Light alcohol drinking and cancer: a meta-analysis
Abstract
Background: There is convincing evidence that alcohol consumption increases the risk of cancer of the colorectum, breast, larynx, liver, esophagus, oral cavity and pharynx. Most of the data derive from studies that focused on the effect of moderate/high alcohol intakes, while little is known about light alcohol drinking (up to 1 drink/day).
Patients and methods: We evaluated the association between light drinking and cancer of the colorectum, breast, larynx, liver, esophagus, oral cavity and pharynx, through a meta-analytic approach. We searched epidemiological studies using PubMed, ISI Web of Science and EMBASE, published before December 2010.
Results: We included 222 articles comprising ∼92 000 light drinkers and 60 000 non-drinkers with cancer. Light drinking was associated with the risk of oropharyngeal cancer [relative risk, RR = 1.17; 95% confidence interval (CI) 1.06-1.29], esophageal squamous cell carcinoma (SCC) (RR = 1.30; 95% CI 1.09-1.56) and female breast cancer (RR = 1.05; 95% CI 1.02-1.08). We estimated that ∼5000 deaths from oropharyngeal cancer, 24 000 from esophageal SCC and 5000 from breast cancer were attributable to light drinking in 2004 worldwide. No association was found for colorectum, liver and larynx tumors.
Conclusions: Light drinking increases the risk of cancer of oral cavity and pharynx, esophagus and female breast.
Alcohol lowers incidence of Non-Hodgkins Lymphoma: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590626/#b32-ar...
Alcohol lowers incidence of melanoma: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590626/#b3-arc...
Light drinking reduces leukemia incidence by 10%: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590626/#b72-ar...
Lower risk of thyroid cancer: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590626/#b20-ar...
Lower risk of renal cell carcinoma: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590626/#b83-ar...
Lower risk of triple negative breast cancer in alcohol drinkers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590626/#b44-ar...
And with electric car & electric heat pump transitions, how much better will it get on top of that going forward?
Also urban people tend to be wealthier, and also live longer.
Presumably you're right, they would be less likely to smoke, and I would imagine also possibly more health conscious in other ways. The authors mention that a different analysis of 15 studies of alcohol use among never-smokers was similar to their own findings, but also caution that tobacco could indeed be having an influence on their results (or even a possible synergistic effect with alcohol).
Here's a top google result. https://www.webmd.com/heart-disease/news/20220125/no-amount-...
And a second https://www.sciencedaily.com/releases/2018/08/180824103018.h...
[1] It's not really a vitamin, because we do produce it internally (as opposed to having to ingest it in diet).
My understanding is that more modern research has unambiguously debunked the "light drinking" assertions.
But this is not something I'd expect you to be convinced of, because I don't have hard evidence on hand. We will have to leave it there, and I will go refresh my understanding some other time, if you will too :)
All the sources here:
When some studies show a lower cancer rate correlated with moderate consumption of certain alcoholic beverages, e.g. wine or beer, it is much more likely that those studies show a beneficial effect of some other substances contained in those beverages.
In that case, it is likely that drinking the non-fermented precursors of those beverages might have the same effects, even in the absence of alcohol, e.g. drinking fresh grape juice instead of wine, or even better, eating red or black grapes instead of drinking juice.
Alcohol in small enough quantities may have negligible bad effects, because humans and their relatives are adapted to tolerate the ingestion of fermented fruits, but there is no reason to expect any good effects.
Breathing is, too, but the important question is what proportion of light drinkers become alcoholics. According the the first legitimate looking hit, 56% of people have had a drink in the last month, 5.6% of people have an "alcohol use disorder."
So, ignoring details, 90% of light drinkers are fine.
Heavy breathers not so much.
Associated or correlated? Which cancers?
I am writing this after having a couple of beers every evening for the past two weeks, and a wine tasting trip too.
Last time I mentioned this on HN, people here have claimed that the effect was psychosomatic.
I think people grossly underestimate the negative health effects of alcohol, and I doubt any amount of research will really change peoples minds.
And you could do better by being a little less preachy and a bit more pedantic, anecdotes and opinions are not facts after all.
the phrase "every man has his vice" is supposed to be interpreted as every man is corrupt and wicked?
Sounds like you're evaluating it through a moralistic/religious lens as opposed to unbiased scientific one. Vice is such a preachy way to frame it.
>You do not need to defend an industry of billions for free.
I don't buy from the giants. 90% of my consumption is locally produced beers from small businesses in my community.
There's no evidence of the contrary from your side - drinking alcohol is like any abusing any other organic solvent, I can't imagine why anyone would presume it'd be any healthier.
However, light to moderate drinking might reduce the risk of cardiovascular disease and diabetes and these might be enough to outweigh the extra risks from cancer. (This is still an active subject of research.)
It also very much causes esophageal cancer. I've known serious alcoholics who have died from both. It makes intuitive sense that constantly irritating your throat might cause cancer.
...and even then, in the vast majority of primary liver cancer cases, cirrhosis is already present, and typically precedes the cancer. So yes, it's very likely that the generally unhealthy lifestyle of the alcoholic is the primary contributor, here.
i think most people know drinking isn’t good for you. people aren’t defending alcohol they’re defending the social value they receive from drinking; and it brings a lot. most people don’t drink that much anyway because it’s not great for you. alcohol usage is highly concentrated on alcoholics who drink like 90% of all alcohol produced
id say of these 3 the one people go to crazy lengths to avoid doing anything about is BMI. everyone knows it’s one of the biggest if they not biggest co-morbidities identified yet a good portion of the world has high BMI and does nothing about it
I think that’s a good message. I certainly feel badly for obese people because, however they got there, they’re going to have a hell of a time getting back to a healthy body size.
I do agree that many people lose that key part of the message when they pass it on.
Feeling bad about your weight is a good motivator to lose weight. It might be bad for your mental health and it could do absolutely nothing for some people but the vast majority of people who keep their weight in check and/or are motivated to lose weight do so more for social reasons than they do for health reasons.
Compared to something like alcoholism, being overweight (which can be similarly deadly) is treated much differently. For alcoholism, the attitude has been changing from "alcoholics are degenerates with weak wills" to "alcoholism is a disease and these people need help" where the attitude toward obesity is going from "fat people are disgusting people who have no self control" to "big is beautiful".
The difference is with alcoholism the message goes from disdain to support but he solution remains the same, a great deal of personal work to solve the problem. With obesity, the message goes from disdain to acceptance and the solution is to just not bring it up.
Educationalist here, actually it isn't :) For many people, this just makes you feel bad - and that's it. For that feeling to result in meaningful action a bunch of conditions have to be met, e.g. the absence of eating disorders (including things like stress eating etc.), a concept of self-efficacy (the idea that one actually is able to change out of one's own will), impulse control, knowledge about food and dieting, the time and money to eat healthier and so on. Often people are perfectly aware that their behaviour is unhealthy, but they lack one or more of those conditions. It therefore is better to focus on providing people the actual means to change (knowledge, methods, better food in school and at work, a supportive environment, taxation to make unhealthy food/drugs more expensive (a thing in the EU)).
Note that I'm fully in support of emphasizing the unhealthy aspects of obesity, though. Providing the facts often just isn't enough.
Are you just asking overweight people or are you asking all people? The people who are overweight today are obviously the group of people for which social pressure is ineffective. I'm talking about all people including the people who are successfully at a healthy weight.
So even though shame might not work to get fat people to lose weight, it could still work to keep people from ever getting fat. Getting shamed for a few pounds means that you can fix the source of shame by dieting for a few weeks, very doable for average people.
They also gave us insight into the mind of the gay anti-gay politician.
I think it's important to not lose sight of the fact that maintaining a healthy weight is a challenge for nearly everyone and undermine what is currently working for those who are not overweight.
Furthermore, I think obesity has somehow found it's way to be more in line with the LGBT style movements of acceptance/tolerance instead of the changing view of addictions as disease instead of character flaws when it clearly should be much more like the latter.
Only if you think you have realistic chances of loosing that weight.
Otherwise that bad feeling will ... get eaten up.
Be anxious, not too much. Mostly over things within your control.
Then it becomes (well, became) the next taboo that nobody wants to touch with a 10 feet pole since its playing with a PR suicide.
And so we have the world we have, and we reached it step by step by exactly this logic. Simple thing is, fat people need help from society just like drug addicts, yet everybody desperately tries to avoid this framing, and thus help is often not deemed necessary/worth the risk of offending. Thus people die needlessly just that somebody doesn't have hurt feelings.
I deal with chronic pain and I’m at the hospital or clinic frequently, often multiple times per week. As someone who is in that environment quite a bit, I can assure you that the dangers of obesity are very clearly and openly discussed; frankly, you can’t walk two steps in a hospital without seeing some sort of PSA about the dangers of obesity.
Your mental model just doesn’t track with what I’ve seen again and again in reality.
The people being told to shut up about it are usually abusing strangers or enemies, and feel very abused and targeted for being criticized for targeting and abusing people. If you were talking about being fat with someone you obviously care about and cares about you, they'd take it in that spirit. If you shamed them for it, they'd hopefully end that fucked up abusive relationship. The only thing I would ever shame a loved one for is their abuse of other people. Otherwise, I want to lift them up, not tear them down.
https://www.outsideonline.com/health/wellness/sunscreen-sun-...
This is coming from someone who spends a lot of time in the sun. Melanoma was never going to have much of an impact on mortality at the population level, the incidence of high grade melanoma is far too low.
Is it coming from someone with a lot of experience evaluating the protocols of epidemiological studies? Sunlight (whether too much or too little) affects us in all sorts of poorly-understood ways; that's why it's useful to do a big correlation study instead of just examining melanomas.
It is, but I prefer to not involve my own credentials as a boring appeal to authority and focus on the argument at hand. I mentioned spending time in the sun to show I have no horse in the race. I only bring up melanoma because the cohort is “Melanoma In Southern Sweden”, but I think your point is fair regarding likely multifactorial causes.
“Sunlight (whether too much or too little) affects us in all sorts of poorly-understood ways; that's why it's useful to do a big correlation study instead of just examining melanomas”
Still, if I were designing a study to measure the impact of exercise on all cause mortality, I would not have a question like “Do you frequently jog to the farmers market to pick up vegetables?”. Half of the questions ask about going on vacation, maybe we are seeing that people who have enough time to “go abroad” twice a year live longer, I would believe that. I hope this is obvious and that even someone who doesn’t have “a lot of experience evaluating” these studies can see the flaw.
The study didn’t include any men!!! A study of women only might not generalize to the whole population, especially when it comes to all cause mortality. One obvious example: men have 1.5x higher risk of dying from melanoma than women. The study excluded individuals with a history of malignant melanoma.
The no-exposure group exercised less and had lower education, and there is a large risk for residual confounding that could have likely been accounted for by using categorical variables with more than 3 options.
Further criticisms include the “no exposure group” having much more women aged 55-64 (with likely much more comorbidities). They used length to follow up time to account for this which has no place in an observational study. The study excluded women who had a history of cancer.
I appreciate the work the authors did, but remain unconvinced that it is sunlight that caused lower mortality in their study.
First of all, they explicitly mention controlling for income disparity. Second, the questions seemed reasonable to me. One for sunbathing in summer, one for sunbathing in winter which mentions travel, one for tanning beds, and one for specifically about vacationing in sunny places.
Keep in mind the context. This study was not designed to answer "is sunlight good for you" or "do people who sunbathe a lot live longer". AFAICT it was designed to answer "is avoiding sunlight bad for you." Those questions seem reasonable to suss out how much someone seeks/avoids sun exposure. There might be better ones, but it seems hubristic to just assume so, so casually.
> The study didn’t include any men!!!
I don't know why they limited the study to women. I assumed it was to make it easier to control for confounds, but they could've had some other reason. Maybe sunscreen ads are mostly targeted towards women in Sweden, and they thought a larger number of women would turn out to be sun-avoiders. In any event, this isn't a problem with the study, this is just complaining that they studied something different than what you're interested in knowing.
> [differences between the most-sun and least-sun in education, exercise, age, etc]
Of course there were differences, those things correlate with pretty much everything worth studying. Are you saying that the authors didn't control for them (then why collect data on them and include it?), or that they did so badly (why do you think that), or something else?
> I appreciate the work the authors did, but remain unconvinced that it is sunlight that caused lower mortality in their study.
I don't think epidemiological studies ever prove that anything causes anything, we're talking about correlations here. The conclusion was that avoiding sun is associated with higher all-cause mortality among women. I'll believe that until there's a reason not to.
"Are you saying that the authors didn't control for them (then why collect data on them and include it?), or that they did so badly (why do you think that), or something else"
Yes, I addressed this above, see my comment on residual confounding, amongst my many other criticisms.
Not when there is a functioning ozone layer.
The thing with UV light though is that it also kills surface bacteria and is involved in vitamin D production. It's very like minerals in that way. Not enough kills you, but it's easy to go from too little to way too much.
To be fair people are also inundated with X increases cancer risk by Y (typically marginal) amount. So much so the noise just gets tuned out. Cigarettes are one of the few things that dramatically increase cancer risk. Enough that just about everyone knows someone who caught a deadly disease from smoking.
Truth is, you will likely not get lung cancer if you smoke.
Only 6% of smokers will get lung cancer. You have a slightly worse than 19 in 20 chance of going through your whole life smoking and not getting lung cancer.
Now, in your statement itself, you move the goalpost. You start with cancer and end with "a deadly disease". Because, yeah, smoking is also linked to several other bad outcomes, not just cancer.
And it is fair to compare those other diseases when talking about why we demonize smoking way more than other things. But we can't do that by focusing on cancer. That's disingenuous.
And it is fair to say that the correct number of cigarettes to smoke is 0. The correct amount of alcohol to consume is none. And the correct BMI to be at is between 18 to 24.
They do exist, but the way this topic is usually talked about in public, and what numbers are often presented, one would have to assume the overwhelming number of lung cancer patients are smokers, but they ain't, at best they make up half, not even because most people with lung cancer stop smoking.
What is common is that pretty much everybody tried smoking at some point in their live or another, particularly when younger. That's what these "Most lung cancer patients smokers/used to smoke!" headlines are regularly based on.
But the number of people that are strict "never smokers", who never even touched a cigarette once in their live, is actually quite low. Yet those are regularly used as a comparison group.
The equivalent for alcohol would be counting every liver cancer as the result of alcohol on the basis of a patient having consumed alcohol, regardless how much or how often, before.
They estimated up to 40% of cancer could be caused by alcohol consumption.
Then I found [1] saying that being cigarette smoker gives you a 25-fold higher increase for lung cancer and 2-fold for bladder cancer.
Considering amounts, and types of cancer, that seems almost incomparable. Though cigarettes sound really bad, and I’m glad I quit with vaping ;)
[0]: https://www.cancer.gov/about-cancer/causes-prevention/risk/a...
[1]: https://www.cancer.net/blog/2021-07/how-does-smoking-increas...
Will just add that since acquiring a rather sensitive personal wearable that continuously captures various quantitative measures about my body- heart rate, temperature, heart rate variability, spo2, and others- that even with the uncertainty that stems from having a single data source- it is VERY clear quantitatively to me how much even small amounts of alcohol affect MY body.
I had a semi serious sickness earlier this year that had me entirely out of commission for a day and at reduced capability for several days. Looking just at the data, a minimal amount of alcohol (for my definition of minimal) is roughly 1/10th the negative impact of that illness. It doesn't feel that way to me, but that's what the data says. That's amazing and terrifying to me.
I am not going to make a specific wearable endorsement but do highly recommend those who have opinions on this matter to collect their own data about their own bodies. Cheers.
The education on alcohol could be a lot better and it shouldn't be hard. Obesity is a much harder problem to solve and I suspect we don't know all the reasons it is on the rise yet.
That's because it doesn't. For the kind of light social/dinner drinking most people do, there is absolutely no evidence whatsoever that it increases your cancer risk (on the contrary, there is some evidence of protective benefits, but epidemiological studies on diet are always full of confounders, so who knows). The reason it appears on lists like these is that alcohol abuse is quite common and leads to liver cancer, among other things, and is associated with other unhealthy choices.
https://www.wcrf.org/diet-activity-and-cancer/risk-factors/a...
That's a big of a stretch. The DNA is "damaged", or better said changed, by everything. And not all alcohol beverages are equivalent. I'm all up for raising awareness at alcoholism especially due to experience in my family in the past, but this is a piss-poor job of doing so. Being alarmist about things has often the opposite effect, especially today.
people who do not drink alcohol die too and usually not at older age.
5 millions deaths worldwide is a drop in the bucket, considering things that could be prevented and are not related to people behavior (10 million people die every year of hunger, many are kids) and, most of all, even if we can correlate alcohol to those deaths (it's mostly smocking and BMI) that doesn't imply that if they did not drink they would have lived longer.
People who abuse of substances find a way to abuse of anything legal or illegal.
Car accidents cause around 1.4 million deaths and 50 million non fatal injuries (difference with alcohol being it doesn't need people to abuse of it).
Pollution is responsible for 9 million deaths/year.
Should we ban road transport?
I also still spend a lot of time around heavy boozers and see how a variety of drunk people behave. So I personally see how objectively bad it is before we really get to specific health issues.
I’m not concerned with how alcohol causes death, I am concerned with how alcohol affects life.
On the health issues, the link between alcohol and cancer is clear and global studies also conclude that no amount of drinking alcohol is safe for you. On the basis that drinking alcohol is a pretty binary choice under the direct control of a human, peer pressure aside, this probably explains why people get defensive because it’s an attack - if you like - on their personal choices.
I cannot personally have an impact on whether my personal pollution emissions - cue gags - affect my health, and improvements in my own driving skills have a ceiling limit on my own safety. But booze is easy, not drinking has a disproportionate impact on me personally.
There’s a difference between banning things to improve public health and personally not partaking in them.
Me observing that people are quick to get defensive over alcohol consumption in general is poking fun at a thing called denial. I get that it’s a defence mechanism to defer anxiety, and the moment I quietly mentioned to friends I wasn’t drinking anymore I received the same defensive reaction from a few of them.
I understand, but that's your personal experience, which is invaluable, but not in general.
People have been drinking since we call them humans and it hasn't affected our path to progress.
Many wild animals do it too! (elephants, bears, monkeys, squirrels, bats, and many others)
I don't think people defend alcohol despite the negative effects, people think alcohol is not the problem, but the way it is consumed can be.
I've also witnessed personally the difference on how Americans drink alcohol in my city (Rome) and how we drink it. It's always surprising to me that they survive to live another day, they drink as they want to destroy themselves, we usually do it for the fun of it.
Same way a wedding or birthday cake is not responsible for obesity, but most obese people love them and eat too much of it.
> On the health issues, the link between alcohol and cancer is clear
not alcohol per se, but large amounts of it.
Almonds contain cyanide, 10 of them raw and you're in big troubles, 50, you're dead.
We simply don't eat as much of them usually.
Paracelsus said it all about it.
Interesting. A common fruity off flavor (or desired flavor depending on what you want) of craft beer is caused by acetaldehyde being produced in the fermentation process. I wonder if certain craft beers are worse than regular beers because it contains acetaldehyde to begin with.
You can flush out acetaldehyde with 2 grams of Taurine before going to bed. It's probably why a big egg breakfast feels good after a long night. This isn't going to make alcohol safer, but you won't have a hang over the next day...
Yes, alcohol is harmful, but in moderation, the harm is not that different than other toxins people are exposed to.
One causes at least the same amount of damage of the other, but there's virtually no way to protect yourself from the former, while you can chose to quit the latter.
Another important distinction is that most people who drink (almost all of them) don't abuse of it, they consume a moderate amount of it in specific circumstances.
But they can't limit the amount of oxygen they need to survive and are forced to inhale venom from the air regardless.
Yes, because the last few decades of drug prohibition have shown how differently it works nowadays.
I'm overly cynical about this particular matter though. Here in Ireland, the government recently introduced minimum unit pricing, selling it as a public health matter—completely ignoring the fact that about a decade ago they had suggested the same policy, but with the motivation that it would encourage people to go to pubs rather than drink at home (among many other moral problems with that bill).
Wikipedia says it was mostly about religious moralists.
Nobody was saying make it illegal, yet that's what people jump to. We need to increase educational awareness of the harms of these compounds because prohibition just makes things worse. Prohibition is why there is fentanyl in the heroin supply for example.
I think you don't see them as defending alcohol because your comment is doing the exact same thing.
Optimizing your life strictly around maximizing potential lifespan is certainly an option, but one that many people would feel is an unworthy tradeoff with what they'd have to give up.
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The difference with smoking vs the other things mentioned frequently in this thread (beyond likelihood of addiction), is that the reductions in lifespan with smoking are huge.
The average smoker loses at least a decade of their expected lifespan from what I can see.
Alcohol's effect on expected lifespan is more disputed, but even those claiming it's a negative in all quantities, generally make far smaller claims as to the degree of reduction for moderate/average use than are the case for smoking.
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Additionally, the average smoker doesn't appear to even be particularly fond of their activity. I do not meet many middle aged smokers that talk in any sort of particularly positive terms about their smoking or that seem to have positive memories associated with it.
Also, to clarify, drinking alcohol does NOT equate to making one's life shorter - that's not at all what the article discusses. Moderate drinking may have no effect, or even a positive effect, on life span.
How about the prosocial effects of low doses of ketamine or other NMDA antagonists such as PCP and dextromethorphan?
Perhaps I'm anti alcohol because you can get the exact same effect from compounds with better risk profiles. Alcohol is a very old drug with a lot of risks compared to the benefit. It hammers so many different receptors, the off target effects are nuts and that's not even mentioning the risk from the toxic metabolite acetaldehyde.
There's no reason to use ethanol with so many better options for the same behavioral modifications.
I personally find libraries incredibly relaxing, but I assume what you mean by "it's not the same" in that a library doesn't serve highly rewarding GABAergic drugs.
People enjoy drinking alcohol because it is rewarding and most have learned to like the taste through the association of that neurological reward. That's generally what enjoyment is, association of reward with an activity. There are many other activities and compounds that are just as rewarding or relaxing but society is conditioned to accept alcohol as the default it seems, at least in some communities.
As for your last point, that is absolutely not true from my experience. Whenever I discuss the risk of cancer that's associated with alcohol consumption the other person generally has no idea, that has been over 90% of my conversations on the topic.
I'm all for people making informed decisions on what they want to put into their bodies but informed is the operative word. There's a reason people don't associate drinking or being fat with cancer the way they do with cigarettes.