Limit alcohol consumption

Evidence

Alcoholic drinks of all types have a similar impact on cancer risk. This Recommendation therefore covers all types of alcoholic drinks, whether beers, wines, spirits (liquors) or any other drinks, as well as other alcohol sources.

The important factor is the amount and frequency of alcohol (ethanol) consumed. Even small amounts of alcohol can increase the risk of several cancers. There is no threshold of alcohol consumption below which cancer risk does not increase, at least for some cancers.

There is strong evidence that consuming alcohol INCREASES the risk of the following cancers:

• mouth, pharynx and larynx
• oesophageal (squamous cell carcinoma)
• breast (postmenopausal)
• liver
• colorectum

There is probable evidence that consuming alcohol INCREASES the risk of

• stomach cancer
• breast cancer (pre-menopause)

There is also probable evidence that consumption of alcoholic drinks helps protect against kidney cancer. However, this finding is far outweighed by the increased risk for other cancers.

Additional information

Other evidence on alcoholic drinks is limited (either in amount or because of issues with study design or other methodological flaws), but is suggestive of an increased risk of lung, pancreatic, and skin cancers. Further research is required, and this limited evidence did not inform this recommendation.

Mechanisms

The mechanisms underlying the relationship between alcohol consumption and cancer are not completely understood.

Acetaldehyde, the principal (and most toxic) metabolite of alcohol, disrupts DNA synthesis and repair. It also induces oxidative stress through increased production of reactive oxygen species, which are potentially genotoxic.

Alcohol may function as a solvent, enabling other dietary or environmental carcinogens (e.g. tobacco) to more easily enter cells.

Heavy drinkers may also have diets that are lacking in essential nutrients, such as folate, making tissue in the body more susceptible to the carcinogenic effects of alcohol.

Implications for other diseases

As well as cancer, alcohol consumption has been linked to more than 200 diseases and conditions, including liver disease (cirrhosis, fatty liver, alcoholic hepatitis), pancreatitis, infectious diseases, cardiovascular disease, early dementia.

Heavy alcohol use is strongly linked to an increase in risk of many cerebrovascular diseases, including hypertensive disease, haemorrhagic stroke, and atrial fibrillation

Some prospective studies suggest people who consume small amounts of alcohol may have lower risks of coronary heart disease and all-cause mortality compared with non-drinkers, though any potential protective effect is seen at low levels of consumption (about one unit a day) and is limited to specific population groups.

Despite this, there are uncertainties about the effects of alcohol on non-cancer outcomes at moderate levels of consumption and, because of this, drinking alcohol is not recommended for any health benefit.

Public health / policy implications

In many countries, alcohol consumption is a public health problem with rates of alcohol use expected to rise in half of the WHO regions unless effective policy reverses the trend. A whole-of-government, whole-of-society approach is necessary to create environments for people and communities that are conducive to limiting alcohol consumption consistent with our Cancer Prevention Recommendations.

A comprehensive package of policies is needed to reduce alcohol consumption at a population level. This includes policies that influence the availability, affordability, and marketing of alcoholic beverages. Policymakers are encouraged to frame specific goals and actions according to their national context.