November 20, 2017 | Erin Bluvas, bluvase@sc.edu
Anthony Alberg, professor and chair of the epidemiology and biostatistics department, has authored Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. The paper appears in the Journal of Clinical Oncology, a leading publication in the area of cancer research. The statement, which Alberg co-authored* with scientists from organizations such as the Mayo Clinic and the MD Anderson Cancer Center, includes evidence related to the cancer risks of alcohol as well as recommendations for policies to minimize excessive alcohol drinking.
Alcohol Use and Cancer Risk
With 3.3 million deaths estimated to occur worldwide annually as a result of harmful alcohol use, the authors note that this lifestyle behavior has already been established as a significant public health problem. What often goes unnoticed, however, is the strong linkage between alcohol use and cancer. Considered in total, in 2012 it was estimated that 5.5 percent of all new cancer cases and 5.8 percent of all cancer deaths worldwide (3.5 percent in the United States) were attributed to alcohol.
Alcohol’s role as a significant contributor to the population burden of cancer is due to the high prevalence of use and its role as a risk factor for several types of cancer. The World Cancer Research Fund/American Institute for Cancer Research and the International Agency for Research on Cancer, a branch of the World Health Organization, have both linked alcohol use to cancers of the oral cavity, pharynx, larynx, esophagus, liver, breast and colon. The risks of these cancers among alcohol drinkers vary according the amount of alcohol consumed. Small increases in cancer risk have been detected among individuals who engage in low levels of alcohol consumption, but the greatest risks are evident among moderate and heavy drinkers.
The cancer risk linked to alcohol drinking may be increased even further when combined with other risk factors. Alcohol drinking and cigarette smoking, for example, have been shown to establish a synergistic interaction in some cases such as oral cancer—making the cancer risks much greater for individuals who engage in both compared with those who only drink alcohol.
There is still progress to be made in completely characterizing the impact of alcohol drinking on the population burden of cancer, sometimes because drinking alcohol goes hand in hand with other risk behaviors. “For some malignancies, alcohol drinking is clearly statistically associated with increased risk but due to its strong correlation with other risk factors, it is difficult to discern if alcohol drinking is truly an independent risk factor,” explains Alberg. “For example, alcohol drinking has consistently been statistically strongly associated with increased lung cancer risk. However, cigarette smokers are also more likely to be alcohol drinkers and cigarette smoking is such an overwhelming lung cancer risk factor that it is difficult to separate the two.”
Alcohol Use Among Patients with Cancer
Much remains to be answered about the impact of alcohol drinking in patients after the diagnosis of cancer. For example, there is limited research on whether cancer patients who quit drinking alcohol experience better outcomes in their cancer treatment and recovery. The majority of these studies, focusing on cancers of the head and neck, suggest that survival is improved after long-term cessation of alcohol use but the results have been mixed for studies of breast cancer.
Additional challenges can be found in the way alcohol is incorporated into clinical treatment in oncology settings. Barriers to effectively addressing alcohol use among cancer patients may include the perception that alcohol alleviates treatment side effects, limited physician knowledge of alcohol use and cancer risk, and differing perspectives and approaches to counseling patients about alcohol use.
Reducing Alcohol Use to Prevent Cancer
“Fortunately, alcohol drinking is a potentially modifiable risk factor that can be targeted with preventive interventions at both the individual and policy levels,” says Alberg.
According to the American Heart Association, American Cancer Society and U.S. Department of Health and Human Services, men should drink no more than one to two drinks per day, and women should drink no more than one drink per day. To help individuals adhere to these recommendations, whether through public health promotion efforts or formal policies, the authors suggest: clinical strategies (e.g., alcohol screening, treatment offers/referrals, counseling interventions), regulation of alcohol outlet density (i.e., limiting the number of alcohol-selling businesses), increased alcohol taxes and prices, maintaining limits on days and hours of sale, restricting youth exposure to advertising of alcoholic beverages, resistance to further privatization of retail alcohol sales in communities with current government control, and inclusion of alcohol strategies in comprehensive cancer control plans.
“Given that alcohol use is quite common, addressing alcohol use—particularly high-risk alcohol use—is an important preventive strategy to decrease the burden of cancer,” says Alberg of the statement’s conclusions. “Policy efforts are likely to be a key element in the overall strategy to address this need.”
*Co-authors include Noelle K. LoConte (University of Wisconsin Madision), Abenaa M. Brewster (MD Anderson Cancer Center), Judith S. Kaur (Mayo Clinic), Janette K. Merrill (American Society of Clinical Oncology).
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