Alcohol and Cancer

Cancer sites with sufficient evidence of an increased risk associated with alcohol intake (11)

• Oral cavity
• Pharynx
• Larynx
• Colon/rectum
• Esophagus (specifically squamous cell carcinoma)
• Hepatocellular carcinoma
• Stomach
• Female breast

Cancer sites with some evidence for an increased risk associated with alcohol intake (11, 12, 13)

• Gallbladder
• Lung
• Pancreatic
• Prostate
• Skin cancer

Cancer sites with some evidence of a decreased risk associated with alcohol intake (11, 14, 13)

• Renal cell carcinoma
• Non-Hodgkin lymphoma

Renewed global attention to cancer risk associated with alcohol intake and a 2018 statement from the American Society of Clinical Oncology support efforts to place alcohol more squarely into the cancer control research agenda (16).  Moderating (or decreasing) alcohol intake is also a logical target for multi-behavioral interventions focusing on other health behavioral risk factors such as tobacco cessation. Despite the International Agency for Research on Cancer and the Department of Health and Human Services listing alcohol as a known carcinogen, public and provider awareness remains low (17, 16). Significant research gaps across the cancer control continuum remain, especially concerning how best to increase awareness and limit alcohol exposure.

Communication and awareness related to alcohol and cancer is relatively sparse

• Examine communicating uncertainty and complexity in relation to alcohol, cancer, and health outcomes at multiple levels.
• Understand and improve patient-provider communication, including identification of barriers, regarding alcohol and cancer (in both primary and specialty care).
• Understand decision-making processes regarding alcohol consumption by patients and caregivers before and along the cancer care continuum.
• Evaluate effects of warning labels in relation to alcohol and cancer prevention.

Intervention development to limit or reduce alcohol consumption for cancer prevention and control and outcomes research are in their formative stages 

• Examine alcohol use post-diagnosis in relation to cancer treatment, prognosis, recurrence, and second primary tumors to identify targets for interventions.
• Examine alcohol’s effects on cancer comorbidities, quality of life, mortality and alcohol’s effects and synergy with other behavioral risk factors, such as tobacco and/or cannabis use, e-cigarette use to improve intervention efforts.
• Test innovative approaches to the dissemination and implementation of proven alcohol cessation interventions in diverse cancer survivor populations and settings.

Natural experiments concerning programs and policies related to alcohol and cancer need further evaluation

• Evaluate WHO’s “best buys” and other approaches to alcohol policy for reducing harm related to cancer in diverse settings.
• Evaluate and model effects of alcohol related policy on the cancer burden.
• Conduct mechanistic studies of behavioral responses to policy concerning alcohol and cancer.

Measurement methods for alcohol use for evaluation of interventions and policy approaches to alcohol and cancer are not complete

• Develop and improve measures of alcohol related behaviors and attitudes as they relate to cancer over the life course.
• Improve methods to assess drinking history (e.g., binge drinking and periods of abstinence) in vulnerable at-risk populations (e.g., adolescents, survivors, people with history of alcohol dependence/abuse).

Despite the clear evidence for alcohol carcinogenicity, further understanding of mechanisms linking alcohol and cancer are needed to better develop and target appropriate interventions

• Increase understanding of mechanisms linking alcohol consumption, cancer treatment effectiveness and risk of recurrence or second cancers to identify targets for intervention development.
• Examine disparities in alcohol consumption patterns and their relationship to cancer by race, socioeconomic factors, and sexual and gender minority populations with explicit attention to improving cancer control via alcohol and addressing alcohol and cancer related disparities.
• Improve estimates of dose-response relationships between light and moderate alcohol consumption and cancer.
• Examine interactions between alcohol consumption and energy balance as it relates to cancer prevention and control to identify targets for intervention development.
• Evaluate the epigenetic effects of alcohol over the life course and cancer risk.
• Examine effects of light and moderate alcohol consumption on aging trajectories and diagnosis and treatment of cancer in the elderly to identify strategies to limit alcohol exposure.

Alcohol use is not independent of other risk factors, therefore research projects addressing alcohol as a target for cancer prevention and control should consider a multi-behavioral framework along with multilevel influences on alcohol use. Where appropriate, investigators should consider co-occurrence of alcohol use with other cancer-related behavioral risk factors (e.g., tobacco use, sun exposure, physical activity, sleep disturbances) when designing interventions. Research gaps also exist in understanding additive, synergistic or antagonistic effects of alcohol use in cancer prevention and control.