The first update of alcohol-linked cancer deaths in the U.S. in three decades shows that booze can be blamed for nearly 20,000 deaths a year -- and it’s not just the heavy drinkers.

Certainly those who downed three or more drinks a day accounted for most of the deaths from seven kinds of cancer, up to 60 percent, according to a new study published in the American Journal of Public Health.

But consuming just 1.5 drinks a day -- or less -- was associated with up to 35 percent of those cancer deaths, suggesting that any alcohol use carries some risk.

“For non-drinkers, it’s another reason to feel happy they don’t drink,” said Dr. Timothy Naimi, the study’s director and an associate professor at the Boston University Schools of Medicine and Public Health. “For drinkers, it shows that when it comes to cancer, the less you drink, the better.”

The study, conducted in conjunction with researchers from the U.S., Canada and France, used recent data and studies on alcohol consumption and cancer mortality to provide a long-delayed update on alcohol-related cancer deaths in America.

The researchers determined that alcohol accounted for about 3.5 percent of the more than 577,000 cancer deaths in the U.S. each year, or about 19,500 cases. That's about what scientists thought it was, but no one had checked for 30 years.

Breast cancer accounted for most alcohol-related cancer deaths in women, about 15 percent of all breast cancer deaths, or some 6,000 cases a year, the study found. In men, cancers of the mouth and throat were the most common cause of alcohol-related cancer deaths, also with about 6,000 cases a year.

Despite the numbers, the link between alcohol and cancer death is not well-known or appreciated, the researchers say.

The total number of alcohol-related cancer deaths is more than the 15,500 deaths a year from ovarian cancer, or the 9,180 deaths from melanoma skin cancer, but it receives much less attention and advocacy than other risk factors, they say.

“I just don’t think there’s enough attention across the board, from physicians or public health,” said Dr. David Nelson, a study co-author and a director of cancer prevention at the National Cancer Institute. “It’s missing in plain sight.”

Part of that may be reluctance on all sides to address the health effects of alcohol use in a country where more than 65 percent of adults are either regular or occasional drinkers, according to the Centers for Disease Control and Prevention.

“It’s hard to talk about something that a lot of people are pretty familiar with,” Nelson said. “It can be uncomfortable.”

Indeed, the cancer findings are likely to be a buzzkill for people who thought they were off the hook for health risks from moderate drinking. Several studies have suggested that those who imbibe “moderately’’ -- up to one drink a day for women, up to two for men -- may boost their heart health, cut cholesterol, and avoid diabetes.

“We love hearing about studies that say that wine and chocolate and sex are good for us,” said Naimi. “And we’ve always been in search of snake oil.”

(In the U.S., a drink is generally regarded as one 12-ounce bottle of beer, a 5-ounce glass of wine or 1.5 ounces of liquor.)

The new study focuses solely on alcohol and cancer deaths and doesn’t venture into the long-simmering debate about the possible benefits of moderate drinking, added Naimi, who is an expert in the area.

“Anything that’s a leading cause of death is not a good preventive agent,” Naimi added.

But Eric Rimm, an associate professor of epidemiology and nutrition at the Harvard School of Public Health said while the new study provides a valuable update of alcohol's effect on cancer deaths, it doesn't change his mind about the positive effects of moderate drinking on heart disease.

"I think they've pooh-poohed the heart benefits, which is as strong as any evidence can be," Rimm said, noting that studies have shown that those who don't drink have a 50 percent higher risk of heart attack than those who do. "I don't think it can be pooh-poohed," he said.

Naimi countered that studies that show benefits from moderate alcohol use are potentially flawed because they compare non-drinkers and drinkers, who may be healthy -- or not -- for other reasons than alcohol use. Non-drinkers may abstain because of existing health problems, for instance, while moderate drinkers might have other factors, such as education, wealth and lifestyle choices that boost their health independent of alcohol. Besides, there’s never been a “gold standard” study that addresses the issue, Naimi said.

But other advocates of the health effects of moderate drinking acknowledge that when it comes to alcohol, less is better.

“When I talk about heart-healthy diets, my first words are not, ‘Have a glass of wine,’” said Dr. Suzanne Steinbaum, director of the women and heart disease program at Lenox Hill Hospital in New York.

She says she has been known to recommend having a glass of wine with dinner, but “we can certainly get the health benefits from other places and other foods.”

No one should start drinking because of any perceived health benefits of alcohol, and more people should be aware of the risks, including cancer, the experts agreed.

“Why can’t people enjoy their glass of wine without twisting it into a health panacea?” Naimi said.

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