The link between cancer risk and alcohol consumption is a well-established one, but most previous research has focused on the harms of large quantities of alcohol, such as the hazards of increasing alcohol consumption over time or frequent binge drinking.
That focus implies low levels of drinking aren’t harmful, but the World Health Organization (WHO) recently released a statement in The Lancet Public Health refuting that assumption and declaring that when it comes to alcohol, there is no safe amount.
In the statement, the WHO points out that the International Agency for Research on Cancer classified alcohol as a Group 1 carcinogen decades ago, a classification that also includes asbestos, radiation, and tobacco. Alcohol causes at least seven types of cancer, the group added, including bowel cancer, breast cancer, and cancers of the head and neck.
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This statement is similar to new Canadian guidelines asserting that zero drinks per week should be the goal, and that risk of cancer increases significantly at three drinks or more per week.
Although the WHO did acknowledge that cancer risk increases as more alcohol is consumed, it also noted that the latest available data indicates half of all alcohol-attributable cancers in European study participants were caused by light-to-moderate consumption. In the EU, light-to-moderate consumption was associated with almost 23,000 new cancer cases in 2017. According to WHO estimates, alcohol consumption also contributed to 3 million deaths in 2016 globally and was responsible for about 5 percent of the global burden of disease and injury.
Those numbers led the WHO to conclude that risk begins “from the first drop of any alcoholic beverage.”
So, does that mean it’s time to empty the liquor cabinet and go zero proof for good? Like so many decisions when it comes to health, the answer seems to be: It depends.
What to Know About Cancer Risk Management and Alcohol
The takeaway of the WHO’s policy, according to some oncologists not involved in the statement, isn’t that everyone needs to be teetotal forever, but that these findings should prompt you to look more closely at how your alcohol consumption may be affecting your overall risk for cancer.
“This policy is really more of a starting point about risk when it comes not just to populations, but also for individuals,” Louis Potters, M.D., chair of radiation medicine at Lenox Hill Hospital in New York, tells Bicycling. “We already knew before this that alcohol was associated with certain types of cancer, but the WHO came in pretty hard to say no level is acceptable. That doesn’t leave any room for tailoring your consumption based on risk level.”
For example, because the combination of smoking and alcohol consumption increases risk considerably compared to just one of those behaviors, someone who smokes should rethink drinking altogether. But if all your other risk factors are low, Potters says occasional or low levels of drinking wouldn’t be as problematic.
In terms of general risk assessment when it comes to cancer, there are some factors you can’t modify, such as genetic susceptibility, says David Cohn, M.D., chair of gynecologic oncology at The Ohio State University Comprehensive Cancer Center. However, there are several that can be managed, and the top ways to manage your cancer risk include tobacco use, excess weight, sun exposure, and of course, alcohol consumption.
“Should you never gain a couple pounds or ever go out into the sun without sunscreen?” Cohn asks Bicycling. “There are tradeoffs in everything we do and that’s not just for cancer risk but also for our health overall. We make decisions all the time based on what’s potentially beneficial or detrimental.”
One consideration when thinking about your cancer risk level and how much you should cut back on drinking is understanding that alcohol is alcohol—no matter its form, according to Eleonora Teplinsky, M.D., head of breast medical oncology at Valley-Mount Sinai Comprehensive Cancer Care and clinical assistant professor of medicine at Icahn School of Medicine at Mount Sinai in New Jersey. “An important point is that all types of alcohol increase risk, as there is often a misconception that wine is safer than hard alcohol, for example,” she tells Bicycling.
Another consideration, adds Potters, is how all health behaviors might be at play here, not just how much you drink. Paying attention to how your lifestyle choices all connect together can drive your decision about whether to have that happy hour beer.
“This is like three-dimensional chess,” he says. “You have to look at how much you exercise, for instance, along with what you eat, whether you’re exposed to environmental pollutants, if you’ve ever smoked, whether you have an ongoing medical issue, how much stress you have. You’ll never be able to mitigate every risk component, which is why it’s important to adjust the ones you can.”
Finding the Balance in Alcohol Consumption
Although the WHO position statement can be helpful for sparking a discussion about risk with your physician, there’s one reaction that’s not very useful—and that’s panic, says Anton Bilchik, M.D., Ph.D., surgical oncologist and division chair of general surgery at Providence Saint John’s Health Center, and director of the gastrointestinal and hepatobiliary program at Saint John’s Cancer Institute in Santa Monica, California.
“For the WHO to classify alcohol as a level 1 carcinogen is highly irresponsible,” he tells Bicycling. “There’s no doubt that high quantities of alcohol increase risk significantly for several types of cancer, as well as other health issues. But to say absolutely no amount is safe, for something that’s been consumed over thousands of years, seems alarmist.”
If alcohol, on its own, were as toxic as the report suggests, he adds, that would lead to far more cancer worldwide than has been diagnosed.
That doesn’t mean the WHO data is flawed—it’s always smart to assess how much you’re drinking and whether you need to cut back—it’s just that there’s more nuance to consider. It’s not as simple as thinking an occasional glass of wine will automatically lead to cancer, says Bilchik.
“The message here really is to educate yourself about risk factors—not just alcohol, but others as well—and know your own predisposition to cancer. It’s like a math equation,” adds Cohn. “Everything you do should be put in context of your potential life span and health span.”
Elizabeth Millard is a freelance writer focusing on health, wellness, fitness, and food.
