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Cancer and Alcohol: 3 Things You Need to Know

Alcohol caused more than 741,000 cancer cases in 2020 — but few people are aware of the link

man's arm resting on a chair arm holding a glass of alcohol

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En español | As the pandemic rages on, you may be finding comfort in a glass (or three) of wine at the end of a stressful day. If that’s the case, you’re not alone. About 1 in 4 (23 percent) people said they drank more during the pandemic to deal with stress, according to a new poll from the American Psychological Association. And in a 2020 survey, 1 in 10 adults age 55 and older reported that their drinking increased since the pandemic began.

All this extra drinking could come with serious consequences — one of them being an increased risk of cancer. A new report published in The Lancet Oncology found that about 741,300 people worldwide developed cancer last year from alcohol use, a number that equates to 4.1 percent of all new cancers diagnosed in 2020. The paper focuses on drinkers who have alcohol-caused cancer, not unlike smokers who have tobacco-caused cancer. 

About three quarters of the alcohol-attributable cancers (76.7 percent) were in men, and most of the cancers were in the esophagus and liver. For women, breast cancer was also a common diagnosis.  

1. Alcohol increases the risk of at least six cancers.

What’s the connection between drinking and cancer? Just like tobacco, alcohol is classified by the National Toxicology program as a cancer-causing substance, or carcinogen — right up there with asbestos, formaldehyde and ultraviolet radiation.

When you drink alcohol the body breaks it down into a chemical compound called acetaldehyde. This chemical can alter the DNA in your body as well as proteins and lipids, explains Farhad Islami, M.D., scientific director of cancer disparity research at the American Cancer Society and a coauthor of the Lancet Oncology report. And these changes can lead to tumor growth.

Alcohol can also adversely affect the regulation of hormones, and it may even promote cancer indirectly by acting as “a solvent for other carcinogenic agents,” Islami explains — meaning it may make it easier for the harmful chemicals in tobacco, for example, to batter the body. This is one possible explanation for why people who smoke and drink are much more likely to develop cancers in the mouth and throat than those who use either alcohol or tobacco alone.

According to the Centers for Disease Control and Prevention (CDC), drinking alcohol raises a person’s risk for six types of cancers: cancer in the mouth and throat; larynx; esophagus; colon and rectum; liver; and breast (in women). What’s more, evidence is mounting that alcohol consumption may be associated with increased risks of melanoma and of prostate and pancreatic cancers, the National Cancer Institute notes.

2. The more alcohol you consume, the greater your risk.

The general rule of thumb when it comes to alcohol and cancer: The more you drink over time — whether it’s wine, beer, cocktails or liquor — the higher your cancer risk, the CDC says.

Nearly half (46.7 percent) of the people who got cancer due to their drinking were “heavy” drinkers (about four or more drinks per day), the Lancet Oncology study found. Slightly fewer (39.4 percent) were “risky” drinkers (about two to four drinks per day). The final group was the “moderate” drinkers, at around one drink a day; they accounted for about 13.9 percent of alcohol-driven cancer cases.

Current CDC guidelines recommend no more than one alcoholic drink a day for women and no more than two for men — and we’re talking conservative pours, with a glass of wine topping off at 5 ounces.


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Because cancer is more common later in life, drinking responsibly may be more crucial for older people who want to lower their risks. “Aging is associated with widespread inflammation in the body,” says George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). And this inflammation can cause a phenomenon known as oxidative stress, which puts the balance between free radicals (the bad guys) and antioxidants (the good guys) out of whack. “Oxidative stress caused by chronic inflammation, combined with age-related declines in antioxidant levels, could contribute to the development of cancers during aging,” Koob adds.

3. Concerned about your risks? Talk with your doctor.   

Even with global studies like the one published in Lancet Oncology and others that examine state-by-state trends in the U.S., it’s still unclear exactly how many cancer cases are directly caused by alcohol “and whether the number of such cases is increasing or decreasing,” Koob says.

But the burden is likely bigger than current estimates, argues Amy Justice, M.D., a clinical epidemiologist and professor of medicine and public health at Yale School of Medicine. In a commentary published alongside the Lancet Oncology study, Justice points out that the results don’t take former drinkers into account. Also, the study relied on self-reported data, which asked people to reveal how much they drank — even if they couldn’t remember and even if it was more than they wanted to admit.

“We do not ask people with diabetes what their glycosylated hemoglobin is, we check it. Then we discuss their risk of adverse health outcomes informed by the test results and their personal risk profile,” Justice writes. “We should use a similar approach to counseling patients regarding risk from alcohol.”

We’re not at that point — yet. In the meantime, experts say, you should talk with your doctor about how much you drink so that you can better understand the risks. Many people aren’t having this conversation about alcohol with health care providers. Indeed, one study found that more than a quarter of older adults who used alcohol were not asked about their drinking by their physician. And women are less likely than men to discuss drinking with their doctor.

Alcohol misuse is often associated with other risky behaviors “that could contribute to an increase in cancer risk during aging, too,” Koob says, though it’s unknown “how these risks and protective factors interact with one another or how the balance of risk and protective factors might have changed over time.”

So in addition to thinking about your drinking, pay attention to how much you exercise and sleep. And if you smoke, try to quit. Some risk factors for cancer are out of your control, like genetics and exposure to certain environmental toxins. But many cancers are preventable.  

For more information on finding and getting help for alcohol use, visit the NIAAA’s website

7 Strategies to Scale Back on Drinking ​

Want to consume less alcohol? Try these tips.

  1. Keep track of how much you drink, be it on a card, calendar or app.
  2. Count and measure. Know the standard drink sizes so you can count your drinks accurately.
  3. Set goals. Decide how many days a week you’ll drink and how much you’ll imbibe on those days.
  4. Find alternatives. Fill your drinking time with healthy activities, hobbies and interests.
  5. Avoid triggers. Think about what makes you more inclined to drink, and try to avoid those situations.
  6. Plan to handle urges. Remind yourself why you’re trying to cut back, distract yourself with another activity, or discuss the difficulties with someone you trust.
  7. Know your “no.” If offered a drink, have a polite, convincing “No, thanks” ready.

Source: National Institute on Alcohol Abuse and Alcoholism

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