A large group of distinguished scientists published a very detailed and rather complex paper describing the association between alcohol consumption and cancer in the BMJ. It is based on data from the EPIC study in Europe, with a mean follow up of 8.8 years for more than 300,000 subjects. The authors describe an increase in risk of many cancers from alcohol intake, but do not give data permitting the detection of a threshold of intake for an adverse effect on cancer risk. The investigators conclude that “In western Europe, an important proportion of cases of cancer can be attributable to alcohol consumption, especially consumption higher than the recommended upper limits.”

Members of the Forum were concerned that the authors did not separate moderate consumption from heavy consumption for their main analyses, ignored the demonstrated benefits of moderate drinking on total mortality, and did not point out other environmental influences (such as smoking, diet, obesity, etc.) that often have much larger effects on the risk of many cancers than does alcohol consumption. The authors make broad statements such as ‘alcohol has negative effects on total mortality’, which is not supported by the data presented in their paper, and is contradicted by most large-scale population-based studies.

Overall, while this paper supports the well-known association between heavy drinking and an increased risk of upper aero-digestive and certain other cancers, it adds little information useful for the prevention of most types of cancer.

Forum Summary:  A large group of distinguished scientists have published a very detailed and rather complex paper describing the association between alcohol consumption and cancer.  It is based on data from the EPIC study in Europe, with a mean follow up of 8.8 years for more than 300,000 subjects.  The authors describe an increase in risk of many cancers from alcohol intake, but do not give data permitting the detection of a threshold of intake for an adverse effect on cancer risk.  The investigators conclude that “In western Europe, an important proportion of cases of cancer can be attributable to alcohol consumption, especially consumption higher than the recommended upper limits.”

Members of the Forum were concerned that the authors did not separate moderate consumption from heavy consumption for their main analyses, ignored the demonstrated benefits of moderate drinking on total mortality, and did not point out other environmental influences (such as smoking, diet, obesity, etc.) that often have much larger effects on the risk of many cancers than does alcohol consumption.  The authors make statements such as alcohol has negative effects on total mortality that are not supported by the data presented in their paper, and are contradicted by most large-scale population-based studies.  Overall, while this paper supports the well-known association between heavy drinking and an increased risk of upper aero-digestive and certain other cancers, it adds little information useful for the prevention of most types of cancer.

The full critique by forum members can be read via this link.

Reference: Schutze M, Boeing H, Pischon T, et al, Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ 2011; 342:d1584 doi: 10.1136/bmj.d1584 (Published 7 April 2011)

Contributions to this critique by the International Scientific Forum on Alcohol Research were made by the following members:

Yuqing Zhang, MD, DSc, Epidemiology, Boston University School of Medicine, Boston, MA, USA.

Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark.

Francesco Orlandi, MD, Dept. of Gastroenterology, Università degli Studi di Ancona. Italy

Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA.

R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA.

Giovanni de Gaetano, MD, PhD, Research Laboratories, Catholic University, Campobasso, Italy.

Roger Corder, PhD, MRPharmS, William Harvey Research Institute, Queen Mary University of London, UK.

For the detailed critique of this paper by the International Scientific Forum on Alcohol Research, go to http://www.bu.edu/alcohol-forum and click on Recent Reports.

Helena Conibear co Director
The International Scientific Forum on Alcohol Research
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Professor R Curtis Ellison co Director
The International Scientific Forum on Alcohol Research
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Contact: R. Curtis Ellison
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Boston University Medical Center