Frequent drinking vs. quantity of alcohol consumption increases risk for GI cancer
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Frequent drinking and not the amount of alcohol consumed per occasion was a more significant risk factor for incident gastrointestinal cancers, according to a study published in JAMA Network Open.
“In the present study, most moderate and heavy drinkers were men, and only 10.8% of moderate drinkers and 5.5% of heavy drinkers were women,” Jung Eun Yoo, MD, PhD, department of family medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea and colleagues wrote. “Therefore, it is possible that the association of alcohol consumption with cancer risk in women was underestimated and appeared to be less prominent than in men. In general, current guidelines on alcohol consumption specify only mean levels of consumption (eg, mean number of units consumed in 1 week). The American Cancer Society recommends that people who drink alcohol limit their intake to no more than two units per day for men and one drink a day for women, and the European Code Against Cancer recommends limiting or cutting out alcohol consumption. In addition to amount per occasion, our study provides a rationale for an emphasis on the frequency of drinking to prevent cancer. Alcohol users who have a glass of wine or beer during dinner every day may develop more cancer than people who occasionally consume several drinks.”
Yoo and colleagues used data from the Korean National Health Insurance System database on 11,737,467 patients without cancer who underwent a national health screening program from Jan. 1, 2009, to Dec. 31, 2010. Investigators followed up with patients 1 year after their health screening data until they were diagnosed with GI cancer or death. Exposures included weekly alcohol consumption (nondrinker [0 g per week], mild drinker [0-104 g per week], moderate drinker [105-209 g per week], and heavy drinker [210 g per week]), drinking frequency and amount per occasion. The primary outcomes included incident GI cancer at six specific sites: esophagus, stomach, colorectal, liver, biliary and pancreas.
Investigators noted of the 11,737,467 patients, 319,202 developed GI cancer. The risk of GI cancer was higher for mild drinkers (adjusted HR, 1.04; 95% CI, 1.03-1.05), moderate drinkers (aHR, 1.14; 95% CI, 1.12-1.15) and heavy drinkers (aHR, 1.28; 95% CI, 1.26-1.29) compared with nondrinkers. Yoo and colleagues said GI cancer risk linearly increased with frequency of drinking in a dose-dependent manner (aHR, 1.39; 95% CI, 1.36-1.41 for individuals who drink every day).
“In contrast, the risk of GI cancer appeared to increase with consumption up to 5 to 7 units per occasion (aHR, 1.15; 95% CI, 1.14-1.16), and then the HRs were no higher for those with a higher intake per session than 5 to 7 units (8-14 units per occasion: aHR, 1.11; 95% CI, 1.09-1.12; greater than14 units per occasion: aHR, 1.11; 95% CI, 1.08-1.14),” Yoo and colleagues wrote.
According to researchers, the risk for GI cancer in similar weekly alcohol consumption levels increased with higher frequency of drinking but decreased with a higher amount per occasion. They noted risk patterns for the six specific sites were similar to those of all the GI cancers.
“These findings suggest that individuals should be counseled about regular low-dose alcohol use in addition to total amount of alcohol consumption or amount per occasion,” Yoo and colleagues wrote.
Perspective
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Jamile' Wakim-Fleming, MD, FACG, FAASLD
It has been known that alcohol consumption is associated with gastrointestinal malignancies such as cancers of the liver, mouth, larynx, pharynx, esophagus, stomach, pancreas and colorectal cancers. And, that cancer risk rises progressively with heavier consumption, notably for amounts of at least 210 g of alcohol per week.
In fact, the American Society of Clinical Oncology advises that alcohol drinking is an established risk factor for several malignancies and the 2020 guidelines from the American Cancer Society advise complete avoidance of alcohol for cancer prevention due to an increased cancer risk evident even with consumption of less than one drink per day.
However, the pattern of alcohol consumption has not been clarified in the past.
In this large population study that included 11,737,467 individuals, based on self-reported questionnaire about the pattern of alcohol consumption (frequency and quantity), it is shown that frequent drinking may be more dangerous than binge drinking with regard to GI cancers.
While this study corroborates our knowledge on the carcinogenicity of alcohol on the GI system, it introduces a novel finding that repeated alcohol consumption, even at lower amounts of alcohol, may have a greater carcinogenic effect on all GI organs than the consumption of larger amounts of alcohol at a lower frequency (for example, binge drinking) and that alcohol has a role on the development of biliary cancers.
Therefore, alcohol users who have a glass of wine or beer during dinner every day may develop more cancer than people who occasionally consume several drinks.
These findings add a new element to our knowledge of the effect of alcohol on the GI system. Some of the plausible explanations for these findings are that alcohol promotes cell division and accumulation of toxic products that are carcinogenic, and that the repetitive consumption of alcohol is more carcinogenic than episodic ingestion due to persistent carcinogenic effect and inability of the immune system to repair alterations of the DNA.
A major limitation to this study is that it is based on self-reported questionnaire that assumes the possibility of underreporting of alcohol consumption. Long-term randomized trials of alcohol consumption are eagerly awaited.
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