摘要：Objectives. Our goal was to provide current estimates of alcohol-attributable cancer mortality and years of potential life lost (YPLL) in the United States. Methods. We used 2 methods to calculate population-attributable fractions. We based relative risks on meta-analyses published since 2000, and adult alcohol consumption on data from the 2009 Alcohol Epidemiologic Data System, 2009 Behavioral Risk Factor Surveillance System, and 2009–2010 National Alcohol Survey. Results. Alcohol consumption resulted in an estimated 18 200 to 21 300 cancer deaths, or 3.2% to 3.7% of all US cancer deaths. The majority of alcohol-attributable female cancer deaths were from breast cancer (56% to 66%), whereas upper airway and esophageal cancer deaths were more common among men (53% to 71%). Alcohol-attributable cancers resulted in 17.0 to 19.1 YPLL for each death. Daily consumption of up to 20 grams of alcohol (≤ 1.5 drinks) accounted for 26% to 35% of alcohol-attributable cancer deaths. Conclusions. Alcohol remains a major contributor to cancer mortality and YPLL. Higher consumption increases risk but there is no safe threshold for alcohol and cancer risk. Reducing alcohol consumption is an important and underemphasized cancer prevention strategy. Alcohol use is estimated to account for about 4% of all deaths worldwide. 1 Research over several decades has consistently shown that alcohol increases the risk for cancers of the oral cavity and pharynx, larynx, esophagus, and liver. 2–5 The biological mechanisms by which alcohol induces cancer are not fully understood, but may include genotoxic effects of acetaldehyde, production of reactive oxygen or nitrogen species, changes in folate metabolism, increased estrogen concentration, or serving as a solvent for tobacco metabolites. 5 The International Agency for Research on Cancer (IARC) and the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) both published comprehensive reviews of the scientific literature on alcohol and cancer risk in 2007. 5–7 In addition to confirming earlier research for the previously mentioned cancers, they concluded that alcohol increases the risk for colon, rectal, and female breast cancer. (The WCRF/AICR used the term “convincing increased risk” upon judging the strength of the evidence for alcohol use with all of these cancers, with the exception of “probable increased risk” for liver cancer [both sexes] and for colorectal cancer among women. 7 ) More recent studies have also found a positive association for colorectal 8–13 and breast cancer 11–14 with alcohol use. Although some researchers report a positive association between alcohol and cancers of the stomach, ovary, prostate, pancreas, bladder, or endometrium, 14–21 this has not been found by others. 11,22–29 There have been surprisingly few efforts to ascertain the number of cancer deaths or years of potential life lost (YPLL) attributable to alcohol in the United States. To our knowledge, Rothman et al. were the first to consider this issue, 3 estimating that alcohol caused 3% of US cancer deaths in 1974. Doll and Peto, in their seminal work on avoidable causes of cancer, came up with the same estimate of 3% (range = 2%–4%) for US cancer deaths in 1978. 4 The Harvard Center for Cancer Prevention in 1996 reported that 3% of US cancers resulted from alcohol use but included no analyses in their report. 30 Boffetta et al. estimated that for the World Health Organization region consisting of the United States, Canada, and Cuba, alcohol was responsible for 3% of cancer deaths in men and 2% in women in 2002. 31 Extensive research has been published over the past 30 years on alcohol use and cancer risk, including more recent studies showing an increased risk of breast and colorectal cancer. In addition, new methods have been developed to better estimate population-level alcohol consumption by demographics based on both survey and sales-based data. Therefore, a comprehensive examination of the population-wide impact in the United States was long overdue. The purpose of our study was to provide current estimates of deaths and YPLL from cancer attributable to alcohol use in the United States. We did so by using sensitivity analyses based on 2 different methodologies and 2 separate nationwide surveys.
