Report Details Alcohols Global Cancer Burden NCI

But the potential threat it poses to people with cancer and longer-term survivors has largely been overlooked, explained Tanya Agurs-Collins, Ph.D., of the Behavioral Research Program in NCI’s Division of Cancer Control and Population Sciences. 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. 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). There is a strong scientific consensus that alcohol drinking can cause several types of cancer (1, 2). In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.

  1. 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.
  2. The U.S. Community Preventive Services Task Force’s (CPSTF) Guide to Community Preventive Services (54), and WHO’s 2010 Global Strategy to Reduce the Harmful Use of Alcohol(8) describe a range of evidence-based alcohol control policies.
  3. More research is needed to better understand alcohol use among people with cancer, the study team wrote.
  4. Dr. LoConte said that she has direct conversations with her patients about drinking and other behaviors that could affect their treatment.

According to the study’s findings, male long-term survivors and younger people being treated for cancer were among those who were particularly likely to be heavy or frequent drinkers. Alcohol and its metabolite acetaldehyde can drive cancer development through several pathways. Many of these pathways are interlinked and show the complexity and breadth of alcohol’s harmful potential.

What is alcohol?

Interactions with clinicians could affect alcohol consumption behavior, as they are relatively trusted sources of health information (45). However, in a cross-sectional survey of cancer survivors, only 14% of regular drinkers recalled receiving counselling from a clinician to quit drinking, although those who did were five-fold more likely to report reducing or stopping drinking compared to those who did not receive counseling (46). These findings suggest that clinicians early signs of liver damage from alcohol may underappreciate cancer risks due to alcohol, and need additional guidance to reinforce clear and consistent messaging to effectively discuss this issue with their patients. Addressing knowledge gaps related to alcohol-cancer communication has potential to increase awareness and affect alcohol consumption behavior. A high proportion of American adults, both drinkers and non-drinkers (35), are unaware of the association between alcohol consumption and cancer risk.

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). 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. 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).

What is the evidence that alcohol drinking can cause cancer?

Ethanol–the principal form of alcohol in alcoholic beverages–is a widely-used, psychoactive, and dependence-producing substance. Alcohol research and control efforts supported by multiple governmental and non-governmental organizations (NGOs) internationally have found that the public health impact of harmful alcohol consumption is substantial. In 2016, it resulted in an estimated 5.1% of the global burden of disease and injury, and 5.3% of deaths (1). A large meta-analysis of 23 health outcomes showed that the number of daily alcohol beverages that minimized harm overall was 0 (95% uncertainty interval 0.00–0.08) (2). In the study, many people being treated for cancer and longer-term cancer survivors reported regularly drinking alcohol—many moderately, but some also heavily and often.

Because overt behaviors appear to be more susceptible to normative influence than clandestine behaviors (44), alcohol consumption behaviors in groups might be especially subject to social sanction. Increased awareness of the alcohol-cancer link might encourage some people to warn family and friends about consumption, although the efficacy of such communication on behavior is unclear. 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. 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. Overall, about 12,000 people in this group reported that they drink alcohol, and nearly 40% reported engaging in hazardous drinking—that is, repeated excessive alcohol use. Of those who may have been actively undergoing treatment for cancer, about 75% drank alcohol, many heavily.

Studying the Impact of Total Diet on Cancer Risk

Both acetaldehyde and ethanol can impact DNA methylation which may lead to changes in the expression of oncogenes and tumour-suppressor genes [21]. Acetaldehyde can inhibit the activity of DNA methyltransferase (DNMT) which is essential for normal DNA methylation; acetaldehyde can also reduce DNMT mRNA levels leading to less production of DNMT [25]. Acetaldehyde and ethanol may also inhibit the synthesis of S-adenosyl-L-methionine (SAMe) which is essential to DNA methylation [21]. Once consumed, alcohol is metabolised by enzymes including alcohol dehydrogenase (ADH), cytochrome P-450 2E1 (CYP2E1) and bacterial catalase, producing acetaldehyde [20].

3. Colorectal Cancer

The accumulation of acetaldehyde has such unpleasant effects (including facial flushing and heart palpitations) that most people who have inherited the ALDH2 variant are unable to consume large amounts of alcohol and therefore have a low risk of developing alcohol-related cancers. The future potential of MR studies is yet to be discovered but disclosing potential sources of biases and confounding in observational studies is necessary to obtain robust estimates of the causal relationship between alcohol consumption and cancer risk. 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.

“I think the perception often is, if you can fit it in a glass, it’s one drink,” Dr. LoConte said. But studies have shown that people pouring their own wine or spirits at home tend to underestimate the amount they’re actually consuming. “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. The estimates of cancer cases attributed to alcohol may have been higher if past consumption had been accounted for, Dr. Abnet said. The breakdown of alcohol can also produce reactive oxygen species, also known as free radicals.

The NCI Alcohol and Cancer Risk Fact Sheet provides a broad overview of alcohol as a risk factor for cancer, and three recent papers explore Division interest in alcohol awareness (7,8) and research needs related to alcohol and cancer prevention and control (9). 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. We conducted a cohort study to investigate the association between the reduction, cessation, or increase of alcohol consumption and the development of alcohol-related cancers and all cancers.

The IARC Monographs program aims to classify cancerous agents according to the strength of the available epidemiological and experimental evidence. 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. The December 2020 NCI Workshop highlighted existing evidence on the alcohol-cancer link, and revealed opportunities to strengthen relevant scientific knowledge. Additionally, the workshop panel recognized that the health, including cancer, impact of increases in alcohol consumption resulting from the coronavirus pandemic (60) will need to be carefully assessed, particularly if these behaviors are sustained long-term. Alcohol regulations are designed to ensure an orderly marketplace, and to minimize or reduce the health, social, and economic harms due to consumption. The U.S. Community Preventive Services Task Force’s (CPSTF) Guide to Community Preventive Services (54), and WHO’s 2010 Global Strategy to Reduce the Harmful Use of Alcohol(8) describe a range of evidence-based alcohol control policies.

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