Impact of Alcohol Consumption on Selected Cancer Incidence Trends Among Adults in the United States, 2008-2019

Abstract Background: Alcohol consumption is a risk factor for certain cancers and is increasing in the United States. We estimated the impact of alcohol consumption on cancer incidence trends in the United States from 2008-2019 across six alcohol-related cancers among men and women. Methods: Average daily alcohol consumption (ADC) was calculated from the National Health Interview Survey (NHIS, 1998-2009) and adjusted to per capita sales data to account for underreporting alcohol use. Population-attributable fractions (PAFs) were calculated combining relative risks from large meta-analyses and annual ADCs estimates for 6 cancers: female breast, colorectum, esophageal squamous cell carcinoma (ESCC), larynx, liver, and oral and pharynx assuming 10-year latency period. PAF estimates were combined with cancer registry data to calculate incidence rates attributable (and unattributable) to ADCs. Results: The highest PAFs were observed for ESCC, ranging from 13.9%-16.7% in women and 26.6%-28.7% in men. The largest increase in overall alcohol-attributable cancer rates were for breast cancer among women, increasing from 6.6 to 8.1 cases per 100,000. High ADC contributed the most cancer cases, but even low ADC levels translated to increased cancer risk. An estimated 18,463 of 297,790 new U.S. breast cancer cases will be attributable to alcohol, with 4,958 due to low consumption. Conclusions: The PAFs for alcohol-related cancers have increased among women and men. Impact: Alcohol consumption is an important contributor to cancer incidence, and troublingly, its impact has increased over time. Implementing strategies to reduce alcohol use at the population level could help lower the incidence of alcohol-associated cancers.