How much alcohol do you drink per day to increase your risk of cancer? JAMA sub-journal gives the answer!

*For medical professionals only

Quit alcohol and promote cancer? Check it out!

Cancer has become the second leading cause of death in the world, and the Lancet has released blockbuster data showing that alcohol consumption has "risen" to the top 2 major carcinogenic risk factors after smoking [1].

As many as 7 cancers have been clearly listed as "alcohol-related cancers.
"
In 2020 alone, there will be more than 740,000 new cases of cancer caused by alcohol consumption worldwide[2].


Although drinking alcohol causes cancer is a consensus, why is it that everyone is far less motivated to quit alcohol than quitting smoking? One reason is that there are currently fewer
studies on changes in alcohol intake, including increases, decreases, and abstinence.

Moreover, alcohol metabolism is also divided into people (species), maybe they are the "chosen children" (bushi) who can drink!
Recently, the Association Between Changes in Alcohol Consumption and Cancer Risk, published in the JAMA sub-journal, analyzed the link between alcohol intake changes and the risk of alcohol-related cancers and the risk of developing cancers in whole groups of Koreans, based on three consecutive health examinations of more than 4.
5 million Koreans
.
Today we are talking about drinking, abstaining from alcohol and cancer

Alcohol-related cancers "7 kings"

       

In 2021, The Lancet Oncology released the Global Burden of Cancer in 2020 attributable to alcohol consumption: a population-based study, which specifically analyzes the global burden of cancer caused by alcohol, and the results show that in 2020, about 740,000 new cancers worldwide are causally related to alcohol consumption
。
The types of cancers with the highest number of new cases associated with alcohol consumption in 2020 include:

1.
Esophageal cancer (189,000 cases)

2.
Liver cancer (154,700 cases)

3.
Breast cancer (98300)

4.
Colon cancer (91500)

5.
Rectal cancer (65100)

6.
Oropharyngeal carcinoma (39400)

7.
Laryngeal cancer (27600)

Global alcohol-related cancer cases, population ratio, and age-standardized incidence in 2020 by cancer site and sex note that East Asian populations, including China, have a higher risk of alcohol-related cancer incidence
than other regions: the regions with the highest rates of alcohol-attributable cancer cases are East Asia (5.
7%) and Central and Eastern Europe (5.
6%), while North Africa (0.
3%) and West Asia (0.
7%) have the lowest
proportions.

The researchers predict that as the economy develops, alcohol consumption in countries such as China and India will also increase, adding to the "icing on the cake"
for alcohol-related cancer data.

A 2020 study published in the British Journal of Cancer analyzed the adjusted risk-adjusted ratio (HR) of cancer associated with total alcohol intake (drink/week) by ≥ Australian participants aged 226162 45 years (2006-2009) [4].


During the median follow-up period of 5.
4 years, a total of 17,332 cases of cancer were diagnosed
.
Different amounts of alcohol consumption lead to varying degrees of increased risk of alcohol-related cancer: the liver bears the brunt of it, and the risk of liver cancer is easily doubled by those who drink more than 28 cups per week compared with light drinkers who drink 1-3.
5 cups per week (10g of alcohol per cup
).
It should be noted that the frame of reference here is "light drinking" rather than "not drinking"
.

HR at carcinogenic risk of alcohol consumption from 2006-2013

Alcoholic ecstasy: quitting alcohol does not prevent cancer, and even increases the risk?

       

Back to the point, the study released by the JAMA sub-journal this time included participants aged ≥40 years old in the Korean National Health Insurance Service, who underwent health screening in 2009 and 2011 and recorded drinking status data
.

Participants were divided into, based on their drinking level:

No alcohol consumption (0 g/d), light alcohol consumption (< 15 g/d), moderate alcohol consumption (15-29.
9 g/d), and heavy alcohol consumption (≥30 g/d);

Then, according to the change in drinking level from 2009 to 2011, it was divided into:

no drinking group, maintenance drinking group, increased drinking group, abstinence group and reduced drinking group
.

The primary endpoints were newly diagnosed alcohol-related cancers, including head and neck cancers (oral and throat cancers), esophageal cancer, colorectal cancer, liver cancer, laryngeal cancer, and female breast cancer, with secondary endpoints being all newly diagnosed cancers (except thyroid cancer).


The 4513746 participants included in the study had an average (SD) age of 53.
6 (9.
6) years, of which 2324172 were males (51.
5%)
.
During the median (IQR) follow-up of 6.
4 (6.
1-6.
6) years, a total of 215676 cancer events (7.
7/1000 person-years) occurred, of which 37.
2% (80263 cases) were alcohol-related cancers
.

First, there is no doubt that increased alcohol consumption is associated
with an increased risk of alcohol-related cancers as well as whole cancers.
A dose-response relationship also occurs in alcohol-related cancers: the risk of alcohol-related cancers increases
when alcohol consumption is changed from no alcohol consumption to mild [adjusted risk ratio (aHR), 1.
03; 95% CI, 1.
00-1.
06], moderate (aHR, 1.
10; 95% CI, 1.
02-1.
18), or severe (aHR, 1.
34; 95% CI, 1.
23-1.
45).

Similarly, the incidence of alcohol-related cancers increased
when alcohol was reduced from mild to moderate (aHR, 1.
10; 95% CI, 1.
05-1.
15) or severe (aHR, 1.
17; 95% CI, 1.
09-1.
25) alcohol consumption compared with persistent light drinkers.

The pattern of the risk of
whole cancers and alcohol-related cancers due to changes in alcohol consumption levels between 2009 and 2011 also applies to all cancers: the increased risk
is not only associated with the failure to drink alcohol to become heavy drinking (aHR, 1.
12; 95% CI, 1.
07-1.
18), but also with mild to severe alcohol consumption (a HR, 1.
09；95%CI，1.
04-1.
13）
。 Among them, if non-drinkers increase their alcohol consumption, the incidence of stomach cancer, liver cancer, gallbladder cancer, lung cancer, multiple myeloma and leukemia is high
.

However, in terms of the change in the risk of alcohol-related cancers and whole cancers by abstinence or alcohol consumption, there is a bit of an "unexpected" and "reasonable" meaning
.

Heavy drinkers who reduce their alcohol consumption have a lower risk of alcohol-related cancers than those who reduce alcohol
moderately or mildly 。 Reducing alcohol consumption from severe to moderate was associated with alcohol-related cancers (aHR, 0.
91; 95% CI, 0.
86-0.
97) and whole cancers (aHR, 0.
96; 95% CI, 0.
92-0.
99) from severe to mild (alcohol-related cancers: aHR, 0.
92; 95% CI, 0.
86-0.
98; all-cancers: aHR, 0.
92; 95% CI, 0.
89-0.
96).

For cancer sites, those who switch from severe to moderate drinkers are less likely to develop breast, kidney, and gallbladder cancers than those who
continue to drink heavy alcohol.

However, if moderate or heavy drinkers start abstaining from alcohol (compared with those who maintain the same level of drinking), not only is there no significant change in alcohol-related cancer risk, but their risk of developing a whole cancer is mildly elevated (moderate: aHR, 1.
07; 95% CI, 1.
03-1.
12; severe aHR, 1.
07; 95% CI, 1.
02-1.
12).


See here, are alcohol lovers ready to forward this article to relatives, friends and doctors who advise you to quit drinking?
However, secondary analysis can immediately make the drunkards "disillusioned"
.
The researchers also conducted 3 consecutive health screenings and drinking behavior analyses of participants whose data were available, and found that participants who quit alcohol during screening in 2011 and persisted through screening until 2013 had
an increased risk of developing alcohol-related cancers and all-cancers.

Participants who reduced their risk
of alcohol-related cancers with varying drinking levels from 2009 to 2013 also benefited significantly, with alcohol-related cancer incidence (aHR, 0.
85; 95% CI, 0.
73-0.
99) and whole cancer (aHR, 0.
89; 95%CI) and whole cancer (aHR, 0.
89; 95% CI) and whole cancer (aHR, 0.
89; 95% CI) in 2011 screening who drank significantly from severe to mild drinking levels, 0.
81-0.
98) or even lower
.
Therefore, reducing alcohol consumption is also to some extent "the harder you work, the luckier you are.
"

In a stratified analysis based on age, sex, and smoking status, the researchers drew a "focus area" for all cancer risks
caused by changes in drinking levels from 2009 to 2013: changes in alcohol consumption were more prominently
associated with alcohol-related and all-cancer species in older, male, and never-smoking participants 。 For example, in alcohol-related cancer aHR who did not drink alcohol became heavy drinkers, ≥ 65 vs<.
65 vs.
65 years old 1.
70 (95% CI, 1.
48-1.
94) vs 1.
34 (95% CI, 1.
20-1.
50), male vs female 1.
47 (95% CI, 1.
35-1.
60) vs 0.
83 (95% CI, 0.
60-1.
16), and current smokers who did not smoke vs≥ 20 pack years were 1.
77 (95% CI), 1.
51-2.
08）vs 1.
49（95%CI，1.
27-1.
75）<b137>。

It's better to quit drinking less than to drink more or to mess around, but the best thing is.
.
.

       

Looking at the three studies, it can be seen that China, men, are the key "victims" of alcohol-related cancer
.
In a report published by The Lancet Oncology, China is ranked as the region with the highest risk of cancer caused by alcohol consumption, and the PAF is significantly higher in
men.

The researchers believe that this is due to the higher frequency of acetaldehyde dehydrogenase mutant alleles (ALDH2*2) in the East Asian population (estimated to be 28%-45%), which slows down the metabolism of acetaldehyde after drinking alcohol and accumulates in the body, causing adverse reactions such as blushing, nausea, vomiting, sweating, and palpitations, which is what we call "drinking on the face"
.
People who "drink to the face" should usually drink little or no alcohol, but the reality is that they will drink it correctly
.

"Small drinking, big drinking hurting the body" is also non-existent
for cancer.
Previous studies have shown that even small amounts of alcohol use increase cancer risk, including most upper GI cancers and gastrointestinal cancers
.
Existing research continues to highlight that there is no safe level of alcohol consumption in terms of
cancer risk.

As for the "abstinence from alcohol does not change or even slightly increase cancer risk" that makes alcohol lovers lucky, or stems from the bias of "pathological abstinence" – people may stop drinking
alcohol when they feel symptoms and/or other adverse health effects.
This phenomenon disappeared after extended follow-up time: in subgroup analyses of those who underwent 3 assessments, those who abstained from alcohol before screening in 2011 and remained non-drinkers at screening in 2013 saw a significant reduction in
risk.
Therefore, quitting alcohol should not only start as early as possible, but also need to be adhered to for
a long time.

In addition to being long enough, it is also crucial to reduce the amount of alcohol consumption enough: both increased and decreased amounts of alcohol consumption have a clear dose-response relationship
with cancer risk.
But no matter how much the drinker reduces or even withdraws, the damage caused is irreparable – and the risk of cancer is still higher
than that of those who do not drink.
Therefore, instead of reducing alcohol consumption and abstaining from drinking, never lifting the glass is the best choice
.

Resources:

[1] GBD 2019 Cancer Risk Factors Collaborators.
The global burden of cancer attributable to risk factors,2010-19:a systematic analysis for the Global Burden of Disease Study 2019.
Lancet.
2022 Aug 20; 400(10352):563-591.
doi:10.
1016/S0140-6736(22)01438-6.
PMID:35988567.

[2] Harriet Rumgay,Kevin Shield et al.
Global burden of cancer in 2020 attributable to alcohol consumption:a population-based study.
Lancet Oncol.
2021 July.
https://doi.
org/10.
1016/S1470-2045(21)00279-5

[3] Yoo JE,Han K,Shin DW,et al.
Association Between Changes in Alcohol Consumption and Cancer Risk[J].
JAMA Netw Open.
2022 Aug 1; 5(8):e2228544.
doi:10.
1001/jamanetworkopen.
2022.
28544.

[4] Peter Sarich.
et al.
Alcohol consumption,drinking patterns and cancer incidence in an Australian cohort of 226,162 participants aged 45 years and over.
British Journal of Cancer.
2020.