Moderate Alcohol Intake and Cancer Incidence in Women

Naomi E. Allen; Valerie Beral; Delphine Casabonne; Sau Wan Kan; Gillian K. Reeves; Anna Brown; Jane Green


J Natl Cancer Inst. 2009;101(5):296-305. 

In This Article

Abstract and Introduction


Background: With the exception of breast cancer, little is known about the effect of moderate intakes of alcohol, or of particular types of alcohol, on cancer risk in women.
Methods: A total of 1 280 296 middle-aged women in the United Kingdom enrolled in the Million Women Study were routinely followed for incident cancer. Cox regression models were used to calculate adjusted relative risks and 95% confidence intervals (CIs) for 21 site-specific cancers according to amount and type of alcoholic beverage consumed. All statistical tests were two-sided.
Results: A quarter of the cohort reported drinking no alcohol; 98% of drinkers consumed fewer than 21 drinks per week, with drinkers consuming an average of 10 g alcohol (1 drink) per day. During an average 7.2 years of follow-up per woman 68 775 invasive cancers occurred. Increasing alcohol consumption was associated with increased risks of cancers of the oral cavity and pharynx (increase per 10 g/d = 29%, 95% CI = 14% to 45%, P trend < .001), esophagus (22%, 95% CI = 8% to 38%, P trend = .002), larynx (44%, 95% CI = 10% to 88%, P trend = .008), rectum (10%, 95% CI = 2% to 18%, P trend = .02), liver (24%, 95% CI = 2% to 51%, P trend = .03), breast (12%, 95% CI = 9% to 14%, P trend < .001), and total cancer (6%, 95% CI = 4% to 7%, P trend < .001). The trends were similar in women who drank wine exclusively and other consumers of alcohol. For cancers of the upper aerodigestive tract, the alcohol-associated risk was confined to current smokers, with little or no effect of alcohol among never and past smokers (P heterogeneity < .001). Increasing levels of alcohol consumption were associated with a decreased risk of thyroid cancer (P trend = .005), non-Hodgkin lymphoma (P trend = .001), and renal cell carcinoma (P trend = .03).
Conclusions: Low to moderate alcohol consumption in women increases the risk of certain cancers. For every additional drink regularly consumed per day, the increase in incidence up to age 75 years per 1000 for women in developed countries is estimated to be about 11 for breast cancer, 1 for cancers of the oral cavity and pharynx, 1 for cancer of the rectum, and 0.7 each for cancers of the esophagus, larynx and liver, giving a total excess of about 15 cancers per 1000 women up to age 75.


Many epidemiological studies have investigated the relationship between drinking alcohol and the risk of cancer. In 2007, the International Agency for Research on Cancer concluded that there is sufficient evidence that alcohol causes cancer of the oral cavity, pharynx, esophagus, larynx, colorectum, liver, and female breast.[1] Results from some previous studies suggested that alcohol may reduce the risk of non-Hodgkin lymphoma, thyroid cancer, and renal cell carcinoma, but the findings are inconsistent.[2,3,4] Most of the evidence for an association of alcohol with cancer risk comes from studies of men with high intakes and, with the exception of breast cancer,[5] little is known about the risk of cancer associated with more moderate intakes typically consumed by women. Even for breast cancer, little is known about the effects of particular types of alcohol or whether the association differs according to other lifestyle factors such as use of hormone replacement therapy.

The main aim of this report is to describe the relationship of low to moderate levels of alcohol intake, mostly below 21 drinks per week (i.e fewer than 3 drinks per day or 30 g alcohol per day), with subsequent risk of cancer, overall and at particular sites, in a large cohort of women in the United Kingdom. A secondary aim is to examine the associations found by the type of alcoholic drink and to determine whether they are modified by other major risk factors for cancer.


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