Author: Alex Thompson

Awareness of Alcohols Link to Cancer Lagging NCI

The 2020–2025 Dietary Guidelines for Americans recommends that adults of legal drinking age can choose not to drink, or to drink in moderation (two drinks or less in a day for men or one drink or less in a day for women). 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. When you drink alcohol, your body breaks it down into a chemical called acetaldehyde. DNA is the cell’s “instruction manual” that controls a cell’s normal growth and function. When DNA is damaged, a cell can begin growing out of control and create a cancer tumor.

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). 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. There likely are additional cancers linked to drinking alcohol, Dr. Orlow says, but more well-designed studies (epidemiological and other) are needed to prove that alcohol is a contributing risk factor.

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. Alcoholic drinks contain ethanol, which is a known carcinogen, and there are several ways in which it may cause cancer. For example, ethanol can increase estrogen in the body, which increases the risk of breast cancer.

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Community strategies can help communities create environments that reduce excessive alcohol use. More research is needed to understand some of the disparities seen in this study, such as with age, Dr. LoConte said. 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. But the All of Us study, Dr. Cao and her colleagues explained, offered a unique opportunity to take a robust look at people in these groups in the United States.

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. The mechanisms by which alcohol consumption may decrease the risks of some cancers are not understood and may be indirect. Print and video campaigns are one approach that has been used to raise awareness. Public health campaigns about the cancer risk posed by alcohol in England and Australia have been effective at raising awareness with their target audiences.

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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. Another study published in 2021 showed that nearly 70% of people did not even know that alcohol was a cancer risk factor.

Nevertheless, the research team also asked participants about the purported heart health benefits of alcohol, to see if it was related to their awareness about alcohol and cancer risk. For people being treated for cancer, regularly consuming a few beers or cocktails also has other potentially harmful consequences, including making their treatments less effective. And for longer-term cancer survivors, there is some evidence that regular alcohol use may increase the chances of their cancer returning. There is strong and consistent evidence that drinking alcohol increases your risk of developing a cancer, based on a growing body of research. Alcohol is estimated to account for 6% of cancer cases in the U.S. — more than 75,000 per year — and nearly 19,000 cancer deaths, according to the American Cancer Society. Alcohol is the third biggest controllable risk factor for the disease, after tobacco smoking and excess weight.

Smaller studies, including several conducted in Europe, have found potentially harmful drinking behaviors among both people being treated for cancer and longer-term survivors. 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. According to the federal government’s Dietary Guidelines for Americans, 2020–2025, individuals who do not drink alcohol should not start drinking for any reason. The Dietary Guidelines also recommends that people who drink alcohol do so in moderation by limiting consumption to 2 drinks or less in a day for men and 1 drink or less in a day for women. Heavy alcohol drinking is defined as having 4 or more drinks on any day or 8 or more drinks per week for women and 5 or more drinks on any day or 15 or more drinks per week for men.

1. Understanding these risks would lead to more fully informed decisions about alcohol use among individuals and families, including cancer survivors and those with a family cancer history.
2. Dr. Klein noted, “[In] less than half a century, we’ve seen major changes in the way people think about tobacco.”
3. Among people of Japanese descent, those who have this form of ADH have a higher risk of pancreatic cancer than those with the more common form of ADH (30).
4. The researchers categorized alcohol use based on responses to several alcohol-specific questions.
5. And although people who identified as Hispanic were less likely than White participants to report drinking alcohol, those who did drink were more likely to drink heavily.
6. When you drink alcohol, your body breaks it down into a chemical called acetaldehyde.

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. The fact that drinking alcohol can cause cancer has received increasing attention in the past few years. Many individuals of East Asian descent carry a version of the gene for ADH that codes for a “superactive” form of the enzyme. This superactive ADH enzyme speeds the conversion of alcohol (ethanol) to toxic acetaldehyde. Among people of Japanese descent, those who have this form of ADH have a higher risk of pancreatic cancer than those with the more common form of ADH (30). 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.

Why Does Alcohol Use Raise Cancer Risk?

The researchers cited the change in public perceptions and tighter regulations for tobacco, which show the importance of public health campaigns and physicians explaining risks to their patients. Dr. Klein noted, “[In] less than half a century, we’ve seen major changes in the way people think about tobacco.” Nearly 4% of cancers diagnosed worldwide in 2020 can be attributed to alcohol consumption, according to the World Health Organization.

How does the combination of alcohol and tobacco affect cancer risk?

Some studies show that drinking three or more alcoholic drinks per day increases the risk of stomach and pancreatic cancers. There is also evidence that drinking alcohol increases the risk for prostate cancer. All alcoholic drinks, including red and white wine, beer, and liquor, are linked with cancer. 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).

Report Details Alcohol’s Global Cancer Burden

The researchers could not verify, however, if the drinking occurred during treatment. Of people who reported a history of cancer, 11,815 (78%) said they drank alcohol. 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.

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. Greater collaboration with other specialties and clinicians who regularly interact with people with cancer, such as oncology nurses, to develop ways to reduce risky drinking behaviors will be needed moving forward, Dr. Agurs-Collins said.