Cancer warning on liquor bottles ‘long overdue’. Even ‘light’, ‘moderate’ drinking poses threat

Even moderate drinking of one-two drinks per day raises cancer risk, say oncologists. New data suggests link of alcohol with cancers of skin, endometrium, ovary, prostate & blood.

A man carrying alcohol bottles in Anand Vihar | Photo: ANI

New Delhi: As a debate rages on whether alcohol bottles should carry cancer risk warnings, there is mounting evidence that liquor can cause malignancies of various kinds, not only those of the digestive tract and organs.

This growing body of scientific evidence also suggests that there may not be a safe limit that eliminates the risk of cancers associated with alcohol in users.

Earlier this month, US Surgeon General Dr Vivek Murthy issued a new advisory outlining the direct link between alcohol consumption and increased cancer risk.

The direct link between alcohol consumption and cancer risk is well-established for at least seven types of cancers, of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), voice box (larynx) and breast, regardless of the type of alcohol consumed, says the advisory.

“Alcohol consumption is the third leading preventable cause of cancer in the US, after tobacco and obesity, increasing risk for at least seven types of cancer,” it adds.

In India, where alcohol use contributed 6.6 percent to the total cancer disability-adjusted life years (DALY) in 2016, second only to tobacco (10.9 percent), among the global burden of risk factors, experts say the warning on alcohol bottles should be considered here as well.

DALY is a way to measure the overall burden of disease in a population.

Alcohol was declared as a Group 1 carcinogen by the World Health Organisation- International Agency for Research on Cancer (WHO-IARC) in 1988, alongside tobacco, asbestos, and formaldehyde, among others—the highest level of classification by the IARC for when “there is enough evidence to conclude that it can cause cancer in humans”.

“In this background, a warning regarding this on alcohol bottles has long been overdue and will be very relevant in the Indian context as well,” Dr Ravi Mehrotra, former director of the Indian Council of Medical Research-National Institute of Cancer Prevention and Research (ICMR-NICPR) and a member of WHO-IARC, told ThePrint.

The National Family Health Survey (NFHS-5) of 2019-2021 had found that 22.9 percent of men and 0.7 percent of women between the ages of 15 and 54 in India consume alcohol.

Globally, 7,41,300 cancer cases worldwide were attributable to alcohol consumption in 2020 and statistics show that heavy drinking—consisting of 15 or more drinks per week for men or eight or more drinks per week for women—contributed the most to cancer incidence compared with moderate drinking.

The US advisory says that health warning labels are well-established and effective approaches to increasing awareness of health hazards and fostering behaviour change.

In India, under the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003, all tobacco products—leading causes of oral and lung cancers—carry graphic health warnings on their packaging.

But a 2023 study found that while these warnings may have “some positive effects”, they need to be made more visible and easier to comprehend to have a more significant influence on discouraging people from taking up smoking or smokeless tobacco.

‘No safe limit’

Ethanol, the organic compound in alcohol, causes cancer through biological mechanisms as the compound breaks down in the body, which means that any beverage containing alcohol, regardless of its price and quality, poses a risk of developing cancer, says the WHO.

Oncologists ThePrint spoke with, too, explained that while there is no safe limit of alcohol use, in terms of eliminating the malignancy risks, the risk increases with the amount and frequency of alcohol consumed, with even moderate drinking of one-two drinks per day raising the chance of developing the condition.

“Heavier drinking significantly raises the risk, with binge-drinking and chronic heavy drinking patterns posing the greatest threat,” Dr Vivek Belathur, medical oncologist with Fortis Hospital in Bengaluru, said.

According to the experts, alcohol’s carcinogenic effects are attributed to its metabolism to acetaldehyde, a toxic compound that damages DNA and disrupts normal cellular function.

In addition, it also raises the possibility of triggering malignancy by inducing oxidative stress.

Oxidative stress is an imbalance of free radicals which are highly reactive, unstable oxygen molecules and antioxidants in the body, which can lead to cell and tissue damage, and may play a role in the development of chronic inflammation.

Furthermore, alcohol’s impact on hormone levels, immune function, and nutrient absorption also contributes to its cancer-promoting properties and it also raises the absorption of other carcinogens in the body.

The WHO also cautions that the risk of developing cancer increases substantially the more alcohol is consumed. However, latest available data indicates that half of all alcohol-attributable cancers in the European region were found caused by “light” and “moderate” alcohol consumption—less than 1.5 litres of wine or less than 3.5 litres of beer or less than 450 millilitres of spirits per week.

“This drinking pattern is responsible for the majority of alcohol-attributable breast cancers in women, with the highest burden observed in countries of the European Union (EU),” the world health body notes.

In the EU, cancer is the leading cause of death—with a steadily increasing incidence rate—and the majority of all alcohol-attributable deaths are due to different types of cancers.

Mounting evidence

While conclusive evidence linking alcohol to cancers related to the digestive tract, apart from breast cancer, has long been present, new data suggests the association of alcohol with various other malignancies as well, Mehrotra added.

These include cancers of skin, endometrium, ovary and prostate, apart from malignancies related to blood.

In 2022, results from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort indicated a positive association between alcohol consumption and skin cancer.

Baseline alcohol intake as well as lifetime alcohol consumption were associated with an increased risk of the development of squamous cell carcinoma, basal cell carcinoma, and melanoma in men, according to the findings.

Scientific evidence has also suggested alcohol consumption equivalent to two or more drinks per day increases risk of endometrial cancer in postmenopausal women and has shown a link between relatively elevated alcohol intake (of the order of 40 gm per day or more) and modest increase of epithelial ovarian cancer risk.

A meta-analysis of studies on prostate cancers had found that consumption of only 2 standard drinks per day increased the cancer risk in men by nearly 20 percent.

And it can harm unborn babies, too. Intake of alcohol during pregnancy has been associated with childhood leukaemia, according to a review published by the US National Cancer Institute, which prompted it to place maternal alcohol consumption during pregnancy in the category of “suggestive carcinogen” for unborn babies.

(Edited by Nida Fatima Siddiqui)