Alcohol facts and evidence

Read the key facts about alcohol and cancer risk, and find the supporting evidence from academic research and scientific studies to see why we say what we do.

The International Agency for Research into Cancer (IARC; part of the World Health Organisation) has classified alcohol as a Group 1 carcinogen since 1988 [1]. IARC's rulings are the gold standard in terms of determining if something causes cancer, and Group 1 is their highest risk category. It means that there is convincing evidence that alcohol causes cancer in humans. More recent reviews by IARC and other agencies have also concluded that drinking alcohol causes cancer [2-6].

A study published in 2011 found that alcohol is responsible for around 4% of UK cancers, about 12,800 cases per year [7, 8]. The proportion of cases down to alcohol was highest for mouth and throat cancers (around 30%), but bowel cancers accounted for the greatest overall number of cases linked to alcohol (around 4,800 cases a year).

 

References

1. IARC, IARC Monographs on the evaluation of carcinogenic risks to humans. Volume 44 Alcohol drinking. 1988. View resource

2. WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases, in WHO Technical Report Series. 2003, WHO: Geneva. P. 95-104. View resource

3. Boyle, P., et al., European Code Against Cancer and scientific justification: third version (2003). Ann Oncol, 2003. 14(7): p. 973-1005. View summary on PubMed

4. World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007. View resource

5. IARC, World Cancer Report, ed. B. Stewart and P. Kleihues. 2003, Lyon IARC Press. View resource

6. IARC Monographs, Volume 100E: Personal habits and indoor combustions. 2012, Lyon IARC Press p377 – 503. View resource

7. Parkin, DM., et al., Cancers attributable to the consumption of alcohol in the UK in 2010. Br J Cancer, 2011. 106 (S2) p. S14- S18. View summary on PubMed

8. Calculated by the Cancer Research UK Statistical Information Team, based on figures from Parkin DM, Boyd L, Darby SC, Mesher D, Sasieni P, Walker LC. The Fraction of Cancer Attributable to Lifestyle and Environmental Factors in the UK in 2010. Br J Cancer. 2014. View resource

Alcohol increases the risk of cancers of the mouth, pharynx (upper throat), larynx (voice box) and oesophagus (gullet or foodpipe) [9].

The more alcohol someone tends to drink, the higher the risk. One review found that people having four or more drinks (where one drink has around 1.5 units of alcohol) a day had about five times the risk of mouth and pharynx cancers compared to people who never drank or drank only occasionally. And the same review also found that even lighter drinkers of no more than one drink a day had a 20% higher risk [10].

 

References

9. Corrao, G., et al., A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med, 2004. 38 (5): p. 613-9. View summary on PubMed

10. Tramacere, I., et al., A meta-analysis of alcohol drinking and oral and pharyngeal cancers. Part 1: overall results and dose risk relation. Oral Oncol, 2010. 46(7): p. 497-503. View summary on PubMed

Regularly drinking even small amounts of alcohol can increase the risk of breast cancer [11, 12]. A review of the evidence in 2012 concluded that having 1 drink a day (around 1.5 units) could increase the risk of breast cancer by 5% [11]. And the risk increases the more a woman drinks, several studies have found that each additional 10g of alcohol drunk a day increases the risk of breast cancer by about 7 - 12% [13-16].

Breast cancer is much rarer in men than in women, and less is known about things that may affect the risk. The small number of cases also makes this difficult to study. But a 2014 review that included 20 different studies suggested that alcohol wasn't linked to breast cancer in men [17].

 

References

11. Seitz, H., et al., Epidemiology and pathophysiology of alcohol and breast cancer: Update 2012. Alcohol and Alcoholism, 2012. View summary on PubMed

12. Bagnardi V, Rota M, Botteri E, et al. Light alcohol drinking and cancer : a meta-analysis. Annals of Oncology. 2013;24(3):301–8. View summary on PubMed

13. Smith-Warner, S., et al., Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA, 1998. 279: p. 535-40. View summary on PubMed

14. Key, J., et al., Meta-analysis of studies of alcohol and breast cancer with consideration of the methodological issues. Cancer Causes Control, 2006. 17(6): p. 759-770. View summary on PubMed

15. Hamajima, N., et al., Alcohol, tobacco and breast cancer – collaborative reanalysis of individual data from 53 epidemiological studies, including 58, 515 women with breast cancer and 95, 067 women without the disease. Br J Cancer, 2002. 87(11): p. 1234-45. View summary on PubMed

16. Allen, N., et al. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst, 2009. 101(5): p. 296-305. View summary on PubMed

17. Cook MB, Guenel P, Gapstur SM, et al. Tobacco and Alcohol in Relation to Male Breast Cancer: An Analysis of the Male Breast Cancer Pooling Project Consortium.; 2014:1–33. View summary on PubMed

Alcohol is one of the main risk factors for liver cancer [18]. Heavy drinking can lead to cirrhosis, a condition where the liver is repeatedly damaged and scar tissue builds up. Cirrhosis increases the risk of liver cancer.

And alcohol aggravates the risk of liver cancer in people with hepatitis B or C infections who are already at higher risk. People with these infections should avoid alcohol, as even small amounts could damage their livers [19].

 

References

18. Stickel, F., et al., Cocarcinogenic effects of alcohol in hepatocarcinogenesis. Gut, 2002. 51: p. 132-139. View summary on PubMed

19. Donato F., et al., Alcohol and hepatocellular carcinoma: the effect of lifetime intake and hepatitis virus infections in men and women. Am J Epidemiol, 2002. 155(4): p.323-31. View summary on PubMed

Studies have shown that alcohol can increase the risk of bowel cancer [9, 20]. A review of 61 studies found that the risk went up the more alcohol people drank, and the heaviest drinkers' (four drinks a day or more) risk went up by about half [20]. Even fairly small amounts can have an effect, the EPIC study found that for every two units a person drinks each day (less than a pint of premium lager or large glass of wine) their risk of bowel cancer goes up by 9% [21].

 

References

9. Corrao, G., et al., A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med, 2004. 38 (5): p. 613-9. View summary on PubMed

20. Fedirko, V., et al., Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Annal Oncol, 2011. 22(9): p. 1958-72. View summary on PubMed

21. Ferrari, P., et al., Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European Prospective Investigation into cancer and nutrition (EPIC). Int J Cancer, 2007. 121(9): p. 2065-72. View summary on PubMed

So far, research hasn't fully answered the question of how alcohol acts to cause different types of cancer. But there are several theories with good evidence. It is likely that alcohol causes different types of cancer in different ways [22].

The theory with the strongest evidence is related to how our bodies process alcohol. It is converted into another chemical called acetaldehyde. Acetaldehyde can cause cancer by damaging our DNA and preventing it from being repaired [23]. The International Agency for Research into Cancer (IARC) classes acetaldehyde associated with drinking alcohol as a Group 1 substance, which means it can cause cancer in humans [6]. Drinking alcohol greatly increases the level of acetaldehyde found in saliva [24]. And a small initial study in 2012 found higher levels of DNA damage in the mouth cells of people after drinking alcohol [25].

Alcohol can increase the level of hormones such as oestrogen in the body [26, 27, 28]. Unusually high levels of oestrogen could cause breast cancer [29].

Alcohol can cause cirrhosis of the liver, by repeatedly damaging the liver's cells. This is turn can cause liver cancer [18].

Alcohol makes it easier for cancer-causing chemicals, such as those found in tobacco, to be absorbed in the mouth or throat [30].

Alcohol reduces the amount of folate in our blood. Folate is a B vitamin that our cells need to create new DNA correctly [31]. But it isn't clear whether alcohol actually causes cancer through lowering folate levels, or whether people's underlying folate levels affect the risk of cancer from alcohol [6].

Alcohol can cause highly reactive molecules known as Reactive Oxygen Species or ROS, to be produced in our bodies and particularly in the liver [18, 23]. These molecules are damaging and they are usually kept at a low level, but when ROS levels are raised, they are known to damage DNA.

 

References

6. IARC Monographs, Volume 100E: Personal habits and indoor combustions. 2012, Lyon IARC Press p377 – 503. View resource

18. Stickel, F., et al., Cocarcinogenic effects of alcohol in hepatocarcinogenesis. Gut, 2002. 51: p. 132-139. View summary on PubMed

22. Purohit, V., et al., Mechanisms of alcohol-associated cancers: introduction and summary of the symposium. Alcohol, 2005. 35(3): p. 155-60. View summary on PubMed

23. Bofetta, P., and M. Hashibe, Alcohol and Cancer. Lancet Oncol, 2006. 7(2): p. 149-56. View summary on PubMed

24. Homann N., et al., High acetaldehyde levels in saliva after ethanol consumption: methodological aspects and pathogenetic implications. Carcinogenesis, 1997. 18(9): p.1739-43. View summary on PubMed

25. Balbo, S., et al., Kinetics of DNA adduct formation in the oral cavity after drinking alcohol. Cancer Epidemiol Biomarkers Prev, Epub Feb 1 2012. View summary on PubMed

26. Onland-Moret, N., et al., Alcohol and endogenous sex steroid levels in postmenopausal women: a cross-sectional study. J Clin Endocrinol Metab, 2005. 90(3): p. 1414-9. View summary on PubMed

27. Key, T., et al., Circulating sex hormones and breast cancer risk factors in postmenopausal women: reanalysis of 13 studies. Brit J Cancer, 2011. 105(5): p. 709-22. View summary on PubMed

28. Rinaldi, S., et al., Relationship of alcohol intake and sex steroid concentrations in blood in pre- and post-menopausal women: the European Prospective Investigation into Cancer and Nutrition. Cancer Causes Control, 2006. 17(8): p.1033-43. View summary on PubMed

29. Key, T., et al., Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst, 2002. 94(8): p. 606-16. View summary on PubMed

30. Howie, N., et al., Short-term exposure to alcohol increases the permeability of human oral mucosa. Oral Dis, 2001. 7(6): p. 349-54. View summary on PubMed

31. Giovannucci, E., Epidemiologic studies of folate and colorectal neoplasia: A review. J Nutr, 2002. 132(S8): p. 2350S-2355S. View summary on PubMed

Tobacco is another cause of mouth, oesophagus (food pipe) and liver cancers and scientists have found that the effects of alcohol and tobacco together are much worse than either by itself [3, 32].

A meta-analysis published in 2012, which combined the results of 49 previous studies, found that non-smokers who drank alcohol were around a third more likely to develop mouth and upper throat cancer than those who didn't drink alcohol. But people who smoke or used to smoke, and who also drank alcohol, were around 3 times as likely to develop the disease [33]. Another study found that the risk of liver cancer was almost 10 times greater in people who smoked and drank heavily [34].

 

References

3. Boyle, P., et al., European Code Against Cancer and scientific justification: third version (2003). Ann Oncol, 2003. 14(7): p. 973-1005. View summary on PubMed 

32. Hashibe, M., et al., Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev, 2009. 18(2): p. 541-50. View summary on PubMed 

33. Turati, R., et al., A meta-analysis of alcohol drinking and oral and pharyngeal cancers: Results from subgroup analyses. Alcohol Alcohol., 2012. View summary on PubMed 

34. Kuper, H., et al., Tobacco smoking, alcohol consumption and their interaction in the causation of hepatocellular carcinoma. Int J Cancer, 2000. 85(4): p. 498-502. View summary on PubMed 

Research has shown that all types of alcoholic drinks, including wine, beer and spirits, can increase the risk of cancer [2, 6, 35]. The risk is linked to the actual alcohol (ethanol) in the drink, and increases with the amount drunk [9].

 

References

2. WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases, in WHO Technical Report Series. 2003, WHO: Geneva. P. 95-104. View resource

6. IARC Monographs, Volume 100E: Personal habits and indoor combustions. 2012, Lyon IARC Press p377 – 503. View resource

9. Corrao, G., et al., A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med, 2004. 38 (5): p. 613-9. View summary on PubMed

35. Blot, W.J., Alcohol and cancer. Cancer Research, 1992. 52(S): p. 2119-2123. View summary on PubMed

The more alcohol someone drinks, the more their cancer risk increases [9]. But even quite small amounts of alcohol, around 1 drink a day, can increase cancer risk [10-12, 36]. Expert reports have concluded that there is no lower limit of alcohol drinking where cancer risk isn't increased [3, 4].

Drinking small amounts of alcohol can offer some protection for people who are at risk of heart disease, which normally applies to people over the age of 40 [37]. A review published in 2011 of 84 studies found that although drinking up to 15g of alcohol a day (about 2 units) reduced the risk of dying from heart disease and stroke, the benefits quickly start to disappear as drinking levels increase [38]. A study has calculated that the best balance between benefits and harms is for people who drink less than 1 unit a day [39].

Because of this many sources, including the European Code Against Cancer and the World Cancer Research Fund, have suggested that women should drink no more than one drink a day, and men should drink no more than 2 drinks [3, 4, 40]. Similarly, the UK government recommends that men don't regularly drink more than 3 - 4 units in a day, and women no more than 2 - 3 units [41]. While these levels can increase the risk of cancer, the overall risk for an individual person is likely to be small.

Most research into the links between alcohol and cancer has looked at the total amount people drink. This research has found that the more a person drinks, the more their cancer risk increases. Much less research has been done into the effect of pattern of drinking, for example whether drinking is spread evenly across the week or concentrated in binges. At the moment, this research does not point in any clear direction. As the number of studies grows, we should be able to better decide whether the pattern of drinking has any effect on cancer risk or health generally [5, 42, 43].

 

References

3. Boyle, P., et al., European Code Against Cancer and scientific justification: third version (2003). Ann Oncol, 2003. 14(7): p. 973-1005. View summary on PubMed

4. World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007. View resource

5. IARC, World Cancer Report, ed. B. Stewart and P. Kleihues. 2003, Lyon IARC Press. View resource

9. Corrao, G., et al., A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med, 2004. 38 (5): p. 613-9. View summary on PubMed

10. Tramacere, I., et al., A meta-analysis of alcohol drinking and oral and pharyngeal cancers. Part 1: overall results and dose risk relation. Oral Oncol, 2010. 46(7): p. 497-503. View summary on PubMed

11. Seitz, H., et al., Epidemiology and pathophysiology of alcohol and breast cancer: Update 2012. Alcohol and Alcoholism, 2012. View summary on PubMed

12. Bagnardi V, Rota M, Botteri E, et al. Light alcohol drinking and cancer : a meta-analysis. Annals of Oncology. 2013;24(3):301–8. View summary on PubMed

36. Bagnardi, V., et al., Alcohol consumption and the risk of cancer: a meta-analysis. Alcohol Res Health, 2001. 25(4): p. 263-70. View summary on PubMed

37. Thun, M.J, et al., Alcohol consumption and mortality among middle aged and elderly US adults. N Engl J Med, 1997. 337(24): p. 1705-14. View summary on PubMed

38. Ronksley, P., et al., Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ, 2011. 342:d671. View summary on PubMed

39. Nichols M., et  al., What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels. BMJ Open, 2012. View summary on PubMed

40. IARC. European Code Against Cancer 4th edition. Lyon; 2014. View resource

41. Public Health England, Change4Life website

42. Breslow, R., et al., Prospective study of alcohol consumption quantity and frequency and cancer-specific mortality in the US population. Am J Epidemiol, 2011. 174(9): p., 1044-53. View summary on PubMed

43. Sun, Q., et al., Alcohol consumption at mid-life and successful ageing in women: A prospective cohort analysis in the Nurses’ Health Study. PLoS Med, 2011. 8(9): e1001090. View summary on PubMed

The risk of alcohol-related cancers increases the more you drink [9]. So by cutting down on what you drink, you could reduce the risk of these cancers.

If you are a heavy drinker, it is not too late to start cutting down. Scientists have found that the risk of mouth, throat and oesophageal (food pipe) cancers reduces over time in people who have given up drinking compared to those who continue [44].

 

References

9. Corrao, G., et al., A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med, 2004. 38 (5): p. 613-9. View summary on PubMed

44. Rehm, R., et al., Alcohol drinking cessation and its effect on esophageal and head and neck cancers: A pooled analysis. Int J Cancer, 2007. 121(5): p. 1132-7. View summary on PubMed

Some studies have found that the children of women who drank alcohol during pregnancy had an increased risk of one type of leukaemia [45]. It is not yet possible to say for sure whether there is a real link, more studies involving larger numbers of people are needed to investigate [6].

Drinking alcohol during pregnancy has been linked to many other conditions and NICE currently recommend that women stop drinking alcohol altogether while trying to conceive and for at least the first 3 months of their pregnancy. After that time, pregnant women who choose to drink alcohol should have no more than a small drink once or twice a week and should avoid binge drinking or becoming drunk [46].

 

References

6. IARC Monographs, Volume 100E: Personal habits and indoor combustions. 2012, Lyon IARC Press p377 – 503. View resource

45. Latino-Martel, P., et al., Maternal alcohol consumption during pregnancy and risk of childhood leukaemia: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev, 2010. 19(5): p. 1238-60. View summary on PubMed

46. National Institute for Health and Clinical Excellence, NICE Clinical Guideline 62: Antenatal Care. 2010. View resource

There are a variety of measurements in use when it comes to alcohol. Government advice officially relates to units. Researchers tend to classify people by how many grams of alcohol they drink. And the amount of alcohol in 'a drink' depends on both how high the alcohol content of the beverage is and the volume you pour.

On the other pages about alcohol, we have tried to only refer to drinks (e.g. 175ml wine or a pint (568ml) of beer). Because this page also includes information on how the risk of cancer changes with the amount people drink, we have also given information on the grams or units of alcohol. Or you can use the information below to help you convert between the different measurements.

  • 1 unit of alcohol contains 8g of alcohol, which is equivalent to 10ml of pure alcohol
  • 10g of alcohol is equivalent to 1.25 units
  • 12.5g of alcohol is equivalent to 1.56 units and is often defined as the amount in 1 drink by researchers.

Of course, drinks of different sizes and strengths have different amounts of alcohol in them..

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