer link might encourage some people to warn family and friends about consumption, although the efficacy of such communication on behavior is unclear. Given the study’s findings, “there’s also a need to better understand why so many cancer survivors have such high alcohol consumption,” she continued. The study team used DNA samples from approximately 150,000 participants (roughly 60,000 men and 90,000 women) in the China Kadoorie Biobank study and measured the frequency of the low-alcohol tolerability alleles how long does ecstasy last for ALDH2 and ADH1B. The data were combined with questionnaires about drinking habits completed by participants at recruitment and subsequent follow-up visits. The participants were tracked for a median period of 11 years through linkage to health insurance records and death registers. To address these unknowns, researchers from Oxford Population Health, Peking University and the Chinese Academy of Medical Sciences, Beijing, used a genetic approach by investigating gene variants linked to lower alcohol consumption in Asian populations.
A large meta-analysis of 23 health outcomes showed that the number of daily alcohol beverages that minimized harm overall was 0 (95% uncertainty interval 0.00–0.08) (2). However, some individuals with the defective form of ALDH2 can become tolerant to the unpleasant effects of acetaldehyde and consume large amounts of alcohol. Epidemiologic studies have shown that such individuals have a higher risk of alcohol-related esophageal cancer, as well as of head and neck cancers, than individuals with the fully active enzyme who drink comparable amounts of alcohol (31). These increased risks are seen only among people who carry the ALDH2 variant and drink alcohol—they are not observed in people who carry the variant but do not drink alcohol.