1. THE ROLE OF DIFFERENT TYPES OF ALCOHOL ON THE RISK OF SELECTED CANCERS
Dr. Silvano Gallus
Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
Copenhagen, 17 October 2006

2. BACKGROUND
Most knowledge on different types of alcoholic beverages and risk of cancer comes from data collected in North America and northern Europe.
We analysed the issue on selected cancers (melanoma, prostate cancer and benign prostatic hyperplasia (BPH) oral cavity and pharynx, and larynx) using data from a network of multicentre case-control studies conducted in Italy.

3. PATIENTS AND METHODS Cancer site Cases Controls Location
Melanoma (CMM)
542
538
Italy (N C S)
Prostate
1294
1451
BPH
1369
Oral cavity and pharynx
749
1772
Italy (N)
Larynx
672
3454
Italy and Switz.
We derived ORs after allowance for study centre, age, sex, education, BMI and smoking. The OR for different types of alcoholic beverages were adjusted also for other types.

4. MELANOMA - RESULTS
Source: Naldi et al., 2004 (Eur J Cancer Prev 13:503-8)

5. MELANOMA - RESULTS
Source: Naldi et al., 2004 (Eur J Cancer Prev 13:503-8)

6. MELANOMA DISCUSSION
We found no appreciable association between alcohol and CMM risk, confirming most of previous studies on the issue.
As compared to non-drinkers, beer drinkers had 20% reduced risk of CMM but the relatively low number of beer drinkers did not reach statistical significance.

7. PROSTATE CANCER AND BPH - RESULTS
Source: Crispo et al., 2004 (Urology 64:717-22)

8. PROSTATE CANCER AND BPH - RESULTS
Source: Crispo et al., 2004 (Urology 64:717-22)

9. PROSTATE CANCER AND BPH - RESULTS
Alcohol consumption showed no consistent association with prostate cancer risk, confirming most of previous studies on the issue.
A significant inverse trend in risk was found for BPH. This may be related to the hormonal correlates (ie, lower androgen levels) of heavy alcohol drinkers.
The pattern of risk was similar with reference to different alcoholic beverages.

10. UPPER AERO-DIGESTIVE TRACT - BACKGROUND
Grønbæk et al., 1998:
“A moderate intake of wine probably does not increase the risk of upper digestive tract cancer, whereas a moderate intake of beer or spirits increases the risk”.

11. UPPER AERO-DIGESTIVE TRACT - BACKGROUND
Cohort study from Denmark – 156 cases
RR (95% CI)
No of drinks/week
Beer
Wine
Spirits
1.0
1-6
1.5 (0.9 to 2.5)
0.8 (0.5 to 1.1)
0.7 (0.5 to 1.1)
>=7
2.9 (1.8 to 4.8)
0.4 (0.2 to 0.8)
1.5 (1.2 to 1.9)
Source: Grønbæk et al., 1998 (BMJ 317:844-7)

12. UPPER AERO-DIGESTIVE TRACT - BACKGROUND
Burch et al., 1981 (JNCI 67: from Canada): “Both beer and spirits showed evidence of increased RR to lifetime nondrinkers, although no evidence was shown that wine use resulted in increased (laryngeal cancer) risk”.
Freudenheim et al., 1992 (Nutr Cancer 17:33-45 from USA): “Beer and hard liquor but not wine were associated with increased (laryngeal cancer) risk”.

13. UPPER AERO-DIGESTIVE TRACT - BACKGROUND
Study
RR (95%CI)
Beer
Wine
Hard liquors
Burch et al., Canada
4.8 (2.4–9.8)
0.5 (0.2–0.9)
1.3 (0.5–3.4)
Olsen et al., Denmark
1.4 (1.1–1.9)
0.6 (0.4–0.9)
1.0 (0.6–1.8)
De Stefani et al., Uruguay –
7.4 (3.0–18.1)
4.0 (1.9–8.2)
Franceschi et al., Italy
1.5 (0.8–2.5)
4.2 (1.6–10.6)
0.8 (0.5–1.3)
Freudenheim et al., USA
2.7 (1.4–5.1)
1.1 (0.6–2.0)
2.2 (1.2–4.0)
Schlecht et al., Brazil
1.8 (0.6–5.7)
1.5 (0.6–4.0)
1.8 (0.6–5.4)
Talamini et al., Italy and Switzerland
3.3 (1.8–6.1)
5.2(2.8–9.9)
2.9 (1.5–5.8)
Source: Altieri et al., 2005 (Oral Oncol 41:956-65)

14. UPPER AERO-DIGESTIVE TRACT - BACKGROUND
Alcohol drinking in North America and northern Europe is qualitatively and quantitatively different as compared to southern Europe.
Country
Overall alcohol*
% From beer
% From wine
% From spirits
France
13.3
15.8
62.0
22.2
Israel
2.1
45.1
12.1
42.2
Italy
9.2
16.0
77.6
6.3
Japan
36.7
6.5
44.9 US
9.1
56.3
18.4
25.2
*Mean per capita annual litres of overall alcohol consumption among adults >= 15 years.
Source: Petty & Scully 2005 (Oral Oncol 41:828-34)

15. ORAL AND PHARYNGEAL CANCERS - RESULTS
Source: Altieri et al., 2004 (Oral Oncol 40:904-9)

16. ORAL AND PHARYNGEAL CANCERS - RESULTS
Source: Altieri et al., 2004 (Oral Oncol 40:904-9)

17. ORAL AND PHARYNGEAL CANCERS - RESULTS
As compared to abstainers or light drinkers, multivariate OR for wine drinkers were 2.2 for drinkers of 3–4 drinks/day, 7.1 for 5–7, 11.8 for 8–11 and 16.1 for ≥12 drinks/day.
After allowance for wine intake, the ORs for beer drinkers were 1.2 for 1–2 drinks/day, and 2.3 for ≥3 drinks/day.
Corresponding values for spirit drinkers were 1.0 and 1.9.

18. LARYNGEAL CANCERS - RESULTS
Source: Garavello et al., 2006 (Eur J Cancer Prev 15:69-73)

19. LARYNGEAL CANCER - RESULTS
Source: Garavello et al., 2006 (Eur J Cancer Prev 15:69-73)

20. LARYNGEAL CANCER - RESULTS
As compared to abstainers or light drinkers, OR for wine drinkers were 1.1, 2.5, 3.3, and 5.9.
After allowance for wine intake, the ORs for beer drinkers were 1.7 for 1-2 drinks/day, and 1.4 for 3 drinks/day, as compared to non beer drinkers.
Corresponding values for spirit drinkers were 0.9 and 1.2.

21. UPPER AERO-DIGESTIVE TRACT - DISCUSSION
In our studies on upper aero-digestive tract cancers, for similar levels of ehanol consumption, the risk for drinkers of beer and spirits were comparable or lower to those of wine drinkers.
The apparent discrepancy between our findings and studies from northern Europe and the USA can be explained in terms of different patterns of drinking, and variable baseline characteristics of heavy drinkers in various populations.

22. UPPER AERO-DIGESTIVE TRACT - CONCLUSIONS
Our findings confirm that the most prevalent alcoholic beverage in each population (and hence most likely the cheapest one) tends to be the one with the highest risk of upper aero-digestive tract cancers.

23. ON THE DISCUSSED ISSUES, 5 PAPERS HAVE BEEN PUBLISHED:
Altieri A, Bosetti C, Gallus S, Franceschi S, Dal Maso L, Talamini R, Levi F, et al. Wine, beer and spirits and risk of oral and pharyngeal cancer: a case-control study from Italy and Switzerland. Oral Oncol 2004;40:904-9.
Altieri A, Garavello W, Bosetti C, Gallus S, La Vecchia C. Alcohol consumption and risk of laryngeal cancer. Oral Oncol 2005;41:
Crispo A, Talamini R, Gallus S, Negri E, Gallo A, Bosetti C, La Vecchia C, et al. Alcohol and the risk of prostate cancer and benign prostatic hyperplasia. Urology 2004;64:
Garavello W, Bosetti C, Gallus S, Dal Maso L, Negri E, Franceschi S, La Vecchia C. Type of alcoholic beverage and the risk of laryngeal cancer. Eur J Cancer Prev 2006;15:69-73.
Naldi L, Gallus S, Tavani A, Imberti GL, La Vecchia C, GISED. Risk of melanoma and vitamin A, coffee and alcohol: a case-control study from Italy. Eur J Cancer Prev 2004;13:503-8.
OTHER PAPERS PUBLISHED WITH THE SUPPORT OF ERAB
Augustin LS, Gallus S, Tavani A, Bosetti C, Negri E, La Vecchia C. Alcohol consumption and acute myocardial infarction: a benefit of alcohol consumed with meals? Epidemiology 2004;15:767-9.
Negri E, La Vecchia C, Pelucchi C, Tavani A. The risk of acute myocardial infarction after stopping drinking. Prev Med 2005;40:725-8.
Acknowledgements: We thank the European Research Advisory Board (ERAB) for their financial contribution to these studies.