To the surprise and concern of oncology researchers who conducted the first-ever large survey study of drinking habits among those with a history of cancer, the population’s consumption of alcohol was quite high.

Alcohol is a well-known risk factor for several cancers, including head and neck, esophagus, colorectal, liver and breast. It contributes to an estimated 5.8% of cancer deaths. What’s more, alcohol consumption is associated with worse health outcomes in people diagnosed with cancer.

But there has been little information about how much alcohol people with cancer actually consume. To fill that gap, Nina Niu Sanford, MD, an assistant professor of radiation oncology at the University of Texas Southwestern Medical Center, and colleagues analyzed data from the National Health Interview Survey (NHIS) covering 2000 to 2017 regarding the self-reported drinking habits of 34,080 people who had ever been diagnosed with cancer.

The study defined excessive drinking according to Centers for Disease Control and Prevention guidelines: more than one daily drink for women and more than two daily drinks for men. The same guidelines were the source of the binge drinking definition: at least five drinks in one day at any point during the previous year.

The results:

  • 5% currently consumed alcohol;
  • 9% of those who consumed alcohol did so more than moderately;
  • 21% of those who consumed alcohol were binge drinkers.

To date, no studies have established a threshold of alcohol consumption below which drinking is safe with regard to the risk of cancer. However, binge drinking in particular is associated with a higher risk of cancer compared with more moderate consumption.

“We recommend that providers screen for alcohol use at regular intervals and provide resources to assist in cutting down use for those who may engage in excessive drinking behaviors,” Sanford said in a press release. “Typically, questions about alcohol use are just asked once when the patient first enters the medical system and then copied into subsequent notes as part of the patient’s social history.”

 

Younger respondents to the study were more likely to binge drink, with 23.6% of those 18 to 34 years old reporting this behavior, compared with just 2.6% of those 75 years old and older. Similarly, those who had been diagnosed with cancers that tend to occur among younger people, including head and neck, cervical and testicular cancers and melanoma, had higher rates of any level of drinking compared with those diagnosed with breast cancer in particular.

 

The study revealed an apparent paradox that people who said they had better health drank to a greater extent. The reason for that, however, may be that people in poorer health either have decided to quit drinking or have been advised to quit by their doctors.

 

“We would hypothesize that individuals with a diagnosis of cancer who self-report poor health status may be those with persistent or recurrent disease who are undergoing active treatment or experiencing persistent side effects from prior treatment and therefore may have been advised not to drink or don’t feel well enough to consume alcohol,” said Brandon A. Mahal, MD, of the McGraw/Patterson Center for Population Sciences at the Dana-Farber Cancer Institute, in Boston.

“However, since causation cannot be established from the NHIS survey, another possibility could be that alcohol use improved the overall self-reported health among cancer survivors, although we think this is less likely. These results point to the fact that more research on alcohol use is needed for all subsets of survivors of cancer, perhaps with an emphasis on reduction in patients who feel well and report excessive drinking.”

To read a press release about the study, click here.

To read the study, click here.

To learn more about alcohol and cancer, click here.