Alcohol and Cancer

Evidence has shown that alcohol is a cause of cancer. The more alcohol used over a lifetime, the greater the risk of developing alcohol-caused cancers.

Alcohol is classified as a Group 1 carcinogen, which means there is no doubt it causes cancer, just like tobacco smoke and asbestos.1 Research has found there is no safe level of alcohol use,2 and the risk of developing an alcohol-caused cancer increases in line with the amount of alcohol consumed.13 Alcohol causes 3% of all cancers, or around 3,500 cancer cases, in Australia each year.4 The less alcohol you drink, the lower your risk of developing an alcohol-caused cancer. Making small changes to your alcohol use can help reduce your risk.

How cancer is formed

Our body is made up of lots of cells – each with its own function and role inside the body. Healthy cells grow, duplicate and die normally, without causing any harm to the body. Most cells have genes inside them which are made up of DNA. When cells multiply, sometimes there can be a change in the DNA. This change is called a mutation and it results in a cell not growing, duplicating or dying as it should. These mutations can happen by chance, sometimes through inherited genetic faults but more commonly from environmental factors including alcohol use.5

While the body’s immune system keeps mutated cells under control, sometimes abnormal cells can sometimes divide uncontrollably, which can form lumps or growths. These are called tumours. Tumours can be made up of cancer cells (malignant or cancerous tumours) or can be made up of non-cancer cells (benign or non-cancerous tumours).6

  • Cancer cells do not know when to stop growing and multiplying.5 This means that if untreated, cancer cells may invade and destroy surrounding tissues.
  • Cancer cells can also spread beyond the area where the cancer first developed. Unlike normal cells, cancer cells do not stick together like normal cells, and they may also produce substances that stimulate them to move.5 Cancer cells can break away from the site in the body where they first grew and move through the blood vessels or lymphatic system and start growing somewhere else in the body. This process is called metastasis.6
  • Cancer cells do not repair themselves or die like normal cells. This is because cancer cells have the ability to override the signals from molecules that tell damaged cells to repair themselves or self-destruct. 5
  • If cells don’t repair the damage to their genes, this can lead to more problems in the gene. New gene faults, or mutations, can make the cancer cells grow faster, spread to other parts of the body, or become resistant to treatment.5

Types of alcohol-caused cancers

There is strong evidence that alcohol causes cancer in at least seven sites 17 in the body including:

  • Oropharynx
  • Larynx
  • Oesophagus
  • Liver
  • Bowel
  • Stomach
  • Female breast

The risk of alcohol-caused cancer at these increases with the amount of alcohol consumed.8

How alcohol consumption damages the cells of the body and increases the risk of alcohol-caused cancer.

There are many mechanisms for how alcohol causes cancer.3

1. Alcohol is broken down and forms acetaldehyde. Acetaldehyde can damage cells because it can bond with DNA causing cells to be replicated incorrectly.3

2. Alcohol can also cause direct tissue damage, and this increases the absorption of other carcinogens (cancer causing agents) that those cells come into contact with.3

3. Alcohol can influence hormone levels, increasing cancer risk.3

4. Alcohol can reduce folate absorption, which can result in big changes in the cell, potentially in ways that can make a cell more likely to become cancerous.9

5. Alcohol can carry other cancer-causing substances into cells. It can act as a solution that carcinogens (for example tobacco) can mix with to help them sneak into cells.10

For cancers of the mouth, pharynx, larynx, oesophagus and liver there is strong evidence that the DNA damage is due to acetaldehyde.18

For breast cancer, the exact mechanism remains uncertain, but a potential mechanism is alcohol interfering with the metabolism of oestrogen, with the liver’s ability to metabolise nutrients, non-nutritive substances (e.g. tea, coffee, and food additives) and hormones. Alcohol may also increase circulating levels of oestrogen, which is an established risk factor for breast cancer.8

Alcohol in combination with other lifestyle factors

Alcohol and smoking

There is evidence that the combined effects of smoking and drinking alcohol can increase the risk of certain cancers, compared with someone who only drank or only smoked. 3

Compared to people who don’t smoke and don’t drink:

  • People who drink alcohol are up to 6 times more likely to develop mouth and throat cancer.
  • People who smoke tobacco are up to 7 times more likely to develop mouth and throat cancer.
  • People who smoke tobacco and drink alcohol heavily 15 are up to 35 times more likely to develop mouth and throat cancer. 3

The combined effect of alcohol and smoking has been estimated to be responsible for more than 75% of cancers of the upper aero-digestive tract, including the lips, mouth, tongue, nose, throat, vocal cords, and part of the oesophagus and windpipe.3

Research shows that drinking one bottle of wine per week is equivalent to the increased lifetime cancer risk of smoking ten cigarettes per week for women and five cigarettes per week for men.12

Alcohol and weight gain

From a nutritional point of view, alcoholic drinks represent ‘empty calories’ – meaning they are high in kilojoules but have limited to no nutritional value.1314

Alcohol has a high energy content with 29 kilojoules per gram of pure alcohol.15 This means that one standard drink (which contains 10g of alcohol), has 290 kilojoules from the alcohol alone.

Because alcohol is typically used in addition to a person’s normal food and drink intake, alcohol can contribute to weight gain. Being overweight or obese is a risk factor for 13 types of cancer including oesophagus, pancreas, liver, bowel, breast (in postmenopausal women), endometrium and kidney.1316 This means that alcohol both directly contributes to cancer risk and contributes indirectly through its impact on weight.

Reducing your drinking will reduce your risk of alcohol-caused cancer

Making small changes to your drinking patterns can help reduce the risk of developing alcohol-caused cancers. This can include:

  • Swapping to low or no alcohol alternatives.
  • Having a few alcohol-free days each week.
  • Counting your drinks.
  • Swapping drinking for social alternatives, like going for a walk with a friend or sport.

Over the next 25 years, if all Australians drank no more than 2 standard drinks of alcohol per day, it is estimated that around 30,000 cases of cancer could be prevented.4

1

International Agency for Research on Cancer. (2012). A review of human carcinogens: Personal habits and indoor combustions. Volume 100. World Health Organization: Geneva. P.34, 377

2

Griswold, MG, Fullman N, Hawley C, et al. (2018). Alcohol use and burden for 195 countries and territories,1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 392, 1015-35.

3

Winstanley, M., Pratt, I., Chapman, K., et al. (2011). Alcohol and cancer: a position statement from Cancer Council Australia. Medical Journal of Australia, 194(9), 479-482.

4

Wilson, L., Antonnson, A., Green, A., et al. (2018). How many cancer cases and deaths are potentially preventable? Estimates for Australia in 2013. International Journal of Cancer, 142(4): 691-701.

5

Cancer Research UK. (2014). How cancer starts. Available from: http://www.cancerresearchuk.org/about-cancer/what-is-cancer/how-cancer-starts/cancer-cells

6

PubMed Health (2013). How do cancer cells grow and spread? Available from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072594/

7

Pandeya, N., Wilson, L., Webb, P., Neale, R., Bain, C., & Whiteman, D. (2015). Cancers in Australia in 2010 attributable to the consumption of alcohol. Australian and New Zealand Journal of Public Health, 39(5), 408-413.

8

Connor, J. (2017). Alcohol consumption as a cause of cancer. Addiction. 112(2):222-228.

9

Xu X, Chen J. One-carbon metabolism and breast cancer: an epidemiological perspective. J Genet Genomics. 2009; 36(4):203-214.

10

Eccles L. How does alcohol increase cancer risk? (2016) World Cancer Research Fund International. Available from: https://www.wcrf.org/int/blog/articles/2016/03/how-does-alcohol-increase-cancer-risk

11

Winstanley, M., Pratt, I., Chapman, K., et al. (2011). Alcohol and cancer: a position statement from Cancer Council Australia. Medical Journal of Australia, 194(9), 479-482.

12

Hydes, T., Burton, R., Inskip, H., Bellis, M., & Sheron, N. (2019). A comparison of gender-linked population cancer risks between alcohol and tobacco: how many cigarettes are there in a bottle of wine? BMC Public Health, 19:316.

13

Cancer Council Australia. (2019). National Cancer Prevention Policy. Available from: https://www.cancer.org.au/policy-and-advocacy/prevention-policy/national-cancer-prevention-policy.html

14

 Whitney, E., & Ebook Library. (2013). Understanding nutrition (2;2nd; ed.). Melbourne: Cengage Learning Australia.

15

Lourenco, S., Oliveira, A., & Lopes, C. (2012). The effect of current and lifetime alcohol consumption on overall and central obesity. European Journal of Clinical Nutrition, 66, 813-818.

16

International Agency for Research on Cancer. (2018). Absence of Excess Body Fatness. Volume 16. IARC Handbooks of Cancer Prevention. Available from: http://publications.iarc.fr/570

17

Wilson, L., Baade, P., Green, A., et al. (2019). The impact of reducing alcohol consumption in Australia: An estimate of the proportion of potentially avoidable cancers 2013-2037. International Journal of Cancer, 145, 2944-2953.

Page last updated: 10 September 2020

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