Alcohol and cancer

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Alcohol psychology

Alcohol use

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Alcohol abuse

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Alcohol consumption and health

Alcohol and cancer Alcohol and weight Alcoholic liver disease Blackouts Effects of alcohol on the body Fetal alcohol syndrome Long-term effects of alcohol

Treatment of alcohol problems

Alcohol education Alcohol detoxification Alcohol rehabilitation Alcoholics anonymous Alateen Alcohol (abstinence) Assessment in alcohol psychology Codependency Drug usage screening Sinclair Method Sobriety

File:Alcohol by Country.png

Total recorded alcohol per capita consumption (15+), in litres of pure alcohol

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

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)."

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. 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, implying a cocarcinogenic interaction between alcohol and tobacco-related carcinogens."

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."

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…"
• induction of CYP2E1
• nutritional deficiencies
• interactions with retinoids
• alcohol and methylation
• alcohol and immune surveillance

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.

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."

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. A 2006 study in mice showed moderate drinking resulted in larger and more robust tumors.

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'.

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…" A European study has found two gene variants which offer "significant" protection against mouth and throat cancers. 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.

Alcohol as a risk factor for specific cancers

Alcohol consumption increases risk

Head and neck cancers

File:Esophageal adenoca.jpg

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."

A WCRF panel found the evidence "convincing" that alcohol can increase the risk of cancers of the mouth, esophagus, pharynx and larynx. The International Head and Neck Cancer Epidemiology (INHANCE) Consortium co-ordinates a meta-study on the issue. 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."

A review of the epidemiological literature published from 1966 to 2006 concluded 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.

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).

Breast cancer

File:BreastCancer.jpg

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

Alcohol is a risk factor for breast cancer. The American Cancer Society lists alcohol as one of over 40 risk factors for the disease. Based on their analyses of the research evidence, the National Cancer Institute and other organizations including Cancer Research UK, the American Society of Clinical Oncology the Mayo Clinic and the Susan G. Komen breast cancer foundation have concluded that alcohol, especially at high levels of consumption, is a risk factor for breast cancer.

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."

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 . 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 . " The nature and inconsistency of the evidence has called into question the existence of any causal link between moderate alcohol consumption and breast cancer 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)."

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. Similarly, research by the Danish National Institute for Public Health found that moderate drinking had virtually no effect on breast cancer risk. Breast cancer constitutes about 7.3% of all cancers. Among women, breast cancer comprises 60% of alcohol-attributable cancers. One study suggests that women who frequently drink red wine may have an increased risk of developing breast cancer.

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

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%.

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

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. "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."

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.

"Folate intake counteracts breast cancer risk associated with alcohol consumption" and "women who drink alcohol and have a high folate intake are not at increased risk of breast cancer". 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. 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. 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.

Studies suggest that drinking alcohol during pregnancy may affect the likelihood of breast cancer in daughters. "For women who are pregnant, ingestion of alcohol, even in moderation, may lead to elevated circulating oestradiol levels, either through a reduction of melatonin or some other mechanism. This may then affect the developing mammary tissue such that the lifetime risk of breast cancer is raised in their daughters."

Breast cancer in men

Male breast cancer is uncommon and, in Western populations, the incidence is less than one case per 100,000 men. 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." "If you drink heavy amounts of alcohol, you have a greater risk of breast cancer."

Heavy alcohol consumption increases risk

Liver cancer

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

Cirrhosis is commonly listed as one of the risk factors for liver cancer. Approximately 5 percent of people with cirrhosis develop the disease. "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 thouight to induce the cancer.

Primary liver cancer can affect anyone, but it occurs most frequently in people with advanced liver diseases. In the United States, the risk is greatest for those with long standing hepatitis B, advanced hepatitis C and cirrhosis. Because hepatitis viruses are so widespread, liver cancer is the second most common cause of cancer death worldwide. "The average age of onset is 60 to 70 years" in the U.S., where "approximately 30% to 40% of patients with liver cancer have no discernible risk factor for liver cancer."

"The cancer is relatively rare in North America and Europe. By contrast, in certain African and East Asian countries, it is the most common of all types of cancer." It's been reported that "Chronic hepatitis B infections cause 80% of all primary liver cancer worldwide."

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."

"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." "These data support the hypothesis that there is an ingredient in coffee that protects against cirrhosis, especially alcoholic cirrhosis.")

"There is compelling epidemiologic data confirming the increased risk of cancer associated with alcohol consumption, which is supported by animal experiments."

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 "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." 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."

Evidence is inconsistent

Colorectal cancer

File:Colon cancer 2.jpg

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

There is a degree of scientific uncertainty about whether alcohol consumption is a risk factor for colorectal cancer, which refers to cancers of the colon and rectum.

The National Institutes of Health,the National Cancer Institute,Cancer Research,, the American Cancer Society, the Mayo Clinic,and the Colorectal Cancer Coalition list alcohol as a risk factor. The M.D. Anderson Cancer Clinic states "Your risk may be higher if you smoke or drink alcohol."

In contrast, the American Society of Clinical Oncology, and the Memorial Sloan-Kettering Cancer Center do not list alcohol as a risk factor.

A WCRF panel report finds the evidence "convincing" that alcoholic drinks increase the risk of colorectal cancer in men at consumption levels above 30 grams of absolute alcohol daily. The National Cancer Institute states, "Heavy alcohol use may also increase the risk of colorectal cancer"

The NIAAA reports that, "Epidemiologic studies have found a small but consistent dose-dependent association between alcohol consumption and colorectal cancereven when controlling for fiber and other dietary factors. Despite the large number of studies, however, causality cannot be determined from the available data."

"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." 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."

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.".

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

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."

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."

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

Drinking may be a cause of earlier onset of colorectal cancer.

Alcohol consumption is not suspected to increase risk

This section lists cancers where alcohol is not thought to be a risk factor but where papers have been published.

Astrocytoma

Alcohol is not listed as a risk factor for astrocytoma.. A study concluded, "Gestational exposure to neurally active medications, alcohol, and tobacco were not risk factors."

Bile duct cancer

Alcohol is not listed as a risk factor for bile duct cancer. .

A study found that, "The use of alcohol and coffee was not related to risk of extrahepatic bile duct cancer.". A study states "We analyzed prospectively the risk for primary liver and extrahepatic biliary tract cancer among 186,395 patients hospitalized with either chronic viral hepatitis, alcoholism, cirrhosis, or any combination of these conditions through linkages between national Swedish registers. Compared with the general population, the relative risk of hepatocellular carcinoma was 34.4 for chronic viral hepatitis alone, 2.4 for alcoholism alone, and 40.7 for cirrhosis alone. Among patients with combinations of these risk conditions, the relative risk of hepatocellular carcinoma was 27.3 for chronic viral hepatitis and alcoholism, 118.5 for chronic viral hepatitis and cirrhosis, 22.4 for alcoholism and cirrhosis, and 171.4 for all 3 conditions. We found limited evidence for an excess risk of intrahepatic, but not for extrahepatic, biliary duct cancer."

Bladder cancer

Alcohol is not listed as a risk factor for bladder cancer.

The research evidence includes a study of over 120,000 subjects in the Netherlands that found no significant relationship between drinking and bladder cancer, a study of high alcohol intake northern Italians tht found no association, even at high levels of consumption, a study in Massachusetts that fouind no association, except that beer significantly reduced bladder cancer risk ." and a study in Los Angeles County that found that "alcohol consumption was strongly associated with reduced risk of bladder cancer."

Central nervous system (CNS) cancers

Alcohol is not listed as a factor for these diseases.

Childhood malignant central nervous system tumours

Studies have examined whether maternal alcohol consumption may play a role in the aetiology of childhood malignant central nervous system (CNS) tumours. "The study does not suggest an increased risk of CNS tumours related to alcohol consumption during pregnancy.". Another such study in Germany similarly found no association between maternal alcohol consumption and CNS tumors.

Cervical cancer

Alcohol is not listed as a risk factor for cervical cancer.

A study concluded "that alcoholic women are at high risk for in situ and invasive cervical cancer" but attributed this to indirect, lifestyle-related reasons.

Ductal carcinoma in situ (DCIS) breast cancer

Alcohol is not a risk factor for DCIS. A study concluded, "DCIS patients and control subjects did not differ with respect to oral contraceptive use, hormone replacement therapy, alcohol consumption or smoking history, or breast self-examination. Associations for LCIS were similar."

Endometrial cancer

File:Endometrial adenocarcinoma gross.jpg

An endometrial adenocarcinoma invading the uterine muscle.

Alcohol is not listed as a risk factor for 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; 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." "Our results suggest that only alcohol consumption equivalent to 2 or more drinks per day increases risk of endometrial cancer in postmenopausal women."

"Considering total alcohol drinking, the relative risk for alcohol drinkers vs. nondrinkers was 1.3 … No relation emerged between duration of alcohol consumption and risk of endometrial cancer. These findings suggest a potential link between alcohol drinking and endometrial cancer risk and are, in any case, inconsistent with a protective role of alcohol in endometrial carcinogenesis."

"We found no association between alcohol consumption and endometrial cancer risk after adjustment for age, body mass index, and smoking. … In conclusion, our results suggest that low alcohol consumption (up to one drink per day) is unlikely to substantially influence risk of endometrial cancer."

Ependymoma

Alcohol is not listed as a risk factor for this cancer.

A review of the literature found that consumption of beer was associated with increased risk in one study but not in another

Fallopian tube cancer

Alcohol is not listed as a risk factor for fallopian tube cancer.

A review of the research found no evidence that drinking is associated with fallopian tube cancer.

Gallbladder cancer

Alcohol is not listed as a risk factor for gallbladder cancer.

The evidence includes studies such as the following: "It is concluded that high intake of alcoholic beverages is associated with the development of liver and gall bladder cancers among workers.". A study of female gallbladder cancer patients in Kerala, India found that 10% consumed alcohol. Another study found no relationship between alcohol consumption and the disease."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."

Inflammatory breast cancer

Inflammatory is the most aggressive and lethal breast cancer Alcohol is not a risk factor for this disease.

Alcohol was not identified as a risk factor in two recent reviews of the research literature.

Intraocular and uveal melanomas

Alcohol is not a risk factor for intraocular or uveal melanomas. A study found no association between alcohol and uveal melanoma.

Leukemia

Alcohol is not listed as a risk factor for leukemia (British spelling leukaemia)

For additional information, see acute lymphocytic leukemia (ALL), acute myleoid leukemia (AML), chronic lymphocytic lymphoma (CLL), chronic myeloid leukemia (CML), eolsino;hilic leukemia, B-cell leukemia, T-cell leukemia, and hairy cell leukemia.

A sample of research includes the following:“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." 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.”

Acute Lymphocytic Leukemia (ALL)

Alcohol is not listed as a risk factor for ALL.

For ALL in children, maternal alcohol consumption during pregnancy is "unlikely to be an important risk factor for ALL"

Acute myeloid leukemia (AML)

Alcohol is not listed as a risk factor for AML.

A study concluded, "In conclusion, even though our study did not show a clear association between alcohol intake and leukemia risk, some of the patterns of the risk estimates (a possible J-shaped dose-response curve between alcohol intake and ALL, AML, and CLL risks, and the positive association between alcohol and CML), may be suggestive."

Childhood AML

"Three studies have reported an increased risk (approximately 1.5-2 fold) in mothers who drank alcoholic beverages during pregnancy. These associations have been particularly apparent in children diagnosed younger than three years of age.".

"Maternal alcohol consumption during pregnancy increases the risk of infant leukemia, especially AML."

Acute non-lymphocytic leukemia (ANLL)

A study concluded, "… maternal use of alcohol during pregnancy was associated with a more than two-fold increased risk of ANLL. … There was no significant elevation in risk for ANLL found for parental use of alcohol 1 year before pregnancy. This study suggests that intrauterine exposure to alcohol may increase the risk for childhood ANLL.

Chronic Lymphocytic Leukemia (CLL)

Alcohol is not listed as a risk factor for CLL.

A study concluded, "In conclusion, even though our study did not show a clear association between alcohol intake and leukemia risk, some of the patterns of the risk estimates (a possible J-shaped dose-response curve between alcohol intake and ALL, AML, and CLL risks, and the positive association between alcohol and CML), may be suggestive."

Chronic myeloid leukemia (CML)

Alcohol is not listed as a risk factor for CML.

A population-based case-control study in Italy found a non-significant positive association between drinking and CML.

Hairy cell leukemia

Alcohol is not listed as a risk factor for hairy cell leukemia Hairy cell leukemia.

A study concluded, "There was no association found for cigarette smoking, alcohol or coffee consumption and hairy cell leukemia."

Lung cancer

Alcohol is not listed as a risk factor for lung cancer.

The National Institute on Alcohol Abuse and Alcoholism reports that “A few studies have linked chronic heavy drinking with cancers of the ...lungs. However, the association is consistently weak and the majority of studies have found no association.”

Commenting on a study by Freudenheim et al 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."

Melanoma

Alcohol is not listed as a risk factor for 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." "High alcohol consumption was associated with an increased risk for melanoma, which remained after adjustment for confounders…". Other studies suggest there is no association for melanoma. "The risk of malignant melanoma was not influenced by alcohol consumption or smoking habits." "There was no evidence that … alcohol or polyunsaturated fats were associated with an increased risk."

There is no association between alcohol and Nonmelanoma skin cancer.

Multiple myeloma (MM)

Alcohol is not listed as a risk factor for multiple myleoma.

A study concluded, "For MM, ever drinkers had a non-significantly decreased risk than non-drinkers…"

Nasopharynageal cancer / Nasopharyngeal carcinoma (NPC)

Alcohol is not listed as a risk factor for nasopharyngeal cancer

A study of over 61,320 Singapore Chinese concluded, "alcohol consumption were not associated with NPC risk. In contrast, smoking duration, smoking intensity, age at smoking initiation, and alcohol consumption all were associated with an increased risk of other oropharyngeal carcinoma. Smoking and alcohol influenced the risk of NPC and other oropharyngeal carcinomas differently in a high-incidence NPC population. Long-term smoking was a risk factor for NPC, but alcohol consumption was not." A Taiwanese study concluded, "Alcohol consumption was not associated with NPC risk." A Chinese study made bo mention of alcohol as a risk factor.

Neuroblastoma

Alcohol is not listed as a risk factor for this cancer.

A study concluded "… the results from this study do not indicate any evidence for a relationship between neuroblastoma and parental tobacco or alcohol use."

Oral malignant melanoma

Alcohol is not listed as a risk factor for this cancer.

An extensive review of the research found no evidence that alcohol is associated with oral malignant melanoma

Ovarian cancer

Alcohol is not listed as a risk for ovarian cancer.

A pooled analysis of ten (10) prospective cohort studies conducted in a number of countries and including 529,638 women found that neither total alcohol consumption nor alcohol from drinking beer, wine or spirits was associated with ovarian cancer risk.." The results of a case-control study in the region of Milan, Italy, "suggests 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" and a review of the literature reported that associations were fouind between alcohol and cancers of the ovary but only at heavy consumption levels of 50 g and 100 g per day."

Pancreatic cancer

Some sources do not list alcohol as a risk for pancreatic cancer.

Cancer Research UK states, "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."

"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, citing the International Agency for Research on Cancer.. Alcohol has been reported as a possible risks in some (but not in most) studies. Drinking alcohol excessively is a cause of acute pancreatitis and chronic pancreatitis.

"Chronic heavy alcohol consumption is a risk factor for pancreatitis, but evidence for an association with pancreatic cancer is inconsistent. Overall, research suggests an increased risk in heavy drinkers , but no increased risk for people consuming up to 30g of alcohol a day."

A study found, "An index of total alcohol consumption showed a greater than two-fold risk for pancreatic cancer for heavy alcohol consumption (four or more drinks per day), primarily due to heavy beer and hard liquor consumption.

"Our findings indicate that alcohol drinking at the levels typically consumed by the general population of the United States is probably not a risk factor for pancreatic cancer. Our data suggest, however, that heavy alcohol drinking may be related to pancreatic cancer risk."

The Iowa Women's Health Study found that, "Relative risks of pancreatic cancer increased with the amount of alcohol consumed (Ptrend = 0.11) after adjustment for age, smoking status, and pack-years of smoking."

"Cases [people with pancreatic cancer] drank significantly more beer than controls (p = 0.005) and there was evidence of a positive trend in risk with total alcohol consumption."

A Swedish study found "Alcoholics had only a modest 40% excess risk of pancreatic cancer … The excess risk for pancreatic cancer among alcoholics is small and could conceivably be attributed to confounding by smoking."

A British study stated, "It was shown that the relative risk of cancer of the pancreas increases with fat and alcohol intakes, … Alcohol may be not directly involved in the aetiology of cancer of the pancreas: its effect could be due to the contents of some alcoholic beverages."

A Dutch study found that, "When compared with data from non-drinkers, the cumulative lifetime consumption of all types of alcohol in grams of ethanol … beer, spirits, red wine and fortified wine was not related to risk. The consumption of white wine was inversely associated with risk …. The uniformly reduced risk estimates for the lifetime number of drinks of white wine were based on small numbers …."

A Polish study concluded, "The findings regarding alcoholic beverages were overall null, although the weakly positive trend in risk with spirits consumption (p = 0.71) may deserve further investigation in view of the special nature of the source of spirits (vodka) in Poland."

"For the most part, consumption of total alcohol, wine, liquor and beer was not associated with pancreatic cancer."

"Data from these two large cohorts do not support any overall association between coffee intake or alcohol intake and risk of pancreatic cancer."

Penile cancer

Alcohol is not a risk factor for penile cancer

Prostate cancer

Alcohol is not listed as a risk factor for prostate cancer.

"Data from the Health Professionals Follow-Up Study showed only a weak association between overall alcohol intake and prostate cancer risk, and no association at all between red wine intake and prostate cancer risk."

"A meta-analysis published in 2001 found a small but significant increased risk for men drinking more than 50 g/day of alcohol, with a slightly higher risk for men consuming more than 100 g/day. Since that analysis, cohort studies in America have found increased risks for men drinking moderate amounts of spirits, and for ‘binge drinkers, but moderate consumption of beer or wine has not been linked to an increased risk."

"Associations were also found between alcohol consumption and cancers of the ovary and prostate, but only for 50 g and 100 g a day." 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."

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.".

Retinoblastoma

Alcohol is not a risk factor for this genetic cancer.

A review of the literature found no evidence that alcohol consumption is a risk factor for this disease

Salivary gland cancer (SGC)

Alcohol is not listed as a risk factor for salivary gland cancer.

A study concluded, "These findings show that smoking, alcohol consumption, and most occupational exposures are unrelated to SGC."

Small intestine cancer

Alcohol is not listed as a risk factor for small intestine cancer.

A study of small intestine cancer patients reported that alcohol consumption was associated with adenocarcinomas and malignant carcinoid tumors.

"Heavy ethanol intake (>80 g a day) was also a risk factor in both men and women, with no increased risk associated with lower levels of ethanol intake, reported a study of patients in Los Angeles County (US)."

"Alcohol and tobacco consumption did not increase the risk of adenocarcinoma of the small intestine. … While the present data are inconsistent with a major effect of tobacco or alcohol, a moderate association between these factors and small bowel cancer may have been obscured by the play of chance."

"Tobacco and alcohol consumption were unrelated to risk of small intestine cancer…"

Stomach cancer

Alcohol is not listed as a risk factor for stomach cancer.

That research includes studies such as these:"While alcohol has been extensively studied as a cause of stomach cancer there is no conclusive evidence that it increases risk. However, results from at least three studies suggest that heavy alcohol consumption may increase the risk of stomach cancer in heavy smokers."

A Taiwanese study concluded, "… cigarette smoking may play the most harmful role in the initial development of gastric cancer, and that drinking alcohol may promote the process."

A Norwegian study found that, "No statistically significant associations between various degrees of exposure to alcohol and risk of gastric cancer was revealed, but combined high use of cigarettes (>20/day) and alcohol (>5 occasions/14 days) increased the risk of noncardia gastric cancer nearly 5-fold (HR = 4.90 [95% CI = 1.90-12.62]), compared to nonusers."

Testicular cancer

Alcohol is not listed as a risk factor for testicular cancer.

A review concluded that "There is no firm evidence of a causal relation between behavior risks [tobacco, alcohol and diet] and testicular cancer."

Thyroid cancer

Alcohol is not listed as a risk factor for 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." Another study suggests that drinking in moderation significantly reduces the risk of some malignant tumors such as thyroid cancer in women. However, another study concludes, "A reduced risk associated with alcohol was eliminated after adjustment for smoking…".

Vaginal cancer

Alcohol is not listed as a risk factor for vaginal cancer.

A Danish study found that "Abstinence from alcohol consumption was associated with low risk for both VV-SCC_vagina and VV-SCC_vulva in our study."

A study concluded that alcoholic women are at high risk for cancer of the vagina. In both studies, indirect, lifestyle-related reasons were cited.

Vulvar cancer

Alcohol is not listed as a risk factor for vulvar cancer

The research includes studies such as the following: A study that reported "No consistent association emerged between milk, meat, liver, alcohol and coffee consumption and risk of vulvar cancer." A Danish study that found that "Abstinence from alcohol consumption was associated with low risk for both VV-SCC_vagina and VV-SCC_vulva in our study." And a Swedish study that concluded concluded that alcoholic women are at no higher risk for cancer of the vulva.

Alcohol consumption might reduce risk

Hodgkin's lymphoma (HL)

A multi-center case-control study of subjects in Spain, Italy, Ireland, Germany, France, and the Czech Republic found results "consistent with previous studies, suggesting a protective effect of alcohol on HL." A population based case-control study in Germany found that alcohol reduced the risk of HL for both men and women but more so for men, whose risk was lowered by 53%.

A population-based case-control study in Italy reported a protective effect of alcohol consumption on risk of HL among non-smokers. Analysis of data from a series of case-control studies in Northern Italy revealed a modest positive effect of alcohol on lowering risk of HL among both smokers and non-smokers.

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" "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."

A study concluded, "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." Researchers who conducted a study in Iowa reported that "In this population-based case-control investigation, we report further evidence that alcohol consumption decreases the risk of RCC among women but not among men. Our ability to show that the association remains after multivariate adjustment for several new confounding factors Ii.e., diet, physical activity, and family history) strengthens support for a true association.

Another study found no relationship between alcohol consumption and risk of kidney cancer among either men or women.

A Finnish study concluded, "These data suggest that alcohol consumption is associated with decreased risk of RCC in male smokers. Because most of the risk reductions were seen at the highest quartile of alcohol intake and alcohol is a risk factor for a number of cancers particularly among smokers, these data should be interpreted with caution." "Our data suggest an inverse association between alcohol intake and risk of renal cell cancer …" Compared with nondrinkers, men who drank one or more drinks per day had a 31% lower risk of kidney cancer among 161,126 Hawaii-Los Angeles Multiethnic Cohort participants.

Non-Hodgkin lymphoma (NHL)

Alcohol is not listed as a risk factor for non-Hodgkin's lymphoma (NHL).

A pooled analysis of data from nine (9) case-control studies from the US, the UK, Sweden and Italy found that men and women who drank alcohol had a lower risk of NHL than did those who did not drink, but the risk didn't decrease with increasing alcohol consumption. ." "Compared with nondrinkers, alcohol consumers had a lower risk for non-Hodgkin's lymphoma overall … and for its main subtypes." A study concluded, "Nonusers of alcohol had an elevated NHL risk compared with users…"

Some studies have found a protective effect on NHL of drinking some forms of alcoholic beverage or in some demographic groups. A study of men in the US found that consumption of wine, but not beer or spirits, was associated with a reduced NHL risk and a large European study found a protective effect of alcohol among men and in non-Mediterranean countries.." A study of older women in Iowa found alcohol to reduce the risk of NHL and the amount of alcohol consumed, rather than the type of alcohollic beverages, appeared to be the main determinant in reducing risk. ."

Some studies have not found a protective effect from drinking. Research in England found no association between frequency of drinking and NHL and research in Sweden found that total beer, wine, or liquor intake was not associated with any major subtype of NHL examined, apart from an association between high wine consumption and increased risk of chronic lymphocytic leukemia.."

One study found alcohol to be a risk factor for NHL.

One study of NHL patients concluded, "Our findings strongly encourage physicians to advice NHL patients to stop smoking and diminish alcohol consumption to obtain improvements in the course of NHL."

Alcohol not listed as a risk factor

This section lists cancers where alcohol is not thought to be a risk factor but where published papers have not yet been found.

Adenoid cancer [2] [3] Adrenal gland cancer [4] Anal cancer [5] Appendix cancer B-cell Leukemia [6] Bartholin's gland cancer Carol A. Johnson, Bartholin's gland cancer, American Family Physician, April, 1989. Basal cell carcinoma [7] Bone cancer [8] Brain cancer [9] Carotid body tumor [10] Central nervous system cancer (craniopharyngioma) [11] Chordoma [12] Crangiopharyngioma [http://www.cancer.net/patient/Cancer+Types/Crangiopharyngioma+-+Childhood Chrondosarcoma [13] Demoplastic infantile ganglioma [14] Eosinophilic leukemia [15] Ewing family of tumors [16] Extragonal germ cell cancer [17] Eye cancer [18] [19] Eyelid cancer [20] Gastrointestinal carcinoid tumors [21] Gastrointestinal stromal cell tumors [22] Germ cell tumor of the brain [23] Hereditary breast cancer [24] Kaposi's sarcoma [25]

Lacrimal gland cancer [26] Malignant mesothelioma [27] Medulloblastoma [28] Meninglioma [29] Metaplastic breast cancer [30] Nasal cavity and paranasal sinus cancer [31] Oliodendroglioma [32] Osteosarcoma [33] Paraganglioma [34] Parathyroid cancer Pineal region tumor [35] Pituitary gland cancer [36] Pleuropulmonary blastoma [37] Sebaceous gland carcinoma [38] Sipple's syndrome [39] Skin cancer [40] Soft tissue cancers [41] Spine or spinal cancer [42] Squamous cell carcinoma [43] T-cell leukemia [44] Thymus cancer [45] Transitional cell cancer of renal pelvis and ureter [46] Urethra or urethral cancer [47] Verrucous carcinoma [48] Wilms tumor [49]

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)"

References

• International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol. 44. United Kingdom: World Health Organization, 1988.

External links

Government and international bodies

• International: International Agency for Research on Cancer home page
• Australia: Cancer Control Bulletin Alcohol and cancer risk
• Australia: POSITION STATEMENT: Alcohol and Cancer Prevention
• Australia: Cancer Institute NSW: Alcohol as a cause of Cancer (PDF format)
• Canada: Public Health Agency of Canada / Agence de santé publique du Canada Review of Lifestyle and Environmental Risk Factors for Breast Cancer (Contents and Introduction) PDF (full report in PDF format)
• UK: Committee on Carcinogenicity of Chemicals in Food, Consumer Products Consumption of alcoholic beverages and risk of breast cancer
• UK: Committee on Carcinogenicity of Chemicals in Food, Consumer Products Evidence for association between consumption of alcoholic beverages and breast cancer
• US: National Institute on Alcohol Abuse and Alcoholism Alcohol Alert No. 21-1993 Alcohol and cancer
• US: National Cancer Institute
• US: National Toxicology Program Report on Carcinogens, Eleventh Edition Alcoholic Beverage Consumption (PDF)
• US: Ohio Department of Health Alcohol and cancer (PDF format)

Cancer charities

• Australia: The Cancer Council Australia Alcohol and cancer prevention
• Australia: The Cancer Council Victoria Alcohol & cancer risk
• Australia: Cancer Council New South Wales Alcohol and Cancer
• New Zealand: Cancer Society of New Zealand Alcohol and cancer
• United Kingdom: Cancer Research UK: Alcohol and cancer
• United Kingdom: Cancer Research UK: Alcohol and cancer: the evidence
• USA: American Cancer Society "Alcohol Increases Hormone Levels, Raising Breast Cancer Risk"

Other sites

• Toronto Cancer Prevention Coalition Alcohol Work Group Report on the Links between Alcohol and Cancer (PDF format)
• Alcohol in Moderation Alcohol & Cancer
• Alcohol and Cancer
• Alcohol consumption and cancer risk

Science sites

• Fred Hutchinson Cancer Research Center Alcohol Use Increases the Risk of Hormonally Sensitive Breast Cancers in Postmenopausal Women