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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]
In the citing paper
“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 steatotic liver disease burden paradox: unravelling the key role of alcohol
Torp, N., Israelsen, M. E., & Krag, A. A. (2024) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-024-01022-y · Cited by 39
Demoury, C., Karakiewicz, P. I., & Parent, M. (2016) · Cancer Epidemiology · doi:10.1016/j.canep.2016.09.004 · Cited by 38
Lee, K. S., Conigrave, J. H., Callinan, S., Wilson, S., Room, R., Perry, J., Slade, T. N., Chikritzhs, T. N., Hayman, N. E., Weatherall, T. J., et al. (2019) · Addiction Science & Clinical Practice · doi:10.1186/s13722-019-0148-2 · Cited by 38
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“…proportion attributable to cancer, producing significant societal harms and costs to governments and health systems worldwide (Baan et al., 2007; Bagnardi et al., 2015; Burton & Sheron, 2018; International Agency for Research on Cancer, 2010; Klein et al., 2019; Praud et al., 2016; World Health…”
BackgroundLaryngeal Cancer in the Modern Era: Evolving Trends in Diagnosis, Treatment, and Survival Outcomes
Hut, A.-R., Boia, E. R., Para, D. M., Iovănescu, G., Horhat, D. I., Mikša, L., Chiriac, M., Galant, R., Motofelea, A. C., & Balica, N. C. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14103367 · Cited by 44
“…relationship where both the amount and duration of intake proportionally elevate the However, this relationship may not be perfectly linear, with a possible “saturation e ff ect” at very high levels of consumption (more than 20 years and over 30 cigare tt es per day) [11,12]. risk [13–15].”
Does Industry-Driven Alcohol Marketing Influence Adolescent Drinking Behaviour? A Systematic Review
Scott, S., Muirhead, C. R., Shucksmith, J., Tyrrell, R., & Kaner, E. (2016) · Alcohol and Alcoholism · doi:10.1093/alcalc/agw085 · Cited by 41
“Nevertheless, the longer and heavier an individual drinks, the greater the risk of developing chronic health problems such as liver disease or cancers later in life (Secretan et al., 2009; Holmes et al., 2014b; Williams et al., 2014; Bagnardi et al., 2015).”
BackgroundThe prominence of smoking‐related mortality among individuals with alcohol‐ or drug‐use disorders
Callaghan, R. C., Gatley, J. M., Sykes, J. R., & Taylor, L. (2016) · Drug and Alcohol Review · doi:10.1111/dar.12475 · Cited by 37
“Alcohol use, for example, not only has an independent effect on head and neck cancers, but also synergistic effect in combination with tobacco use on these outcomes [13,23].”
Fang, H., Shan, S., Zhou, Y., & Zhong, L. (2018) · BMC Cancer · doi:10.1186/s12885-018-4351-4 · Cited by 37
“Further, the intake dose was different between men and women [84].”
The interaction of gender and smoking on bladder cancer risks
Janisch, F., Shariat, S. F., Schernhammer, E. S., Rink, M., & Fajković, H. (2019) · Current Opinion in Urology · doi:10.1097/mou.0000000000000602 · Cited by 37
Alcohol policies and alcohol-attributable cancer mortality in U.S. States
Alattas, M., Ross, C. S., Henehan, E. R., & Naimi, T. S. (2019) · Chemico-Biological Interactions · doi:10.1016/j.cbi.2019.108885 · Cited by 40
Assessment of the Antitumor Potential of Umbelliprenin, a Naturally Occurring Sesquiterpene Coumarin
Shahzadi, I., Ali, Z., Baek, S. H., Mirza, B., & Ahn, K. S. (2020) · Biomedicines · doi:10.3390/biomedicines8050126 · Cited by 40
Bosetti, C., Traini, E., Alam, S., Allen, C. A., Carreras, G., Compton, K., Fitzmaurice, C., Force, L. M., Gallus, S., Gorini, G., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-79176-3 · Cited by 37
Lee, S. W., Kim, S. M., Hur, W., Kang, B.-Y., Lee, H. L., Nam, H., Yoo, S. H., Sung, P. S., Kwon, J. H., Jang, J. W., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0261067 · Cited by 40
Bell, L., Garnett, C., Bao, Y., Cheng, Z., Qian, T., Perski, O., Potts, H. W. W., & Williamson, E. (2023) · JMIR mHealth and uHealth · doi:10.2196/38342 · Cited by 35
“Hazardous and harmful alcohol consumption is one of the major risk factors for many disease outcomes and poses a major public health burden [1,2].”
BackgroundAlcohol as a Risk Factor for Cancer
Cao, Y., & Giovannucci, E. L. (2016) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2016.05.012 · Cited by 37
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Seidenberg, A. B., Wiseman, K. P., & Klein, W. M. P. (2022) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-22-0420 · Cited by 36
Uniting Epidemiology and Experimental Disease Models for Alcohol-Related Pancreatic Disease
Setiawan, V. W. (2017) · Alcohol research · doi:10.35946/arcr.v38.2.03 · Cited by 37
“19) compared with nondrinkers and occasional drinkers (Bagnardi et al. 2015).”
InfluentialVsevolozhskaya, O. A., & Anthony, J. C. (2015) · Neuropsychopharmacology · doi:10.1038/npp.2015.213 · Cited by 35
Proportion of cancer cases and deaths attributable to alcohol consumption by US state, 2013-2016
Sauer, A. G., Fedewa, S. A., Bandi, P., Minihan, A. K., Stokłosa, M., Drope, J. M., Gapstur, S. M., Jemal, A., & Islami, F. (2021) · Cancer Epidemiology · doi:10.1016/j.canep.2021.101893 · Cited by 34
Self-citationUpdated fraction of cancer attributable to lifestyle and environmental factors in Denmark in 2018
Tybjerg, A. J., Friis, S., Brown, K., Nilbert, M. C., Mørch, L. S., & Køster, B. (2022) · Scientific Reports · doi:10.1038/s41598-021-04564-2 · Cited by 35
Exposure to alcohol and overall survival in head and neck cancer: A regional cohort study
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Influence of Psychological Factors in Breast and Lung Cancer Risk – A Systematic Review
Pereira, M. A., Araújo, A., Simões, M., & da Costa, C. J. M. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.769394 · Cited by 34
Genetically Predicted Circulating Levels of Cytokines and the Risk of Cancer
Song, J., Li, A., Qian, Y., Liu, B., Lv, L., Ye, D., Sun, X., & Mao, Y. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.886144 · Cited by 33
Ethanol versus Phytochemicals in Wine: Oral Cancer Risk in a Light Drinking Perspective
Varoni, E. M., Lodi, G., & Iriti, M. (2015) · International Journal of Molecular Sciences · doi:10.3390/ijms160817029 · Cited by 34
“[11] Meta-analysis No Oral and pharyngeal cancer RR 1 = 5.”
Background
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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