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16-September-2008 16:15:17 - cancer Alcohol and Health Short-term effects of alcohol Long-term effects of alcohol Alcohol and cardiovascular disease Alcoholic liver disease Alcoholic hepatitis Alcohol and cancer Alcohol and weight Fetal alcohol syndrome Fetal Alcohol Spectrum Disorder Alcoholism Blackout alcohol-related amnesia Wernicke-Korsakoff syndrome Recommended maximum intake Total recorded alcohol per capita consumption 15+, in litres of pure alcohol Total recorded alcohol per capita consumption 15+, in litres of pure alcohol1 Considerable evidence suggests a connection between heavy alcohol consumption and increased risk for cancer, with an estimated 2 to 4 percent of all cancer cases thought to be caused either directly or indirectly by alcohol2 indicates the NIAAA.3 3.6% of all cancer cases worldwide are related to alcohol drinking, resulting in 3.5% of all cancer deaths.4 Contents 1 Alcohol as a carcinogen and cocarcinogen 2 Possible mechanisms of alcohol as a carcinogen 2.1 Effect of alcohol on the progress of cancer when established 3 Genetic variation and cancer risk 4 Alcohol as a risk factor for specific cancers 4.1 Alcohol consumption is believed to increase risk 4.1.1 Head and neck cancers 4.1.2 Breast cancer 4.1.2.1 Breast cancer in men 4.1.3 Colorectal cancer 4.2 Heavy alcohol consumption appears to increase risk 4.2.1 Liver cancer 4.2.2 Ovarian cancer 4.3 Evidence is inconsistent and inconclusive 4.3.1 Endometrial cancer 4.3.2 Gallbladder cancer 4.3.3 Leukemia 4.3.4 Lung cancer 4.3.5 Malignant melanoma 4.3.6 Non-Hodgkin lymphoma NHL 4.3.7 Pancreatic cancer 4.3.8 Prostate cancer 4.3.9 Small intestine cancer 4.3.10 Thyroid cancer 4.4 Alcohol consumption is not suspected to increase risk 4.4.1 Bile duct cancer 4.4.2 Bladder cancer 4.4.3 Cervical cancer 4.4.4 Stomach cancer 4.4.5 Testicular cancer 4.4.6 Vaginal cancer 4.4.7 Vulvar cancer 4.5 Alcohol consumption might reduce risk 4.5.1 Hodgkin's lymphoma HL 4.5.2 Kidney cancer Renal cell carcinoma RCC 4.6 Alcohol not listed as a risk factor 5 Recommended maximum alcohol intake 5.1 Relative health risks 6 References 7 External links Alcohol as a carcinogen and cocarcinogen The International Agency for Research on Cancer Centre International de Recherche sur le Cancer of the World Health Organization has classified alcohol as a Group 1 carcinogen. Its evaluation states, There is sufficient evidence for the carcinogenicity of alcoholic beverages in humans.... Alcoholic beverages are carcinogenic to humans Group 1.5 The U.S. National Institute on Alcohol Abuse and Alcoholism NIAAA reports that Although there is no evidence that alcohol itself is a carcinogen, alcohol may act as a cocarcinogen by enhancing the carcinogenic effects of other chemicals. For example, studies indicate that alcohol enhances tobacco's ability to stimulate tumor formation in rats.6 In humans, the risk for mouth, tracheal, and esophageal cancer is 35 times greater for people who both smoke and drink than for people who neither smoke nor drink,7 implying a cocarcinogenic interaction between alcohol and tobacco-related carcinogens.3 The NIAAA states that Although epidemiologic studies have found a clear association between alcohol consumption and development of certain types of cancer, study findings are often inconsistent and may vary by country and by type of cancer.3 Possible mechanisms of alcohol as a carcinogen In a review, Pöschl and Seitz list some possible mechanisms of alcohol as a carcinogen: local effects of alcohol acetaldehyde Studies have suggested that high concentrations of acetaldehyde, which is produced as the body breaks down ethanol, could damage DNA in healthy cells. ... Researchers at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland, have added weight to this idea by showing that the damage occurs at concentrations of acetaldehyde similar to those in saliva and the gastrointestinal tract while people drink alcohol. Acetaldehyde appears to react with polyamines - naturally occurring compounds essential for cell growth - to create a particularly dangerous type of mutagenic DNA base called a Cr-Pdg adduct...891011 induction of CYP2E1 nutritional deficiencies interactions with retinoids alcohol and methylation alcohol and immune surveillance12 Purohita et al propose an overlapping list: production of acetaldehyde, which is a weak mutagen and carcinogen induction of cytochrome P450 2E1 and associated oxidative stress and conversion of procarcinogens to carcinogens depletion of S-adenosylmethionine and, consequently, induction of global DNA hypomethylation; induction of increased production of inhibitory guanine nucleotide regulatory proteins and components of extracellular signal-regulated kinase-mitogen-activated protein kinase signaling accumulation of iron and associated oxidative stress inactivation of the tumor suppressor gene BRCA1 and increased estrogen responsiveness primarily in breast impairment of retinoic acid metabolism.13 Effect of alcohol on the progress of cancer when established A study of the influence of alcohol intake on tumor growth of hepatocellular carcinoma HCC in patients with type C cirrhosis, found that alcohol influenced tumor volume doubling time TVDT. In conclusion we found that alcohol intake was closely related to the tumor growth of HCC in patients with type C cirrhosis.14 A study of chick embryos suggests that alcohol stimulates their tumor growth by fueling the production of a growth factor that stimulates blood vessel development in tumors.1516 A 2006 study in mice showed moderate drinking resulted in larger and more robust tumors.17 A study where high amounts of alcohol were given to mice suggests that it accelerates their cancer growth by speeding up the loss of body fat and depressing immune activity - particularly that of 'killer t-cells'.1819 Genetic variation and cancer risk A study found that the ADH1C1 allele and genotype ADH1C1/1 were significantly more frequent in patients with alcohol-related cancers...20 A European study has found two gene variants which offer significant protection against mouth and throat cancers. 21 Alcohol is a known porphyrinogenic chemical. Several studies in Europe published on Pubmed have linked the inherited hepatic porphyrias with a predisposition to hepatocellular carcinoma. Typical risk factors for HCC need not be present with the acute hepatic porphyrias, specifically acute intermittent porphyria, variegate porphyria and herary coproporphyria. Porphyria cutanea tarda is also associated with HCC, but with typical risk factors including evidence of hepatotropic viruses, hemochromatosis and alcoholic cirrhosis. Tyrosinemia Type I, an inherited disorder in tyrosine metabolism impacting the second enzyme in the heme metabolic pathway is associated with a high risk of developing HCC in younger populations, including children. Alcohol as a risk factor for specific cancers Alcohol consumption is believed to increase risk The WCRF panel report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective finds the evidence convincing that alcoholic drinks increase the risk of the following cancers: mouth, pharynx and larynx, oesophagus, colorectum men, breast pre- and postmenopause.22 Head and neck cancers Endoscopic image of patient with esophageal adenocarcinoma seen at gastro-esophageal junction. Endoscopic image of patient with esophageal adenocarcinoma seen at gastro-esophageal junction. Head and neck cancers, as used in this article, mean cancers of the mouth, esophagus, pharynx and larynx. The U.S. National Cancer Institute states Drinking alcohol increases the risk of cancers of the mouth, esophagus, pharynx, larynx, and liver in men and women, ... In general, these risks increase after about one daily drink for women and two daily drinks for men. A drink is defined as 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. ... Also, using alcohol with tobacco is riskier than using either one alone, because it further increases the chances of getting cancers of the mouth, throat, and esophagus.23 The International Head and Neck Cancer Epidemiology INHANCE Consortium co-ordinates a meta-study on the issue.24 A study looking at laryngeal cancer and beverage type concluded, This study thus indicates that in the Italian population characterized by frequent wine consumption, wine is the beverage most strongly related to the risk of laryngeal cancer.25 The American Cancer Society estimates that in 2007, cancer of the oral cavity and pharynx represents 3% of new cancer cases and 7550 deaths. Cancer of the esophagus caused 13,940 deaths and cancer of the larynx 3,660 deaths.26 According to Centre for Addiction and Mental Health Principal Investigator Dr. Jürgen Rehm, existing research consistently shows a relationship between alcohol consumption and an increased risk for cancer of the esophagus, larynx and oral cavity. Dr. Rehm and his team analyzed epidemiological literature from 1966 to 2006 to further investigate this association and their results, published in the September issue of the International Journal of Cancer, showed that: The risk of esophageal cancer nearly doubled in the first two years following alcohol cessation, a sharp increase that may be due to the fact that some people only stop drinking when they are already experiencing disease symptoms. However, risk then decreased rapidly and significantly after longer periods of abstention. Risk of head and neck cancer only reduced significantly after 10 years of cessation. After more than 20 years of alcohol cessation, the risks for both cancers were similar to those seen in people who never drank alcohol.2728 Although they are also located in the head or neck, alcohol consumption is not a risk factor for brain cancer, eye cancer, pituitary gland cancer, thymus cancer, salivary gland cancer, thyroid cancer, nasal cavity and paranasal sinus cancer, or adenoid cancer see below. Breast cancer Mastectomy specimen containing a very large cancer of the breast in this case, an invasive ductal carcinoma. Mastectomy specimen containing a very large cancer of the breast in this case, an invasive ductal carcinoma. Alcohol increases the risk of breast cancer in women. A review concludes that studies confirm previous observations that there appears to be an association between alcohol intake and increased risk of breast cancer in women. On balance, there was a weak association between the amount of alcohol consumed and the relative risk.29 The National Institute on Alcohol Abuse and Alcoholism NIAAA concludes that Chronic alcohol consumption has been associated with a small averaging 10 percent increase in a woman's risk of breast cancer3031 .32 According to these studies, the risk appears to increase as the quantity and duration of alcohol consumption increases. Other studies, however, have found no evidence of such a link333435 .3 The nature and inconsistency of the evidence has called into question the existence of any causal link between moderate alcohol consumption and breast cancer The Committee on Carcinogenicity of Chemicals in Food, Consumer Products concludes, The new research estimates that a woman drinking an average of two units of alcohol per day has a lifetime risk of developing breast cancer 8% higher than a woman who drinks an average of one unit of alcohol per day. The risk of breast cancer further increases with each additional drink consumed per day. ... The research also concludes that approximately 6% between 3.2% and 8.8% of breast cancers reported in the UK each year could be prevented if drinking was reduced to a very low level i.e. less than 1 unit/week.36 It has been reported that Two drinks daily increase the risk of getting breast cancer by about 25 percent. NCI but the evidence is inconsistent. The Framingham study has tracked individuals since the 1940s. Data from that research found that drinking alcohol moderately did not increase breast cancer risk.37 Similarly, research by the Danish National Institute for Public Health found that moderate drinking had virtually no effect on breast cancer risk.38 Breast cancer constitutes about 7.3% of all cancers.26 Among women, breast cancer comprises 60% of alcohol-attributable cancers.39 One study suggests that women who frequently drink red wine may have an increased risk of developing breast cancer.40 Alcohol consumption has been shown to increase the rate of breast cancer in women.41 A study of 17,647 nurses found that high drinking levels more than doubled risk of breast cancer. The relative risk of breast cancer was 2.30 ... for alcohol intake of 22-27 drinks per week, compared to 1-3 drinks per week. Among alcohol consumers, weekly alcohol intake increased the risk of breast cancer with 2% for each additional drink consumed. Weekend consumption increased the risk with 4% for each additional drink consumed Friday through Sunday. Binge drinking of 4-5 drinks on the last weekday increased risk by 55%.42 The findings from this prospective study suggest that moderate alcohol consumption increases breast cancer risk.43 A study showed that one or two alcoholic drinks a day increases the risk of breast cancer by 10 per cent compared with light drinkers who drank less than one drink a day. Women who have three or more drinks a day increase their risk of breast cancer by 30 per cent. The type of drink was not a factor.44 A typical 50-year-old woman has a five-year breast cancer risk of about 3 percent. If her risk jumps by 30 percent, her individual risk is still only about 4 percent.45 One of the largest studies of its kind has found that alcohol is a substantial risk factor for development of the most common type of breast cancer - the 70% of tumors that are classified as positive for both the estrogen and progesterone receptors ER+/PR+. Researchers report that even moderate alcohol consumption, defined as one or two drinks per day, increased risk of developing this kind of cancer, and the more a woman drank, the higher her risk. Compared to women who did not drink at all, women who had three or more glasses of alcohol daily had as much as a 51% increased risk of ER+/PR+ breast cancer.46 Deaths from heart disease greatly exceed those caused by breast cancer. Each year more than 500,000 American women die of heart disease, compared with 43,500 who die from breast cancer. According to a large long-term study published in December by the American Cancer Society, having one drink a day raises a woman's risk of dying of breast cancer by 11 percent but diminishes overall mortality by 20 percent because of alcohol's protective effects on the heart. Dr. Smith-Warner and her colleagues noted, however, that there are ways other than drinking alcohol to reduce a woman's cardiac risk, including regular exercise, maintaining a normal body weight, controlling blood pressure and cholesterol, not smoking and taking aspirin.47 However, this statement should not be taken to conclude that the 9 percent difference allows one to justify alcohol use solely because it is good for your heart. The American Institute for Cancer Research states that while evidence that drinking modest amounts of alcohol is associated with a lower risk for coronary heart disease in men, and perhaps women, drinking higher amounts of alcohol raises the risk of cancer along with risks for high blood pressure, stroke, heart disease, birth defects, inflammation of the pancreas, damage to the brain and heart, malnutrition, osteoporosis, accidents, violence and suicide. The American Institute for Cancer Research further states that there are better ways to decrease your heart disease risk, including exercising, reaching and maintaining a healthy weight, lowering saturated fats and trans fats in your diet, controlling blood pressure and not smoking.48 Folate intake counteracts breast cancer risk associated with alcohol consumption49 and women who drink alcohol and have a high folate intake are not at increased risk of breast cancer.50 Those who have a high 200 micrograms or more per day level of folate folic acid or Vitamin B9 in their diet are not at increased risk of breast cancer compared to those who abstain from alcohol.51 A study of over 17,000 Australian women aged 40-69 over a period of about ten years found that those who consumed 40 grams of alcohol about three to four drinks per day have a higher risk of breast cancer than do women who abstain from alcohol. However, in women who take 200 micrograms of folate or folic acid Vitamin B9 every day, the risk of breast cancer drops below that of alcohol abstainers. 52 See Folic acid for more. A study on mice suggests that, when breast cancer is established, drinking as little as two alcoholic drinks a day increases the growth rate of tumors. Alcohol causes cancer cells' blood vessels to grow which in turn fuels the growth of the tumor, a process known as angiogenesis.53 Breast cancer in men Male breast cancer is uncommon and, in Western populations, the incidence is less than one case per 100,000 men.54 There is no evidence to suggest that the effect of alcohol varies between genders. Heavy alcohol intake increases the risk of breast cancer in men.55 If you drink heavy amounts of alcohol, you have a greater risk of breast cancer.56 Colorectal cancer Colectomy specimen containing an invasive colorectal carcinoma the crater-like, reddish, irregularly-shaped tumor. Colectomy specimen containing an invasive colorectal carcinoma the crater-like, reddish, irregularly-shaped tumor. Colorectal cancer refers to cancers of the colon or rectum. Colorectal cancer constitutes about 9.7% of all cancers.26 The WCRF panel report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective finds the evidence convincing that alcoholic drinks increase the risk of colorectal cancer in men22 The National Cancer Institute states, Heavy alcohol use may also increase the risk of colorectal cancer 57 The NIAAA reports that, Epidemiologic studies have found a small but consistent dose-dependent association between alcohol consumption and colorectal cancer5859even when controlling for fiber and other dietary factors.6061 Despite the large number of studies, however, causality cannot be determined from the available data.3 Heavy alcohol use may also increase the risk of colorectal cancer NCI. One study found that People who drink more 30 grams of alcohol per day and especially those who drink more than 45 grams per day appear to have a slightly higher risk for colorectal cancer.6263 Another found that The consumption of one or more alcoholic beverages a day at baseline was associated with approximately a 70% greater risk of colon cancer.646566 One study found that While there was a more than twofold increased risk of significant colorectal neoplasia in people who drink spirits and beer, people who drank wine had a lower risk. In our sample, people who drank more than eight servings of beer or spirits per week had at least a one in five chance of having significant colorectal neoplasia detected by screening colonoscopy..67 Other research suggests that to minimize your risk of developing colorectal cancer, it's best to drink in moderation3 The EPIC study suggests that people who drink 15 grams of alcohol a day - equivalent to about two units - have about a 10 percent increased risk of bowel cancer. Those who drank more than 30 grams of alcohol - equivalent to three to four units which is less than a couple of pints of strong lager - increased their bowel cancer risk by around 25 per cent. 6869 A study found, The proportion of patients with adenomas was 29.6% in abstainers, 22.1% in moderate drinkers, and 36.7% in heavy drinkers. It concluded Consumption of less than seven alcohol drinks per week does not increase the risk of having a colorectal adenoma. We found evidence in this study that moderate alcohol consumption among long-term smokers may potentially decrease the risk of an adenoma compared to abstainers.70 A Japanese study concluded, One fourth of colorectal cancer cases in men were attributable to an alcohol intake of ≥23 g/day.71 Drinking may be a cause of earlier onset of colorectal cancer.72 Heavy alcohol consumption appears to increase risk Liver cancer Hepatocellular carcinoma in an individual that was hepatitis C positive. Autopsy specimen. Hepatocellular carcinoma in an individual that was hepatitis C positive. Autopsy specimen. The NIAAA reports that Prolonged, heavy drinking has been associated in many cases with primary liver cancer. However, it is liver cirrhosis, whether caused by alcohol or another factor, that is thought to induce the cancer.7374 The chances of getting liver cancer increase markedly with five or more drinks per day NCI. Drinking coffee may reduce the risk. Coffee drinking was inversely associated with HCC regardless of its aetiology.75 These data support the hypothesis that there is an ingredient in coffee that protects against cirrhosis, especially alcoholic cirrhosis.76 There is compelling epidemiologic data confirming the increased risk of cancer associated with alcohol consumption, which is supported by animal experiments.77 In areas of Africa and Asia, liver cancer afflicts 50 or more people per 100,000 per year, usually associated with cirrhosis caused by hepatitis viruses. In the United States, liver cancer is relatively uncommon, afflicting approximately 2 people per 100,000, but excessive alcohol consumption is linked to as many as 36% of these cases by some investigators2783 Mortality rates of hepatocellular carcinoma HCC are high in Italy compared with other Western countries. ... Overall, 61% of HCC were attributable to HCV hepatitis C virus, 13% to HBV hepatitis B virus, and 18% to heavy alcohol drinking.79 A study in the province of Brescia, northern Italy concluded, On the basis of population attributable risks AR, heavy alcohol intake seems to be the single most relevant cause of HCC in this area AR: 45%, followed by HCV AR: 36%, and HBV AR: 22% infection.80 Ovarian cancer Associations were also found between alcohol consumption and cancers of the ovary ..., but only for 50 g and 100 g a day.81 Thus, the results of this study suggest that relatively elevated alcohol intake of the order of 40 g per day or more may cause a modest increase of epithelial ovarian cancer risk.82 This pooled analysis does not support an association between moderate alcohol intake and ovarian cancer risk.83 Evidence is inconsistent and inconclusive Endometrial cancer An endometrial adenocarcinoma invading the uterine muscle. An endometrial adenocarcinoma invading the uterine muscle. Thirteen studies to date have reported on the relationship between endometrial cancer and alcohol consumption. Only two of these studies have reported that endometrial cancer incidence is associated with consumption of alcohol; all the others have reported either no definite association, or an inverse association. Six studies showed an inverse association; that is, drinking was associated with a lower risk of endometrial cancer ...if such an inverse association exists, it appears to be more pronounced in younger, or premenopausal, women.84 Our results suggest that only alcohol consumption equivalent to 2 or more drinks per day increases risk of endometrial cancer in postmenopausal women.85 Considering total alcohol drinking, the relative risk for alcohol drinkers vs. nondrinkers was 1.3 ... No relation emerged between duration of alcohol consumption and risk of endometrial cancer. These findings suggest a potential link between alcohol drinking and endometrial cancer risk and are, in any case, inconsistent with a protective role of alcohol in endometrial carcinogenesis.86 Gallbladder cancer It is concluded that high intake of alcoholic beverages is associated with the development of liver and gall bladder cancers among workers.87. A study of female gallbladder cancer patients in Kerala, India found that 10% consumed alcohol.88 Another study found no relationship between alcohol consumption and the disease.89 There was no clear association between alcohol consumption and the risk. ... Drinking may pose an elevated risk among men, but that seems to be less true among women.90 Leukemia Leukemia British spelling: leukaemia. There is no association between drinking alcohol and adult leukemia. Results from the few studies that have examined the association between alcohol use during pregnancy and childhood leukemia are conflicting, reported a study that found an association.91 A review published by the National Cancer Institute placed maternal alcohol consumption during pregnancy in the category of suggestive and asserts that it is unlikely to be an important risk factor. 92 Leukemia constitutes about 7.8% of all cancers.26 Lung cancer Drinking isn't a risk for lung cancer according to the analyses of scientific research by the American Lung Association 93 and other medical groups that have analyzed the totality of medical evidence 94 95 9697 Globally, lung cancer is the most frequent malignancy in males, while it is the fifth most common cancer in females. 1 It is a major cause of death, constituting about 28.8% of all cancers.26 The NIAA reports that A few studies have linked chronic heavy drinking with cancers of the stomach, pancreas, and lungs International Agency for Research on cancer. However, the association is consistently weak and the majority of studies have found no association International Agency for Research on Cancer.3 Chronic heavy alcohol consumption possibly increases the risk of lung cancer, but the evidence is inadequate to date.98 Commenting on a study by Freudenheim et al99 R. Curtis Ellison MD writes, This study, like others, suggests a weak, positive association between consuming larger amounts of alcohol 2 drinks a day and lung cancer risk.100 Malignant melanoma In interview data from the U.S.A.'s Third National Cancer Survey, alcohol ingestion was associated with a higher occurrence of cancers of the breast, thyroid, and malignant melanoma. Data from other studies support the first two associations.101 High alcohol consumption was associated with an increased risk for melanoma, which remained after adjustment for confounders....102 Other studies suggest there is no association for melanoma. The risk of malignant melanoma was not influenced by alcohol consumption or smoking habits.103 There was no evidence that ... alcohol or polyunsaturated fats were associated with an increased risk.104 There is no association between alcohol and Nonmelanoma skin cancer. Non-Hodgkin lymphoma NHL Some studies find no association between alcohol and NHL. Alcohol does not appear to be a major etiologic factor for overall NHL, nor its common subtypes.105 NHL was not associated with smoking or alcohol, but collaborative studies could further investigate the risks of rarer WHO subtypes following these exposures.106 Some studies suggest a higher risk of NHL from alcohol. ...beer drinkers showed an increased OR of 5.5 95% 1.1-26.7 in men. It could be concluded that ... beer and 'mate' drinking are risk factors for NHL in the Uruguayan population.107 Other studies have suggested a protective effect in some groups. The results of this large-scale European study ... did not support an association between tobacco and NHL and suggested a protective effect of alcohol on development of NHL for men and in non-Merranean countries.108 These data suggest that moderate alcohol consumption is inversely associated with the risk of NHL in older women and the amount of alcohol consumed, rather than the type of alcoholic beverages, appears to be the main effect determinant.109 In contrast, another study concluded, These data show that consumption of wine, but not of beer or spirits, is associated with a reduced NHL risk.110 A meta-review concluded, People who drink alcoholic beverages might have a lower risk of NHL than those who do not, and this risk might vary by NHL subtype. Further study designs are needed to determine whether confounding lifestyle factors or immunomodulatory effects of alcohol explain this association.111 In the present study, heavy tobacco smoking, and particularly, heavy alcohol drinking were associated with poor survival in NHL patients. Our findings strongly encourage physicians to advice NHL patients to stop smoking and diminish alcohol consumption to obtain improvements in the course of NHL.112 Pancreatic cancer A few studies have linked chronic heavy drinking with cancers of the stomach, pancreas, and lungs. However, the association is consistently weak and the majority of studies have found no association, write the NIAAA,3 citing the International Agency for Research on Cancer..113 Alcohol has been reported as a possible risks in some but not in most studies.114 Drinking alcohol excessively is a cause of acute pancreatitis and chronic pancreatitis. About 7 out of 10 cases of chronic pancreatitis are due to long term heavy drinking. Chronic pancreatitis is a known risk factor for cancer of the pancreas. But chronic pancreatitis that is due to alcohol doesn't increase risk as much as other types of chronic pancreatitis. So if there is a link with alcohol and pancreatic cancer risk, it is only very slight.115 Chronic heavy alcohol consumption is a risk factor for pancreatitis, but evidence for an association with pancreatic cancer is inconsistent. Overall, research suggests an increased risk in heavy drinkers116117118 , but no increased risk for people consuming up to 30g of alcohol a day119.120 A study found, An index of total alcohol consumption showed a greater than two-fold risk for pancreatic cancer for heavy alcohol consumption four or more drinks per day, primarily due to heavy beer and hard liquor consumption.121 Our findings indicate that alcohol drinking at the levels typically consumed by the general population of the United States is probably not a risk factor for pancreatic cancer. Our data suggest, however, that heavy alcohol drinking may be related to pancreatic cancer risk.118 The Iowa Women's Health Study found that, Relative risks of pancreatic cancer increased with the amount of alcohol consumed Ptrend = 0.11 after adjustment for age, smoking status, and pack-years of smoking.122 Cases people with pancreatic cancer drank significantly more beer than controls p = 0.005 and there was evidence of a positive trend in risk with total alcohol consumption.123 A Swedish study found Alcoholics had only a modest 40% excess risk of pancreatic cancer ... The excess risk for pancreatic cancer among alcoholics is small and could conceivably be attributed to confounding by smoking.117 A British study stated, It was shown that the relative risk of cancer of the pancreas increases with fat and alcohol intakes, ... Alcohol may be not directly involved in the aetiology of cancer of the pancreas: its effect could be due to the contents of some alcoholic beverages.124 A Dutch study found that, When compared with data from non-drinkers, the cumulative lifetime consumption of all types of alcohol in grams of ethanol ... beer, spirits, red wine and fortified wine was not related to risk. The consumption of white wine was inversely associated with risk .... The uniformly reduced risk estimates for the lifetime number of drinks of white wine were based on small numbers ....125 A Polish study concluded, The findings regarding alcoholic beverages were overall null, although the weakly positive trend in risk with spirits consumption p = 0.71 may deserve further investigation in view of the special nature of the source of spirits vodka in Poland.126 For the most part, consumption of total alcohol, wine, liquor and beer was not associated with pancreatic cancer.127 Data from these two large cohorts do not support any overall association between coffee intake or alcohol intake and risk of pancreatic cancer.119 Prostate cancer A meta-analysis published in 2001 found a small but significant increased risk for men drinking more than 50 g/day of alcohol, with a slightly higher risk for men consuming more than 100 g/day.128 Since that analysis, cohort studies in America have found increased risks for men drinking moderate amounts of spirits, and for 'binge drinkers,129 but moderate consumption of beer or wine has not been linked to an increased risk.130131132 Associations were also found between alcohol consumption and cancers of the ovary and prostate, but only for 50 g and 100 g a day.81 However, one study concludes, In contrast to the majority of previous studies, we found a positive association between moderate alcohol consumption and the risk of prostate cancer. Liquor, but not wine or beer, consumption was positively associated with prostate cancer.130 The Fred Hutchinson Cancer Research Center found that men who consumed four or more glasses of red wine per week reduced their risk of prostate cancer by 50 percent. They found no significant effects - positive nor negative - associated with the consumption of beer or hard liquor and no consistent risk reduction with white wine, which suggests that there must be a beneficial compound in red wine that other types of alcohol lack. That compound ... may be an antioxidant called resveratrol, which is abundant in the skins of red grapes..133131 Small intestine cancer The study also found that both cigarette smoking and alcohol consumption were associated with both types of tumor adenocarcinomas and malignant carcinoid tumors, and were independent risk factors.134 Heavy ethanol intake 80 g a day was also a risk factor in both men and women, with no increased risk associated with lower levels of ethanol intake.135 Alcohol and tobacco consumption did not increase the risk of adenocarcinoma of the small intestine. ... While the present data are inconsistent with a major effect of tobacco or alcohol, a moderate association between these factors and small bowel cancer may have been obscured by the play of chance.136 Tobacco and alcohol consumption were unrelated to risk of small intestine cancer...137 Thyroid cancer In interview data from the U.S.A.'s Third National Cancer Survey, alcohol ingestion was associated with a higher occurrence of cancers of the breast, thyroid, and malignant melanoma. Data from other studies support the first two associations.101 Another study suggests that drinking in moderation significantly reduces the risk of some malignant tumors such as thyroid cancer in women.138 However, another study concludes, A reduced risk associated with alcohol was eliminated after adjustment for smoking....139 Alcohol consumption is not suspected to increase risk Bile duct cancer The use of alcohol and coffee was not related to risk of extrahepatic bile duct cancer.140 We found limited evidence for an excess risk of intrahepatic, but not for extrahepatic, biliary duct cancer.141 Bladder cancer Our data suggest that total and beverage-specific alcohol consumption are not associated with an increased risk of bladder cancer.142 A Dutch study concludes, The results of this study do not suggest an important association between alcohol consumption and bladder cancer risk.143 Our study, based on a population with high alcohol mainly wine intake, found no association between bladder cancer risk and alcohol intake, even at high levels of consumption.144 Alcohol consumption was strongly associated with a reduced risk of bladder cancer. The effect was modified by the type of alcoholic beverage, cigarette smoking and frequency of urination.145 Cervical cancer A study concluded that alcoholic women are at high risk for in situ and invasive cervical cancer but attributed this to indirect, lifestyle-related reasons.146 Stomach cancer While alcohol has been extensively studied as a cause of stomach cancer there is no conclusive evidence that it increases risk. However, results from at least three studies suggest that heavy alcohol consumption may increase the risk of stomach cancer in heavy smokers. 147 148 149 150 A Taiwanese study concluded, ... cigarette smoking may play the most harmful role in the initial development of gastric cancer, and that drinking alcohol may promote the process.147 A Norwegian study found that, No statistically significant associations between various degrees of exposure to alcohol and risk of gastric cancer was revealed, but combined high use of cigarettes 20/day and alcohol 5 occasions/14 days increased the risk of noncardia gastric cancer nearly 5-fold HR = 4.90 95% CI = 1.90-12.62, compared to nonusers.149 Alcohol consumption, even when chronic and heavy, probably does not affect the risk of stomach cancer.98 Testicular cancer A review concluded that There is no firm evidence of a causal relation between behavior risks tobacco, alcohol and diet and testicular cancer.151 Vaginal cancer A Danish study found that Abstinence from alcohol consumption was associated with low risk for both VV-SCCvagina and VV-SCCvulva in our study. 152 A study concluded that alcoholic women are at high risk for cancer of the vagina.146 In both studies, indirect, lifestyle-related reasons were cited. Vulvar cancer No consistent association emerged between milk, meat, liver, alcohol and coffee consumption and risk of vulvar cancer.153 A Danish study found that Abstinence from alcohol consumption was associated with low risk for both VV-SCCvagina and VV-SCCvulva in our study. 152 Indirect, lifestyle-related reasons were cited. In contrast, a Swedish study concluded that alcoholic women are at no higher risk for cancer of the vulva.146 Alcohol consumption might reduce risk Hodgkin's lymphoma HL One study concluded, Our study indicates a protective effect of alcohol consumption for nonsmoking HL cases.154 Kidney cancer Renal cell carcinoma RCC Moderate alcohol consumption was associated with a lower risk of renal cell cancer among both women and men in this pooled analysis.155 This pooled analysis found an inverse association between alcohol drinking and RCC. Risks continued to decrease even above eight drinks per day i.e. 100 g/day of alcohol intake, with no apparent levelling in risk.156 Results from our prospective cohort study of middle-aged and elderly women indicate that moderate alcohol consumption may be associated with decreased risk of RCC.157 A small study concluded that its findings suggest an inverse association of alcohol consumption and RCC development among women but not among men.158 Another small study concluded that No significant relationship emerged, nor any differences between the sexes.159 Alcohol not listed as a risk factor Acute lymphocystic leukemia 2 Acute myeloid leukemia 3 Adenoid cancer 4 5 Adrenal gland cancer 6 Anal cancer 7 Appendix cancer160 Bartholin's gland cancer Carol A. Johnson, Bartholin's gland cancer, American Family Physician, April, 1989. Basal cell carcinoma 8 Bone cancer 9 Brain cancer 10 Central nervous system cancer craniopharyngioma 11 Chordoma 12 Chrondosarcoma 13 Chronic lymphocystic leukemia 14 Chronic myeloid leukemia 15 Ewing's family of tumors 16 Extragonal germ cell cancer 17 Eye cancer 18 19 Fallopian tube cancer 20 Gastrointestinal carcinoid tumors 21 Gastrointestinal stromal cell tumors 22 Hairy cell leukemia 23 Kaposi's sarcoma 24 Melanoma 25 Malignant mesothelioma 26 Multiple myeloma 27 Nasal cavity and paranasal sinus cancer 28 Osteosarcoma 29 Penile cancer30 Pituitary gland cancer 31 Pleuropulmonary blastoma 32 Retinoblastoma 33 Salivary gland cancer 34 Sipple's syndrome 35 Skin cancer 36 Soft tissue cancers 37 Spine or spinal cancer 38 Squamous cell carcinoma 39 Thymus cancer 40 Transitional cell cancer of renal pelvis and ureter 41 Urethra or urethral cancer 42 Wilms tumor 43 Recommended maximum alcohol intake Main article: Recommended maximum intake of alcoholic beverages As outlined above, there is no recommended alcohol intake with respect to cancer risk alone as it varies with each individual cancer. See Recommended maximum intake of alcoholic beverages for a list of governments' guidances on alcohol intake which, for a man, range from 140-280g per week. One meta-analysis suggests that risks of cancers may start below the recommended levels. Risk increased significantly for drinkers, compared with non-drinkers, beginning at an intake of 25 g 2 standard drinks per day for the following: cancers of the oral cavity and pharynx relative risk, RR, 1.9, esophagus RR 1.4, larynx RR 1.4, breast RR 1.3, liver RR 1.2, colon RR 1.1, and rectum RR 1.1161162 Relative health risks An increase in risk of a particular cancer through drinking needs to balanced against the benefits of moderate drinking on reducing heart attacks. See Alcohol and cardiovascular disease for more. There are, of course, many ways of reducing your risk of a heart attack either without, or in addition to, drinking alcohol, such as controlling your weight, eating an appropriate diet, and exercising. 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Freudenheim, Edward Giovannucci, Saxon Graham, Pamela L. Horn-Ross, Michael F. Leitzmann, Marjorie L. McCullough, Anthony B. Miller, Alexander S. Parker, Carmen Rodriguez, Thomas E. Rohan, Arthur Schatzkin, Leo J. Schouten, Mikko Virtanen, Walter C. Willett, Alicja Wolk, Shumin M. Zhang, Stephanie A. Smith-Warner Alcohol Intake and Renal Cell Cancer in a Pooled Analysis of 12 Prospective Studies JNCI Journal of the National Cancer Institute 2007 9910:801-810; doi:10.1093/jnci/djk181 ^ C. Pelucchi, C. Galeone, M. Montella, J. Polesel, A. Crispo, R. Talamini, E. Negri1, V. Ramazzotti, M. Grimaldi, S. Franceschi and C. La Vecchia Alcohol consumption and renal cell cancer risk in two Italian case-control studies Annals of Oncology doi:10.1093/annonc/mdm590 ^ Rashidkhani, B., Åkesson, A., Lindblad, P, and Wolk, A. Alcohol consumption and risk of renal cell carcinoma: A prospective study of Swedish women International Journal of Cancer, 2005 December 10, 1175, 848-853 ^ Alexander S. 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External links Government and international bodies International: International Agency for Research on Cancer home page Australia: Cancer Control Bulletin Alcohol and cancer risk PDF format Canada: Public Health Agency of Canada / Agence de santé publique du Canada Review of Lifestyle and Environmental Risk Factors for Breast Cancer Contents and Introduction PDF full report in PDF format UK: Committee on Carcinogenicity of Chemicals in Food, Consumer Products Consumption of alcoholic beverages and risk of breast cancer UK: Committee on Carcinogenicity of Chemicals in Food, Consumer Products Evidence for association between consumption of alcoholic beverages and breast cancer US: National Institute on Alcohol Abuse and Alcoholism Alcohol Alert No. 21-1993 Alcohol and cancer US: National Cancer Institute US: National Toxicology Program Report on Carcinogens, Eleventh ion Alcoholic Beverage Consumption PDF US: Ohio Department of Health Alcohol and cancer PDF format Cancer charities Australia: The Cancer Council Australia Alcohol and cancer prevention Australia: The Cancer Council Victoria Alcohol cancer risk Australia: Cancer Council New South Wales Alcohol and Cancer New Zealand: Cancer Society of New Zealand Alcohol and cancer United Kingdom: Cancer Research UK: Alcohol and cancer United Kingdom: Cancer Research UK: Alcohol and cancer: the evidence USA: American Cancer Society Alcohol Increases Hormone Levels, Raising Breast Cancer Risk Other sites Toronto Cancer Prevention Coalition Alcohol Work Group Report on the Links between Alcohol and Cancer PDF format Alcohol in Moderation Alcohol Cancer Alcohol and Cancer Science sites Fred Hutchinson Cancer Research Center Alcohol Use Increases the Risk of Hormonally Sensitive Breast Cancers in Postmenopausal Women Retrieved from http://en..org/wiki/Alcohol_and_cancer Categories: Alcohol abuse | Oncology | IARC Group 1 carcinogensHidden category: Pages with DOIs broken since 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 14 August 2008, at 16:13
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