Author: James Anderson

New genetic study confirms that alcohol is a direct cause of cancer Nuffield Department of Population Health

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. 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. By comparison, according to the most recent data from the Centers for Disease Control and Prevention, about 17% of US adults binge drink and 6% report heavy drinking (15 or more drinks a week for men, 8 for women).

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 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. Evidence from Western countries already strongly indicates that alcohol is a direct cause of cancer in the head, neck, oesophagus, liver, colon and breast. But it has been difficult to establish whether alcohol directly causes cancer, or if it is linked to possible confounding factors (such as smoking and diet) that could generate biased results.

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However, they may not reflect the typical serving sizes people may encounter in daily life. Overall, eastern Asia and central and eastern Europe had the highest proportions of cancer cases attributed to alcohol consumption, and northern Africa and western Asia had the lowest. Trends for women differed slightly, with the highest proportions of cancer cases attributed to alcohol consumption found in central, eastern, and western Europe; Australia; and New Zealand.

But studies have only begun to look at the associations between binge drinking and cancer, he added. The study had several limitations, including that it only looked at current alcohol consumption, not past drinking habits, said Dr. Abnet. Surveys worldwide often have not collected information about past alcohol use, “but for a lot of people, there’s a pattern where they drink more heavily when they’re young and moderately as they get older,” he explained. Similarly, for esophageal cancer, the researchers zeroed in on a type called squamous cell carcinoma, which is the only type known to be triggered by alcohol consumption. “This may make the estimates of alcohol-related cancers lower than previous studies, but they’re more precise,” said Dr. Abnet.

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Only a few studies have tried to capture the drinking behaviors of cancer survivors, including those still undergoing treatment, said Dr. Agurs-Collins, who was not involved in this new study. And little has been done to understand how to help those who are heavier drinkers change their behavior. Nearly 750,000 cases of cancer diagnosed worldwide in 2020, or 4%, can be attributed to alcohol consumption, according to a new study from the World Health Organization (WHO).

“If you’re pouring it yourself, a lot of people may not be [doing things like] using a shot glass to make a mixed drink at home. That’s a major concern with excessive alcohol consumption, that people aren’t honest with themselves,” said Dr. Abnet. A serving of alcohol is measured by volume, but the amount of alcohol in a serving can vary greatly depending on the variety or brand of beer or wine or the type of mixed drink or cocktail—as well as how much is poured. “A lot of our surveys just estimate the total number of drinks per week and haven’t differentiated between the person who has one drink a day each week and someone who has 7 drinks just one day a week,” he said. Using blood tests to get a more accurate estimate of true alcohol consumption could also benefit future research, wrote Amy Justice, M.D., Ph.D., of Yale University, in an accompanying editorial. “The sooner we start accurately measuring alcohol exposure, the sooner we can understand the true excess burden of cancer attributable to alcohol and effectively intervene,” Dr. Justice wrote.

1. That said, Dr. DuVall continued, high alcohol use in AYAs who have or had cancer is not necessarily surprising.
2. A study published in 2023 found widespread mistaken beliefs that the risk varies by beverage type, with the lowest cancer risk assigned to wine.
3. Surveys worldwide often have not collected information about past alcohol use, “but for a lot of people, there’s a pattern where they drink more heavily when they’re young and moderately as they get older,” he explained.
4. For example, ethanol can increase estrogen in the body, which increases the risk of breast cancer.
5. The COVID-19 pandemic also appears to have caused a spike in drinking among women in the United States and elsewhere, explained Dr. LoConte.
6. “This may make the estimates of alcohol-related cancers lower than previous studies, but they’re more precise,” said Dr. Abnet.

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. It is important to continue studying cancers linked to alcohol, as patterns of alcohol use continue to shift over time, Dr. Abnet said. For example, in many parts of the world, women have begun drinking more than they used to, he explained. And, he added, if drinking rises within a group, their cancer cases are eventually likely to rise as well. Binge drinking—consuming five or more drinks within a few hours for men or four for women—is also likely more dangerous than any other type of drinking, Dr. Abnet explained.

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Studies have shown that “high-risk behaviors are higher in [AYA] survivors,” Dr. DuVall said. That said, Dr. DuVall continued, high alcohol use in AYAs who have or had cancer is not necessarily surprising. The results, the study team argued, should be a wake-up call for all those involved in cancer care. Alcoholic beverages may also contain a variety of carcinogenic contaminants that are introduced during fermentation and production, such as nitrosamines, asbestos fibers, phenols, and hydrocarbons.

The public is largely unaware of the link between alcohol consumption and increased cancer risk. 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.

More than just light drinking

Since women rarely drink alcohol in China, the main analysis focused on men, a third of whom drank regularly (most weeks in the past year). “The high prevalence of cancer survivors engaged in hazardous drinking highlights the need for immediate interventions,” they wrote. For the study, the research team identified 15,199 participants who, between May 2018 and January 2022, reported a history of cancer on their initial survey. Alcohol can also have more subtle cancer-promoting effects, including impairing the body’s ability to metabolize and absorb a variety of nutrients it needs to prevent cancer. It can also increase blood levels of estrogen, a sex hormone linked to breast cancer, and make the carcinogens found in tobacco smoke easier for the body to absorb. There have been decades of public education campaigns about the health risks of tobacco, warning labels on tobacco products, and smokefree laws.

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. However, some individuals with the defective form of ALDH2 can become tolerant to the unpleasant effects of acetaldehyde and consume large amounts of alcohol. 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. But most Americans aren’t aware of this link, thanks to seemingly contradictory research and mixed messaging from public health experts. A study published in 2023 found widespread mistaken beliefs that the risk varies by beverage type, with the lowest cancer risk assigned to wine.