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Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis
Open accessAbstract
BACKGROUND: Alcohol is a risk factor for cancer of the oral cavity, pharynx, oesophagus, colorectum, liver, larynx and female breast, whereas its impact on other cancers remains controversial. METHODS: We investigated the effect of alcohol on 23 cancer types through a meta-analytic approach. We used dose-response meta-regression models and investigated potential sources of heterogeneity. RESULTS: A total of 572 studies, including 486 538 cancer cases, were identified. Relative risks (RRs) for heavy drinkers compared with nondrinkers and occasional drinkers were 5.13 for oral and pharyngeal cancer, 4.95 for oesophageal squamous cell carcinoma, 1.44 for colorectal, 2.65 for laryngeal and 1.61 for breast cancer; for those neoplasms there was a clear dose-risk relationship. Heavy drinkers also had a significantly higher risk of cancer of the stomach (RR 1.21), liver (2.07), gallbladder (2.64), pancreas (1.19) and lung (1.15). There was indication of a positive association between alcohol consumption and risk of melanoma and prostate cancer. Alcohol consumption and risk of Hodgkin's and Non-Hodgkin's lymphomas were inversely associated. CONCLUSIONS: Alcohol increases risk of cancer of oral cavity and pharynx, oesophagus, colorectum, liver, larynx and female breast. There is accumulating evidence that alcohol drinking is associated with some other cancers such as pancreas and prostate cancer and melanoma.
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“The increase in the risk of developing cancer (stratified by cancer site) for increasing average daily amounts of alcohol consumed (measured in grams of pure alcohol consumed per day) has been observed to be linear on an exponentiated scale; however, the magnitude of these risk increases varies by cancer site 169, 170, 171.”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [169]
In the citing paper
“However, no association was found between excess alcohol consumption and the dementias,11 CHD,91 lung76 or liver cancer.99”
From Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction (2019) · cites this paper as [76]
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“Excess alcohol consumption was associated with an increased risk of stroke, bowel and breast cancer (between 20% and 50%).11,76,97”
From Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction (2019) · cites this paper as [76]
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The socioeconomic profile of alcohol-attributable mortality in South Africa: a modelling study
Probst, C., Parry, C. D. H., Wïttchen, H., & Rehm, J. T. (2018) · BMC Medicine · doi:10.1186/s12916-018-1080-0 · Cited by 70
“At the same time, the potential underestimation of the prevalence of current alcohol use could have led to an underestimation of AAFs for causes of death with flatter risk curves and an elevated risk at low levels of consumption such as cancers [63] or lower respiratory infections [64].”
BackgroundWitlox, W. J. A., van Osch, F., Brinkman, M. T., Jochems, S. H. J., Goossens, M. E., Weiderpass, E., White, E., van den Brandt, P. A., Giles, G. G., Milne, R. L., et al. (2019) · European Journal of Nutrition · doi:10.1007/s00394-019-01907-8 · Cited by 67
Holst, C., Tolstrup, J. S., Sørensen, H. J., & Becker, U. (2017) · Addiction · doi:10.1111/add.13799 · Cited by 61
Stockwell, T. R., Solomon, R., O’Brien, P., Vallance, K., & Hobin, E. P. (2020) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2020.81.284 · Cited by 66
Miranti, E., Stolzenberg‐Solomon, R. Z., Weinstein, S. J., Selhub, J., Männistö, S., Taylor, P. R., Freedman, N. D., Albanes, D., Abnet, C. C., & Murphy, G. A. (2017) · International Journal of Cancer · doi:10.1002/ijc.30809 · Cited by 63
Laryngeal Cancer: Epidemiology, Etiology, and Prevention: A Narrative Review
Igissinov, N., Zatonskikh, V., Telmanova, Z., Тулебаев, Р. К., & Moore, M. A. (2023) · Iranian Journal of Public Health · doi:10.18502/ijph.v52i11.14025 · Cited by 62
Traditional and commercial alcohols and esophageal cancer risk in Kenya
Menya, D., Kigen, N., Oduor, M., Maina, S. K., Some, F. F., Chumba, D., Ayuo, P. O., Osano, O., Middleton, D. R. S., Schüz, J., et al. (2018) · International Journal of Cancer · doi:10.1002/ijc.31804 · Cited by 61
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Dickerman, B. A., Markt, S. C., Koskenvuo, M. J., Pukkala, ., Mucci, L. A., & Kaprio, J. A. (2016) · Cancer Causes & Control · doi:10.1007/s10552-016-0778-6 · Cited by 60
“21] for heavy drinkers; reference = non/occasional drinkers) [1].”
Zhang, X., Liu, Y., Li, S., Lichtenstein, A. H., Chen, S., Na, M., Veldheer, S., Xing, A., Wang, Y., Wu, S., et al. (2021) · Nutrition Journal · doi:10.1186/s12937-021-00671-y · Cited by 62
“alcohol is associated with lower risk for total cancer and cancers of lung, cervix, thyroid, and kidney [9].”
BackgroundCancer Progress and Priorities: Prostate Cancer
Kensler, K. H., & Rebbeck, T. R. (2020) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-19-0412 · Cited by 67
“However, prior meta-analyses found no significant association and the WCRF/AICR found no conclusive evidence for an association (53, 67, 68).”
Alcohol Consumption Among Adults With a Cancer Diagnosis in the All of Us Research Program
Shi, M., Luo, C., Oduyale, O. K., Zong, X., LoConte, N. K., & Cao, Y. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.28328 · Cited by 63
Gu, J., Yan, S., Wang, B., Shen, F., Cao, H., Fan, J., & Wang, Y. (2015) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2671 · Cited by 59
“The association between alcohol intake and GBC risk was summarized in a recently published meta-analysis [56], which was based on four case-control and four cohort studies.”
BackgroundResultLessons learned from the INHANCE consortium: An overview of recent results on head and neck cancer
Bravi, F., Lee, Y. A., Hashibe, M., Boffetta, P., Conway, D. I., Ferraroni, M., Vecchia, C. L., & Edefonti, V. C. (2020) · Oral Diseases · doi:10.1111/odi.13502 · Cited by 58
“Meta-analyses of aggregated published data from epidemiological studies on the role of several risk factors for HNC or its sub-sites have been conducted (Bagnardi et al., 2015; Cirmi et al., 2018; Conway et al., 2008; Franceschi et al., 1992; Paget-Bailly et al., 2012; Pavia et al., 2006; Radoi & Luce, 2013; Zuo et al…”
BackgroundSelf-citationBeneficial effects of olive oil and Mediterranean diet on cancer physio-pathology and incidence
Farràs, M., Almanza‐Aguilera, E., Hernáez, Á., Agustí, N., Julve, J., Fitó, M., & Castañer, O. (2020) · Seminars in Cancer Biology · doi:10.1016/j.semcancer.2020.11.011 · Cited by 62
LeHew, C. W., Weatherspoon, D. J., Peterson, C. E., Goben, A. H., Reitmajer, K., Sroussi, H., & Kaste, L. M. (2017) · Epidemiologic Reviews · doi:10.1093/epirev/mxw001 · Cited by 62
“0) were found for heavy drinking (37, 38), HPV (45), and smokeless tobacco (47).”
BackgroundDugué, P., Hodge, A. M., Brinkman, M. T., Bassett, J. K., Shivappa, N., Hébert, J. R., Hopper, J. L., English, D. R., Milne, R. L., & Giles, G. G. (2016) · International Journal of Cancer · doi:10.1002/ijc.30175 · Cited by 57
“This is however unlikely to have strongly influenced the results of our study, as a recent meta-analysis found no evidence for an association between alcohol and UCC risk.(45) In this study, we chose to focus on three widely used dietary scores.”
ResultLiu, Z., Song, C., Suo, C., Fan, H. X., Zhang, T., Li, J., & Chen, X. (2022) · BMC Medicine · doi:10.1186/s12916-022-02622-8 · Cited by 55
Environment factors, DNA methylation, and cancer
Liu, J., Huang, B., Ding, F., & Li, Y. (2023) · Environmental Geochemistry and Health · doi:10.1007/s10653-023-01749-8 · Cited by 59
“In addition, the relationship between alcohol and gastric, lung, epithelial ovarian, and prostate cancer [69] is controversial.”
BackgroundKhushalani, J. S., Qin, J., Ekwueme, D. U., & White, A. L. (2019) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2019.101029 · Cited by 55
“Alcohol consumption is a risk factor for breast cancer even at low to moderate levels of consumption (Cao et al., 2015; Bagnardi et al., 2015).”
BackgroundAlcohol use disorder and the gut
Haber, P., & Kortt, N. C. (2020) · Addiction · doi:10.1111/add.15147 · Cited by 54
Jun, S., Park, H., Kim, U. J., Lee, H. A., Park, B., Lee, S. Y., Jee, S. H., & Park, H. (2024) · Journal of Korean Medical Science · doi:10.3346/jkms.2024.39.e185 · Cited by 61
From intestinal dysbiosis to alcohol-associated liver disease
Mendes, B. G., & Schnabl, B. (2020) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2020.0086 · Cited by 57
Sarich, P., Canfell, K., Egger, S. J., Banks, E., Joshy, G., Grogan, P. B., & Weber, M. F. (2020) · British Journal of Cancer · doi:10.1038/s41416-020-01101-2 · Cited by 53
Liu, X., Peveri, G., Bosetti, C., Bagnardi, V., Specchia, C., Gallus, S., & Lugo, A. (2019) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2019.07.019 · Cited by 52
Self-citationAlcohol consumption, polygenic risk score, and early- and late-onset colorectal cancer risk
Chen, X., Li, H., Guo, F., Hoffmeister, M., & Brenner, H. (2022) · EClinicalMedicine · doi:10.1016/j.eclinm.2022.101460 · Cited by 52
Etiology of lung cancer: Evidence from epidemiologic studies
Zou, K., Sun, P., Huang, H., Zhuo, H., Qie, R., Xie, Y., Luo, J., Li, N., Li, J., He, J., et al. (2022) · Journal of the National Cancer Center · doi:10.1016/j.jncc.2022.09.004 · Cited by 55
Scala, M., Bosetti, C., Bagnardi, V., Possenti, I., Specchia, C., Gallus, S., & Lugo, A. (2023) · Journal of Epidemiology · doi:10.2188/jea.je20220206 · Cited by 52
Self-citation
Metadata
- Authors
- Bagnardi, V, Rota, M., Botteri, E., Tramacere, I., Islami, F., Fedirko, V, Scotti, L., Jenab, M., Turati, F., Pasquali, E., Pelucchi, C., Galeone, C., Bellocco, R., Negri, E., Corrao, G., Boffetta, P., & La Vecchia, C.
- Affiliations
- European Institute of Oncology (IT)
- Mario Negri Institute for Pharmacological Research (IT)
- Fondazione IRCCS Istituto Neurologico Carlo Besta (IT)
- American Cancer Society (US)
- Emory University (US)
- University of Milano-Bicocca (IT)
- Centre international de recherche sur le cancer (FR)
- Karolinska Institutet (SE)
- Tisch Cancer Institute (US)
- Corresponding author
- Bagnardi, V
- ORCID
- Venue
- British Journal of Cancer
- Published
- 2014-11-25
- Volume
- 112
- Issue
- 3
- Pages
- 580-593
- ISSN
- 0007-0920 (ISSN-L)
- 1532-1827
- PMC
- PMC4453639
- OpenAlex
- W1965385210
- Cited by
- 1,342
- References
- 70
- Citations by year
- 2026: 130 · 2025: 149 · 2024: 129 · 2023: 139 · 2022: 158 · 2021: 133 · 2020: 123 · 2019: 108 · 2018: 100 · 2017: 86 · 2016: 64 · 2015: 21
- FWCI
- 42.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-sa
- www.springer.com/tdm (unspecified)
- Locations
- British Journal of Cancer (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion, other-oa)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Funders
- World Health Organization
- Fondazione Umberto Veronesi
- Associazione Italiana per la Ricerca sul Cancro (10258)
- Fondazione Italiana per la Ricerca sul Cancro
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
- Health Sciences › Medicine › Surgery › Esophageal Cancer Research and Treatment
- Keywords
- alcohol consumption, alcohol and cancer risk, dose-response relationship, heavy drinking, oral and pharyngeal cancer, esophageal squamous cell carcinoma, colorectal cancer, laryngeal cancer, breast cancer, liver cancer, gastric cancer, gallbladder cancer, pancreatic cancer, lung cancer, melanoma, prostate cancer, Hodgkin's disease, non-Hodgkin lymphoma
- MeSH terms
- Esophageal Squamous Cell Carcinoma, Alcohol Drinking, Breast Neoplasms, Carcinoma, Squamous Cell, Dose-Response Relationship, Drug, Esophageal Neoplasms, Female, Humans, Male, Melanoma, Mouth Neoplasms, Neoplasms, Pharyngeal Neoplasms, Prostatic Neoplasms, Risk Factors, Incidence, Case-Control Studies
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