Exploring the Connection Between Alcohol Use and Cancer Risk

Numerous recent studies have been added to the growing body of research linking increased alcohol consumption with a greater risk for cancer and worse cancer-related outcomes. Other new findings suggest high rates of risky drinking among cancer survivors in the United States.

Patterns of Use and Possible Mechanisms

In a 2023 study, Shi et al examined patterns of alcohol use among 15,199 US adult cancer survivors from the National Institutes of Health All of Us Research Program.¹

The results revealed that 77.7% of participants were current drinkers, with many of them exceeding moderate drinking (13.0%) or engaging in binge drinking (23.8%) or hazardous drinking (38.3%). Similar rates were observed in a subset of 1839 patients who were currently receiving cancer treatment, with comparable rates across treatment types.¹

Such findings may be cause for concern, given the reported connection between alcohol intake and cancer risk and outcomes.

“Notably, alcohol consumption is causally linked with multiple types of cancer — including cancers of the oral cavity, pharynx, larynx, colorectum, and liver, as well as esophageal squamous cell carcinoma and female breast cancer — and is also gaining recognition as a potential risk factor for some other cancers such as pancreatic and prostate cancer,” explained senior study author Yin Cao, ScD, MPH, associate professor of surgery in the division of public health sciences at Washington University School of Medicine in St Louis, Missouri.¹ Among people with cancer, alcohol intake has been linked to increased risk of recurrence, secondary tumors, and mortality.¹

Although the potential mechanisms driving these associations remain unclear, Dr Cao noted that “in general, alcohol itself is considered a direct carcinogen, with sufficient evidence in experimental animals for the carcinogenicity of its primary component ethanol and its metabolite acetaldehyde.”²

Regarding the increased risk of breast cancer associated with higher alcohol intake, one of the most common hypothesized mechanisms is “high circulating levels of acetaldehyde resulting from increased alcohol metabolism, especially in premenopausal women,” according to Marilyn Kwan, PhD, senior research scientist at Kaiser Permanente Northern California Division of Research in Oakland, California.

Another possible mechanism involves “alcohol-elevating endogenous estrogen levels and upregulating estrogen receptors under certain hormonal conditions in premenopausal and postmenopausal women,” as stated in a study by Dr Kwan and colleagues.³

In addition to these proposed mechanisms, alcohol is “known to have neurotoxic, cardiotoxic, and hepatotoxic effects, which may affect therapeutic efficacy,” Dr Cao said.