Reevaluating the Alcohol–Cancer Link: Long-Term Cancer Mortality Outcomes in the REGARDS Study

BACKGROUND: Cancer prevention strategies often focus on behavior change such as increased screening, smoking cessation, and healthy diets. Recently, enthusiasm for addressing alcohol as a significant cancer risk factor has gained attention. Using a large, population-based cohort, we sought to determine independent associations between alcohol consumption and cancer mortality. METHODS: We used data from the REGARDS cohort study, which enrolled 30,239 adults 45+ years between 2003 and 2007 and follows them today. At enrollment, participants self-reported alcohol consumption as none, light (≤ 3 drinks/week), moderate (4-7 drinks/week for women, 4-14 drinks/week for men), and heavy (≥ 8 drinks/week for women and ≥ 15 drinks/week for men). We estimated Cox models to determine associations between alcohol consumption and cancer mortality. RESULTS: Among 26,694 participants, mean age was 64.4 (SD 9.4) years, 44% were male, 42% were Non-Hispanic Black, 63% reported no alcohol, 22% light, 11% moderate, and 4% heavy alcohol consumption. Over a median 13.3-year follow-up, we observed 2306 cancer deaths. After full adjustment for covariates, compared to abstainers, heavy drinkers had an increased risk of cancer death (1.21; 95% CI 1.01-1.45), and light drinkers had a decreased risk of cancer mortality (0.87; 95% CI 0.78-0.98), and there was no association between moderate drinking and cancer mortality. CONCLUSIONS: Our findings contribute to the growing evidence that heavy alcohol use is consistently linked with higher cancer mortality. We encourage cancer prevention strategies to step away from isolating single health behaviors and consider holistic perspectives of an individual's lifestyle including physical activity, smoking, diet, and alcohol consumption.