There's no safe level of drinking when it comes to cancer risk, oncologists warn

The American Society of Clinical Oncology (ASCO) on Tuesday issued a statement highlighting the connection between alcohol consumption and relative risk of cancer.

According to the New York Times' "Well," while other medical groups have cited alcohol consumption as a possible cause of cancer, the new paper marks the first time ASCO has taken an official stance on the matter.

ASCO based the statement, published in the Journal of Clinical Oncology, on a review of existing studies. According to Reuters, the statement follows an ASCO survey that found 70% of U.S. residents do not recognize alcohol consumption as a cancer risk factor.

ASCO's statement on alcohol and cancer risk

In the statement, ASCO called for minimizing alcohol consumption, stating that "alcohol is causally associated with oropharyngeal and larynx cancer, esophageal cancer, hepatocellular carcinoma, breast cancer, and colon cancer." According to the statement, research suggests an estimated 5.5% of new cancers and 5.8% of cancer deaths worldwide in 2012 were attributable to alcohol. In the United States specifically, research shows an estimated 3.5% of cancer deaths are attributable to alcohol.

ASCO wrote that a systematic review from the World Cancer Research Fund/American Institute for Cancer "judged the evidence to be convincing that drinking alcohol was a cause of cancers of the oral cavity, pharynx, larynx, esophagus, breast, and colorectum (in men)." Meanwhile, among women, "alcohol was judged to be a probable cause of increased risk of liver cancer and colorectal cancer," ASCO stated. According to ASCO, the World Health Organization's International Agency for Research on Cancer (IARC) reached "virtually identical conclusions."

ASCO in the statement also noted that alcohol consumption can exacerbate the negative health effects of smoking. Further, among patients who already have cancer, alcohol consumption can adversely affect treatment and outcomes. However, ASCO said a former drinker who stops consuming alcohol for at least 20 years can revert his or her cancer risk to that of a non-drinker.

Heavy drinking poses the greatest risk, but light and moderate drinking also carries risk

In the statement, ASCO added that while heavy, long-term drinkers are linked to the greatest risk of cancer, even light and moderate drinkers have an increased risk. ASCO in the statement provided data on how alcohol consumption increased the relative risk of developing cancer—not the absolute risk.

ASCO wrote that individuals who qualify as heavy drinkers—defined by CDC as eight or more drinks weekly for women and 15 or more for men—was associated with a roughly fivefold increase among men and women in the risk of cancers of the esophagus and the oral cavity and pharynx when compared individuals who do not drink. Heavy drinking was also associated with an elevated risk of colorectal, liver, and larynx cancers among men and women, and—among women—breast cancer.

Meanwhile, people who drink moderately—which CDC defines as one drink daily for women and two for men—were associated with about double the risk of oral cavity and pharynx cancer, and more than double the risk of squamous cell carcinoma of the esophagus, compared with people who do not drink, according to ASCO. As with heavy drinkers, moderate drinkers also had increased risk of colorectal, liver, larynx, and—among women—breast cancers.

And even light drinkers—who according to Reuters are defined as people who consume less than one drink per day—had elevated risks of certain cancers, including esophageal squamous cell carcinoma among men and women, and, for women, breast cancer.  

ASCO calls for public health initiatives

ASCO in the statement called for new public health initiatives to reduce alcohol use, such as imposing taxes and restricting ads geared toward minors.

The group also stated its opposition to "pinkwashing," wherein alcohol companies put a pink ribbon—indicating support for curing breast cancer—on a product to boost sales. ASCO said it objects to the practice "given the consistent evidence that shows the link between alcohol consumption and an increased risk of breast cancer."  

Discussion

ASCO President Bruce Johnson, said that while "people typically don't associate drinking beer, wine, and hard liquor with increasing their risk of developing cancer in their lifetimes," the connection "between increased alcohol consumption and cancer has been firmly established." He added that he hopes this knowledge enables doctors "to help their patients reduce their risk of cancer."

Separately, Noelle LoConte, lead author of the statement and an associate professor at the University of Wisconsin-Madison, said she hopes oncologists can be a "loud voice for policy change." She added, "We hope that this paper makes a splash with other physicians so they can get alcohol prevention on their radar, too." LoConte continued, "The message is not, 'Don't drink.' It's, 'If you want to reduce your cancer risk, drink less. And if you don't drink, don't start.'"

Separately, Susan Gapstur, VP for epidemiology at the American Cancer Society, said, "The story of alcohol has been quite consistent and has been peeled away like an onion over time, and we're continuing to learn more about the mechanisms involved," Gapstur said. "We don't have randomized trials, but sometimes when you start looking at the coherence of all the evidence, including the observational epidemiology, the lab studies, the mechanistic studies, you begin to see a picture and get more clarity."

Anne McTiernan, a scientist at the Fred Hutchinson Cancer Research Center, said she was glad to see oncologists focus on alcohol, saying, "That puts some weight behind this" (Rabin, "Well," New York Times, 11/7; Platzman Weinstock, Reuters, 11/7; Thorbecke, ABC News, 11/7; ASCO statement, 11/7; Lomangino, Health News Review, 11/8).

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