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Alcohol and Cancer: Existing Knowledge and Evidence Gaps Across the Cancer Continuum PMC

golf1995พฤษภาคม 22, 2023

Oxidative stress can be induced by activation of certain pathways which produce reactive oxygen species (ROS) such as superoxide anion and hydrogen peroxide. One pathway by which ethanol achieves this is through increased CYP2E1 activity which produces high quantities of ROS whilst oxidising ethanol to acetaldehyde [27]. Other sources of ROS during ethanol metabolism include the mitochondrial respiratory chain and some cytosolic enzymes [28]. More than 30 years ago, in 1988, the International Agency for Research on Cancer (IARC) classified alcoholic beverages as a group 1 carcinogen, the most severe classification [4].

Researchers have explored trends over earlier time periods in previous studies and found similar associations. While alcohol consumption is declining in some areas of the world, such as parts of Europe, it’s on the rise in other areas, including China, India, and many sub-Saharan African nations. Because these alleles are allocated at birth and are independent of other lifestyle factors (such as smoking), they can be used as a proxy for alcohol intake, to assess how alcohol consumption affects disease risks. Particularly troublesome is that so many younger people—those within the 15–39 age range of adolescents and young adults, or AYAs—reported heavy drinking, said Adam DuVall, M.D., of the University of Chicago Cancer Center, who specializes in treating blood cancers in children and AYAs. The fact that drinking alcohol can cause cancer has received increasing attention in the past few years.

For cancer specifically, an estimated 4.1% of all new cases globally in 2020 (3), and from 2013 through 2016, 4.8% of all cases annually in the U.S., were attributable to alcohol consumption (4). Current evidence suggests that “[t]here is no threshold of alcohol consumption below which cancer risk does not increase, at least for some cancers ” (5), and cancer prevention guidelines indicate that it is best not to drink alcohol (5, 6). Despite the large body of scientific evidence on the topic, the full cancer burden due to alcohol remains uncertain because for many cancer (sub)types associations with risk and survivorship are inconsistent or there are few studies. Moreover, most U.S. adults are unaware of the alcohol-cancer link (7), and the interrelationships of alcohol control regulations and cancer risk is unclear. WCRF found an inverse association between alcohol consumption and kidney cancer risk (RR 0.92 (95% CI 0.86–0.97) per 10 g per day) [7].

Previous studies have raised concerns that drinking even a small amount of alcohol increases the risk of cancer,29 including most upper aerodigestive tract cancers and gastrointestinal cancers.30,31 The present study highlights that there is no safe level of alcohol consumption in terms of cancer risk. For oral and oropharyngeal cancer, an MR study using genetic data on 6000 oral or oropharyngeal cancer cases and 6600 controls found a positive causal effect of alcohol consumption independent of smoking [16]. The authors concluded that previous estimates of the association between alcohol and oral and oropharyngeal cancer from observational studies may have been underestimated [16]. Another MR study on UK Biobank data found that drinking alcohol, especially above the UK’s low-risk guideline of up to 14 units per week, was causally related with head and neck cancers, but not breast cancer [17].

  1. Binge drinking—consuming five or more drinks within a few hours for men or four for women—is also likely more dangerous than any other type of drinking, Dr. Abnet explained.
  2. However, based on more recent, comprehensive studies, public health experts now generally agree that alcohol—including wine—does not have a so-called “cardioprotective” effect.
  3. Retinoid metabolism and the normal function of the immune system are both impaired by ethanol, while ethanol may lead to increases in sex hormone levels, as well as dysbiosis of the microbiome and liver cirrhosis.
  4. However, this association was restricted to light and moderate drinking in Bagnardi and colleagues’ meta-analysis (RR 0.92 (95% CI 0.86–0.99) and 0.79 (95% CI 0.72–0.86), respectively) [8].
  5. Meaning  Findings of this study suggest that drinking cessation and reduction should be reinforced for the prevention of cancer.

Sex hormone levels may be increased by alcohol through oxidative stress and through inhibition of the steroid degradation enzymes sulfotransferase and 2-hydroxylase [39]. Heavy use of alcohol has also been linked with increased circulating levels of oestrone and oestradiol as well as dehydroepiandrosterone sulphate (DHEAS) [39]. DHEAS is metabolised to oestrogen by aromatase, the activity of which is also increased in chronic alcohol consumers [40]. A large cohort study found DHEAS levels 25% higher among women consuming at least 20 g alcohol per day compared with non-drinkers [41].

How does alcohol affect the risk of cancer?

It also found that, even among those who are aware, there’s a belief that it varies by the type of alcohol. For example, more participants were aware of the cancer risks from hard liquor and beer than about the risk zantac and alcohol from wine, with some participants believing wine lowers your cancer risk. Numerous changes need to be made to raise public awareness of the fact that drinking alcohol raises the risk of several types of cancer.

3. Colorectal Cancer

A further updated MR study using UK Biobank data did not find an association between alcohol exposure and cancer of any site, though they noted limitations of a lack of precision in their analyses due to low variance explained by the single nucleotide polymorphisms [18]. An MR analysis by Ong and colleagues found no significant increase in breast cancer risk per genetically predicted drink per day (odds ratio 1.00 (95% CI 0.93–1.08)) [19]. Many observational studies have been conducted to identify and define the risks from drinking alcohol and cancer development. Some limitations in these studies have been identified, such as lack of sufficient adjustment of confounding factors, for example tobacco smoking and alcohol consumption are both common risk factors for oral cavity cancer. There are also concerns around reverse causality, with the reference categories of alcohol non-drinkers possibly including former drinkers who still have an elevated risk of cancer.

What is the evidence that alcohol drinking can cause cancer?

Design, Setting, and Participants  This population-based cohort study analyzed adult beneficiaries in the Korean National Health Insurance Service. Participants (aged ≥40 years) included those who underwent a national health screening in both 2009 and 2011 and had available data on their drinking status. Inflammation is a key pathway to cancer progression at several sites and is enhanced by alcohol use. Chronic alcohol consumption can recruit specific white blood cells (monocytes and macrophages) to the tumour microenvironment. These white blood cells produce pro-inflammatory cytokines, such as tumour necrosis factor α (TNF-α) and the interleukins IL-1, IL-6, and IL-8 [31,33], which activate oxidant-generating enzymes leading to downstream formation of ROS [30]. The biggest such wins would likely come from helping heavy drinkers cut back or quit, she added.

Researchers and health professionals can do more to help break down these misconceptions, Dr. LoConte added. “We need to really make sure that we reinforce the message that all alcohol increases cancer https://rehabliving.net/ risk,” she said. Noelle LoConte, M.D., an oncologist at the University of Wisconsin-Madison who studies alcohol and cancer risk, said that these findings confirm what doctors have long observed.

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“If you’re pouring it yourself, a lot of people may not be [doing things like] using a shot glass to make a mixed drink at home. That’s a major concern with excessive alcohol consumption, that people aren’t honest with themselves,” said Dr. Abnet. I think there is a chunk of society that, if they knew [about the risk], would drink differently,” she said. The processes that the body uses to break down alcohol produce a compound called acetaldehyde, a toxin that several organizations have classified as a probable cause of cancer in people. Approximately 4% of cancers diagnosed worldwide in 2020 can be attributed to alcohol consumption, according to a new WHO report. The researchers cited the change in public perceptions and tighter regulations for tobacco, which show the importance of public health campaigns and physicians explaining risks to their patients.

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