Exploring the Connection Between Alcohol Use and Cancer Risk

Accumulating Evidence

Multiple studies published in recent years explored associations between alcohol consumption and a range of cancer types. Using data from more than 5 million people aged 20 to 49 years in the Korean National Health Insurance Service database, a population-based study published in 2023 examined the relationship between levels of alcohol intake and the risk for early-onset colorectal cancer (CRC).⁴

In this study, light drinking was defined as less than 10 g of alcohol per day for men and women, while moderate drinking was defined as less than 30 g per day for men and less than 20 g per day for women. Heavy drinking was defined as 30 g or more per day for men and 20 g or more per day for women.⁴

The investigators identified 8314 incident cases of early-onset CRC and observed higher rates of early-onset CRC among moderate drinkers (adjusted hazard ratio [aHR], 1.09; 95% CI, 1.02-1.16) and heavy drinkers (aHR, 1.20; 95% CI, 1.11-1.29), compared with light drinkers.⁴

A significant dose-response relationship between drinking frequency and early-onset CRC risk was observed, with a progressively higher risk associated with drinking 1 to 2 days per week (7%), 3 to 4 days per week (14%), and 5 or more days per week (27%) compared with nondrinkers.⁴

Using the same Korean database, a study published in 2022 investigated links between changes in alcohol consumption between screenings conducted in 2009 and 2011 and the risk for various cancer types among participants aged 40 years and older.⁵

The results showed an increase in drinking levels correlated with an increase in cancer risk, and cessation or a decrease in drinking correlated with a decrease in cancer risk. For example, patients who went from nondrinker to heavy drinker (30 g or more per day) between the screenings had an aHR of 1.34 (95% CI, 1.23-1.45), but those who reduced their drinking from heavy to mild (less than 15 g per day) lowered their risks for alcohol-related cancers (aHR, 0.92; 95% CI, 0.86-0.98) and all cancers (aHR, 0.92; 95% CI, 0.89-0.96) compared with sustained heavy drinking.⁵

Other recent research found associations between higher levels of alcohol intake and the risk for various types of skin cancer as well as prostate cancer. However, findings regarding alcohol and prostate cancer have been somewhat mixed.^6,7

A 2019 study demonstrated a lower risk of lethal prostate cancer in cancer-free men who were alcohol drinkers compared with nondrinkers (HR, 0.84; 95% CI, 0.71-0.99), and moderate red wine consumption (vs no red wine intake) among men with prostate cancer was associated with a lower risk of progression to lethal disease (HR, 0.50; 95% CI, 0.29-0.86; P =.05).⁸

In an earlier study involving men undergoing prostate biopsy, current alcohol use was not associated with the risk for prostate cancer, whereas heavier alcohol intake earlier in life (odds ratio [OR], 3.21; P_trend =.020) and higher cumulative lifetime alcohol intake (OR, 3.20; P_trend =.003) were associated with greater odds of a diagnosis of high-grade prostate cancer.⁹

Two new studies aimed to elucidate the relationship between alcohol use and breast cancer. Among 3659 breast cancer survivors participating in the ongoing Pathways Study, Dr Kwan and colleagues found that alcohol consumption was not linked to cancer recurrence or mortality in the overall sample. In women with a body mass index of 30 kg/m² or higher, an increase in occasional drinking (HR, 0.71; 95% CI, 0.54-0.94) and regular drinking (HR, 0.77; 95% CI, 0.56-1.08) around the time of diagnosis and up to 6 months postdiagnosis was associated with a lower mortality risk (P <.05).³ 

A study of 2889 US Black women from the African American Breast Cancer Epidemiology and Risk (AMBER) Consortium showed that consumption of 7 or more — compared with 7 or fewer — drinks per week associated with an increased risk of any invasive breast cancer (OR, 1.30; 95% CI, 1.00-1.68), ER-negative breast cancer (OR, 1.48; 95% CI, 1.01–2.14), and PR-negative breast cancer (OR, 1.50; 95% CI, 1.07-2.10).¹⁰

Additionally, an “analysis of variants in four genomic regions harboring ethanol metabolism genes … identified significant associations between rs79865122-C in CYP2E1 and odds of ER− and triple negative breast cancer,” as described in the paper.¹⁰

Clinical Implications

Dr Cao emphasized the need to address high-risk drinking in cancer care settings and said that “all providers, including oncologists, nurses, therapists, and counselors, could play a vital role” in supporting patients in limiting alcohol intake. She advised that clinicians assess each patient’s level of alcohol consumption and educate them about the potential harms of risky alcohol use.

“Given the societal norms surrounding alcohol and the general lack of awareness of alcohol’s short- and long-term impact on cancer outcomes, gently providing support to patients with higher alcohol intake and offering them guidance while understanding the cultural and societal contexts of drinking can make a difference,” she stated.  

Although there are currently “no guidelines for breast cancer survivors on alcohol use, our study findings suggest that doctors can tell patients that in the absence of specific guidelines for survivors, it makes sense for them to follow the guidelines for breast cancer prevention, which suggest that women not drink more than 1 alcoholic drink per day,” Dr Kwan explained.³

The findings by Dr Cao and others “highlight the need for immediate interventions to reduce alcohol intake among cancer survivors,” and additional research is needed to further explore “alcohol consumption patterns among cancer survivors and its impact on therapeutic efficacy and treatment outcomes,” she said. “Large-scale, integrated data with longitudinal data on patterns of alcohol consumption, along with information on treatment, related outcomes, and long-term survival data, is much needed to thoroughly characterize alcohol’s impact following cancer diagnosis.”

References

1. Shi M, Luo C, Oduyale OK, Zong X, LoConte NK, Cao Y. Alcohol consumption among adults with a cancer diagnosis in the All of Us Research Program. JAMA Netw Open. 2023;6(8):e2328328. doi:10.1001/jamanetworkopen.2023.28328

2. Pflaum T, Hausler T, Baumung C, et al. Carcinogenic compounds in alcoholic beverages: an update. Arch Toxicol. 2016;90(10):2349-2367. doi:10.1007/s00204-016-1770-3

3. Kwan ML, Valice E, Ergas IJ, et al. Alcohol consumption and prognosis and survival in breast cancer survivors: The Pathways Study. Cancer. Published online August 9, 2023. doi:10.1002/cncr.34972

4. Jin EH, Han K, Shin CM, et al. Sex and tumor-site differences in the association of alcohol intake with the risk of early-onset colorectal cancer. J Clin Oncol. 2023;41(22):3816-3825. doi:10.1200/JCO.22.01895

5. Yoo JE, Han K, Shin DW, et al. Association between changes in alcohol consumption and cancer risk. JAMA Netw Open. 2022;5(8):e2228544. doi:10.1001/jamanetworkopen.2022.28544

6. Mahamat-Saleh Y, Al-Rahmoun M, Severi G, et al. Baseline and lifetime alcohol consumption and risk of skin cancer in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC). Int J Cancer. 2023;152(3):348-362. doi:10.1002/ijc.34253

7. Macke AJ, Petrosyan A. Alcohol and prostate cancer: time to draw conclusions. Biomolecules. 2022;12(3):375. doi:10.3390/biom12030375

8. Downer MK, Kenfield SA, Stampfer MJ, et al. Alcohol intake and risk of lethal prostate cancer in the Health Professionals Follow-Up Study. J Clin Oncol. 2019;37(17):1499-1511. doi:10.1200/JCO.18.02462

9. Michael J, Howard LE, Markt SC, et al. Early-life alcohol intake and high-grade prostate cancer: Results from an equal-access, racially diverse biopsy cohort. Cancer Prev Res (Phila). 2018;11(10):621-628. doi:10.1158/1940-6207.CAPR-18-0057

10. Young KL, Olshan AF, Lunetta K, et al. Influence of alcohol consumption and alcohol metabolism variants on breast cancer risk among Black women: results from the AMBER consortium. Breast Cancer Res. 2023;25(1):66. doi:10.1186/s13058-023-01660-1