Association Between Changes in Alcohol Consumption and Cancer Risk
Although numerous studies have shown an association between alcohol consumption and cancer, how changes in alcohol use behavior increase or decrease the incidence of cancer is not well understood.
To investigate the association between the reduction, cessation, or increase of alcohol consumption and the development of alcohol-related cancers and all cancers.
Design, Setting, and Participants
This population-based cohort study analyzed adult beneficiaries in the Korean National Health Insurance Service. Participants (aged ≥40 years) included those who underwent a national health screening in both 2009 and 2011 and had available data on their alcohol use status. Data were analyzed from April 16 to July 6, 2020.
Alcohol consumption level, which was self-reported by participants in health screening questionnaires, was categorized into none (0 g/d), mild (<15 g/d), moderate (15-29.9 g/d), and heavy (≥30 g/d) alcohol use. Based on changes in alcohol consumption levels from 2009 to 2011, participants were categorized into the following groups: nonuser, sustainer, increaser, quitter, and reducer.
Main Outcomes and Measures
The primary outcome was newly diagnosed alcohol-related cancers (including cancers of the head and neck, esophagus, colorectum, liver, larynx, and female breast), and the secondary outcome was all newly diagnosed cancers (except for thyroid cancer).
Among the 4, 513 ,746 participants (mean [SD] age, 53.6 [9.6] years; 2 324 172 [51.5%] men), the incidence rate of cancer was 7.7 per 1000 person-years during a median (IQR) follow-up of 6.4 (6.1-6.6) years.
Compared with the sustainer groups at each alcohol use level, the increaser groups had a higher risk of alcohol-related cancers and all cancers.
The increased alcohol-related cancer incidence was associated with dose; those who changed from nonuse to mild (adjusted hazard ratio [aHR], 1.03; 95% CI, 1.00-1.06), moderate (aHR, 1.10; 95% CI, 1.02-1.18), or heavy (aHR, 1.34; 95% CI, 1.23-1.45) alcohol use levels had an associated higher risk than those who did not use alcohol.
Those with mild alcohol use levels who quit alcohol use had a lower risk of alcohol-related cancer (aHR, 0.96; 95% CI, 0.92-0.99) than those who sustained their alcohol use levels.
Those with moderate (aHR, 1.07; 95% CI, 1.03-1.12) or heavy (aHR, 1.07; 95% CI, 1.02-1.12) alcohol use levels who quit alcohol use had a higher all cancer incidence than those who sustained their levels, but when quitting was sustained, this increase in risk disappeared.
Compared with sustained heavy alcohol use, reduced heavy alcohol use levels to moderate levels (alcohol-related cancer: aHR, 0.91 [95% CI, 0.86-0.97]; all cancers: aHR, 0.96 [95% CI, 0.92-0.99]) or mild levels (alcohol-related cancer: aHR, 0.92 [95% CI, 0.86-0.98]; all cancers: aHR, 0.92 [95% CI, 0.89-0.96]) were associated with decreased cancer risk.
Conclusions and Relevance
Results of this study showed that increased alcohol consumption was associated with higher risks for alcohol-related and all cancers, whereas sustained quitting and reduced alcohol use were associated with lower risks for alcohol-related and all cancers. Alcohol cessation and reduction should be reinforced for the prevention of cancer.