The details matter
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An estimated 20,000 U.S. cancer deaths a year can be
attributed to alcohol use, mostly among men, a 2024 study says. The World Health
Organization classifies alcohol as a Group 1 carcinogen –
the highest risk group, which also includes asbestos, radiation, and tobacco.
Another recent study of 135,000
adults in the United Kingdom aged 60 and above who drink alcohol found that
virtually any amount of alcohol increases the risk of cancer, particularly
among people with existing health problems or who live in low-income areas.
Yet a 2023 analysis of
national survey data by a National Cancer Institute-backed team found that
“awareness of the alcohol-cancer link is low.” The analysis said that only 32%
were aware that drinking hard liquor boosts cancer risk, while 25% knew of that
link for beer and just 20% for wine. And 10% incorrectly believed that drinking
wine reduces cancer risk.
To better understand how alcohol can impact cancer risk, we
turned to Eden Bernstein, MD, an assistant professor
of hospital medicine in
the University of Colorado Department of Medicine. Bernstein
has a research and clinical interest in alcohol use disorder,
a medical condition defined as an impaired ability to stop or control alcohol
use despite adverse social, occupational, or health consequences.
What are some cancer risks involved with drinking alcohol?
Several cancers have been linked to alcohol consumption.
Most of them relate to the gastrointestinal tract – cancer of the lips,
the mouth, the esophagus, the colon, and the
rectum. It has also been linked to cancer of the larynx and the liver. In women,
there’s also an increased risk of breast cancer.
In terms of cancer risk, does it matter how much or how
often you drink?
The degree to which alcohol increases your risk of cancer
varies by the specific cancer type, as well as by the amount you drink, how
often you drink, and how long you’re exposed to alcohol.
There’s no minimum amount of alcohol that’s considered
totally safe from a cancer prevention standpoint, but the cancer risk is
proportional to the amount of alcohol you drink. Most guidelines recommend that
women should have no more than one drink a day, and men should drink no more
than two per day.
A recent study estimated
that 17,000 U.S. cancer deaths a year could be prevented if everyone adhered to
those guidelines.
Does it matter what you drink – liquor, beer, or wine?
The cancer risk from alcohol is a byproduct of the
metabolism of the alcohol molecule. So it doesn’t really matter if you’re
drinking liquor, beer, or wine. If that alcohol molecule is there, the cancer
risk is there. That said, the risk is higher if you’re drinking drinks with a
higher alcohol concentration and therefore consuming more alcohol overall.
Are there other factors that can accentuate the effects
of drinking alcohol on cancer?
In medicine, risk factors are thought of as additive – they
compound one another. In the context of cancer, many people who drink alcohol
also smoke. Drinking and smoking are each a risk factor for cancer, but those
two risk factors together work synergistically in a way that increases your
risk beyond the sum of the individual components.
And things like genetics can come into play. For example, a
genetic variant common among some people of Asian ancestry predisposes a higher
risk of developing cancer with exposure to alcohol.
The link between alcohol and cancer seems well
established, but it also seems that public awareness is lacking.
Yes, and so a lot of the research going into this area is
focused on how to adequately communicate this risk to the general public. Many
patients aren’t aware of the cancer link when they start to make decisions
about their alcohol consumption.
What treatments are available for alcohol use disorder,
and how well do they work?
There are several medications for alcohol use disorder that
are approved by the FDA to help reduce drinking, and there are some that are
used off label. A lot of them are based on very rigorous evidence, including
randomized controlled trials, that consistently show that they’re effective in
helping patients reduce drinking.
One of the most effective of these medications is
naltrexone, available as a pill or in a long-acting injectable formulation. It
helps reduce cravings for alcohol. Some patients take it and stop drinking
completely, and others cut down their drinking. It should be prescribed as part
of a comprehensive treatment plan for alcohol use disorder.
But what’s striking to me about these medications is just
how underutilized they are. We know from a variety of studies that many
patients that have alcohol use disorder never receive those medications. So
there’s a lot of effort across the U.S. to try to increase the prescribing of
these medications.
What would be your advice to a patient who drinks alcohol who is concerned about the risk of cancer or other health problems?
For patients who have alcohol use disorder, which is a form of addiction, the thinking has changed a bit. In these circumstances, it’s always best to stop drinking completely. But there’s also been a recognition that for a lot of patients, that’s not always immediately possible.
It’s a
chronic condition that’s not always treated in one go. So we’re coming to
understand that in the short term, any sort of drinking reduction is a win as
we continue longer-term treatment engagement, which can involve medications,
psychotherapy, mutual-help groups, and treatment of underlying mental health
conditions. You can’t do that if you drive someone away by making them feel
like they failed because they didn’t stop drinking completely.
For someone who drinks but who doesn’t have alcohol use
disorder, it’s about helping them understand the risks of alcohol, including
the link to cancer, individualized based on their unique patterns of alcohol
consumption and medical history.
And just as with smoking, there’s evidence that reducing or stopping your alcohol consumption now can reduce your risk of cancer later. It’s never too late to make these changes and still see benefits from them.
