Since that time, new data have become available, these have been incorporated into the Monograph, and taken into consideration in the present evaluation. Exposure Data 1. Types and ethanol content of alcoholic beverages 1. Types of alcoholic beverages The predominant types of commercially produced alcoholic beverages are beer, wine and spirits.
Basic papillary urothelial neoplasm of low malignant potential immunohistochemistry for beer are malted barley, water, hops and yeast. Wheat may be used.
Nearly all wine is produced from grapes, although wine can be also made from other fruits and berries. Spirits are frequently produced from cereals e. Main beverage types i. In addition to commercialized products, in many developing countries different types of home- or locally produced alcoholic beverages such as sorghum beer, palm wine or sugarcane spirits are consumed WHO, Home- or locally produced alcoholic beverages are produced through fermentation of seed, grains, fruit, vegetables or parts of palm trees, by a fairly simple production process.
Alcohol content differs according to the main beverage type and may also vary by country.
However, lower or higher ethanol content in alcoholic beverages is also possible. The ethanol content in beer can range from 2.
There is a trend in recent years towards higher To calculate the amount of ethanol contained in a specific drink, the amount e. Chemical composition The main components of most alcoholic beverages are ethanol and water. Services Reg. Volatile compounds include aliphatic carbonyl compounds, alcohols, monocarboxylic acids and their esters, nitrogen- and sulfur-containing compounds, hydrocarbons, terpenic compounds, and heterocyclic and aromatic compounds.
Non-volatile extracts of alcoholic beverages comprise unfermented sugars, di- and tribasic carboxylic acids, colouring substances, tannic and polyphenolic substances and inorganic salts IARC, Occasionally, toxic additives, that are not permitted for use in commercial production have been identified in alcoholic beverages. These include methanol, diethylene glycol used as sweetener and chloroacetic acid or its bromine analogue, sodium azide and salicylic acid, which are used as fungicides or bactericides Ough, Contaminants may also be present in alcoholic beverages.
Contaminants are defined as substances that are not intentionally added but are present in alcoholic beverages due to production, manufacture, processing, preparation, treatment, papillary urothelial neoplasm of low malignant potential immunohistochemistry, packaging, transport or holding, or as a result of environmental contamination. Contaminants and toxins found in alcoholic beverages are nitrosamines, mycotoxins, ethyl carbamate, pesticides, thermal processing contaminants, benzene, and inorganic contaminants such as lead, cadmium, arsenic, copper, chromium, inorganic anions, and organometals IARC, In view of the potential carcinogenicity of acetaldehyde and its known toxic properties, recent studies attempted to estimate exposure to acetaldehyde from alcoholic beverages outside ethanol metabolism at known levels of alcohol exposure.
Trends in consumption of alcoholic beverages Volume, pattern and quality of consumed alcohol are included in the description of differential exposure to alcohol.
In —09, WHO conducted the Global Survey on Alcohol and Health, collecting data on alcohol consumption, alcohol-related harm papillary urothelial neoplasm of low malignant potential immunohistochemistry policy responses from its Member States.
Diagnostic Pathology: Cytopathology
Total adult per capita consumption in litres of pure alcohol is defined as the total amount of alcohol consumed per person, taking into account recorded consumption i. Recorded adult per capita consumption is calculated from production, export and import data, or sales data. Unrecorded consumption is computed from representative surveys, specific empirical investigations or expert opinion.
Overall, there is a wide variation in the volume of alcohol consumed across countries. As presented in Table 1. Apart from some countries in Africa and a few countries in other parts of the world, alcohol consumption in the other regions is generally lower. Table 1.
Globally, men consume more alcohol than women. This is reflected in the differences in the number of lifetime abstainers, past year abstainers and former drinkers Table 1.
A former drinker is a person who did not consume any alcohol during the past year. Generally, the percentage of lifetime and past year abstainers is higher in women than in men. The prevalence of lifetime, past-year abstainers, and former drinkers are calculated from large representative surveys.
Alcohol consumption remains low in the Eastern Mediterranean Region. Cancer in Humans 2. Description of cohort studies 2. Studies in the general population Cohort studies are classified by the country in which the study was conducted Table 2.
Since the previous IARC Monograph IARC,data on the association between alcohol consumption and risk of cancer have been published from several cohorts, including updates of cohorts described previously Bongaerts et al.
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Studies in special populations This group of studies is characterized by the assumption that the study subjects have a pattern of consumption of alcoholic beverages that is different from that of the general population, e.
Because of the availability of national registries of populations, inpatients and cancer, these studies were largely performed in Scandinavian countries. The estimation of risk in these individuals is not based upon a comparison of exposed and unexposed subjects within the cohort, but with the expected rates of cancer in the general population. Thygesen et al. Cancers of the upper aerodigestive tract 2. Cancer of the oral cavity and pharynx It was concluded in the previous IARC Monograph IARC, that consumption of alcoholic beverages is causally related to cancer of the oral cavity and pharynx, and that the risk increases in a dose-dependent manner.
Significant increases in risk were found with increasing amount of alcohol consumption in all papillary urothelial neoplasm of low malignant potential immunohistochemistry Freedman et al. In one case—control study conducted in Taiwan, China among patients attending a hospital clinic Yen hpv tumore seno al. Friborg et al. In most studies an approximate threefold increased risk was found at relatively high levels of intake i.
There is increasing evidence from recent papillary urothelial neoplasm of low malignant potential immunohistochemistry studies that risk may already be increased at more moderate intake, particularly in women Freedman et al. Consistent with many earlier studies, risks were found to be elevated among recent former drinkers, most likely due to ill health directly related to the cancer or its precursors. Studies have been hampered with low numbers of women at the ockovani hpv zdarma levels of exposure.
From a large-scale cohort study, Weikert et al. One study in Taiwan, China found no association with alcohol consumption among non-smoking ever-drinkers for cancer of the oral cavity Yen et al. The joint effect of alcohol consumption and tobacco smoking on the risk of cancers of the oral cavity and pharynx is described in Section 2. Cancer of the larynx It was concluded in the previous IARC Monograph IARC, that consumption of alcoholic beverages is causally related to cancer of the larynx, and that the risk increases in a dose-dependent manner.
In one further case—control study in Uruguay De Stefani et al. This study provided no information on individual exposures or results adjusted for potential confounders b Intensity and duration Previous studies consistently showed that increasing alcohol consumption is associated with an increased risk of cancer of the larynx IARC, Bagnardi et al.
This is consistent with the 1. Compatible with this, Freedman et al. Papiloma (hpv) sintomas men, the dose—response relationship is slightly weaker Freedman et al.
In a large case—control study in Italy there was clear evidence of a dose—response relationship for men and women combined Garavello et al. Altieri et al. Data published recently largely supports this view Garavello et al. More recent studies that vierme omida examined the joint effect of alcohol consumption and tobacco smoking on the risk of cancer of the larynx are described in Section 2.
The increased risk is largely restricted to squamous cell carcinoma, with little or no association for adenocarcinoma of the oesophagus.
A case—control study in Uruguay De Stefani et al. Consistently, a 3—8 fold increased risk with high intakes of alcohol has been reported in more recent studies Lee et al. In several studies an increased risk has been found with duration of drinking Lee et al.
Risk is similar when alcohol consumption is based papillary urothelial neoplasm of low malignant potential immunohistochemistry measures of either baseline or lifetime alcohol consumption Fan et al. In a meta-analysis of 5 case—control studies Rehm et al. Similar results were obtained from a cohort study Ozasa et al.
Risks are elevated among more former drinkers, who most likely cease drinking due to ill health directly related to the cancer or its precursors Rehm et al. This is supported by data from more recent studies Lee et al. Although the risk associated with a high alcohol intake among men with a flushing response was higher than among those with no flushing response, the differences were not significant.
Details of the association of alcohol consumption according to genetic variants in alcohol-metabolizing genes related to the flushing response are presented in Section 2. Pandeya et al. Recent studies that have examined the joint effect of alcohol consumption and tobacco smoking on the risk of cytology vs hpv testing for cervical cancer screening in the general population of the oesophagus are described in Section 2.
Cancers of the upper aerodigestive tract combined a Overview of cohort and case—control studies In the previous IARC Monograph IARC, the association between consumption of alcoholic beverages and risk of cancer of the upper aerodigestive tract combined was not evaluated.
Since then, three cohort studies Thygesen et al. All studies reported significant increases in risk with alcoholic beverage consumption, observed in both men and women Freedman et al.
Other studies have reported increases in risk at more moderate levels of consumption, particularly among women Freedman et al.
Most previous studies as outlined in IARC,as well as recent data from the European Prospective Investigation into Cancer and Nutrition have found similar increased risks with increasing alcohol intake among both non-smokers and smokers Weikert et al. In a large cohort study among women in the United Kingdom with a low to moderate alcohol intake, alcohol consumption was not associated with an increased risk of cancers of the upper aerodigestive tract in never smokers or former smokers, but was strongly associated with an increased risk among current smokers Allen et al.
This conclusion was largely based on a pooled analysis of eight cohort studies of alcohol intake papillomavirus koira cancer of the colorectum conducted in Europe and North America, which found a relative risk RR of about 1. Of the nine cohort studies that examined the association of consumption of alcoholic beverages and risk of cancer of the colorectum, seven confirmed a significant positive association Akhter et al.
In only two cohort studies was no overall association reported, although both of these likely included very few cases with a high alcohol intake Kabat et al. In one further study Engeset et al. This is consistent with findings from one meta-analysis and one pooled analysis Table 2. In a meta-analysis of 21 cohort studies a significant increased risk for cancer of the colorectum, and for colon and rectal cancer separately, for heavy drinkers compared to light or non-drinkers was found Huxley et al.
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There was also a significant positive association of consumption of alcoholic beverages for men and women with both cancer of the colon and of the rectum in a pooled analysis of five cohort studies in Japan Mizoue et al.
Most of the studies treatment hpv tonsil cancer which the association of alcohol intake has been examined by more detailed subsite definitions within the colon are more consistent in showing a positive association with alcohol intake for cancer of the distal colon, but a weak or null association for cancer of the proximal colon Akhter et al.
Cohort studies in special populations Since IARCin one cohort study papillary urothelial neoplasm of low malignant potential immunohistochemistry the Netherlands a significantly higher rate of rectal cancer among male alcohol abusers compared with national rates, but no association with colon cancer was found Table 2.
1. Exposure Data
Among women, rates of both colon and rectal cancer were similar among alcohol abusers and the national population, although there were relatively low numbers for each cancer site Thygesen et al.
Case—control studies Since IARCreports on the association of consumption papillary urothelial neoplasm of low malignant potential immunohistochemistry alcoholic beverages and cancer of the colorectum have come from 10 case—control studies. There was a significant positive association in five, three of which found an increased risk of cancer of the colorectum at relatively high levels of consumption Gao et al.
No association for consumption of alcoholic beverages and cancer of the colorectum was reported for five case—control studies Wang et al. Dose—response relationship One pooled analysis of eight cohort studies Cho et al. Other studies found an increased risk for cancer of the colorectum or rectum only with lower amounts of alcohol i.
Types of alcoholic beverage a Other metrics of exposure Few studies have examined the association between cancer of the colorectum and other metrics of exposure average alcohol intake, over a lifetime or specifically during early adulthood, age at starting, duration. The limited evidence suggests that there is no strong association with duration of drinking in years or age at started drinking Ferrari et al.
In most earlier studies and some recent studies the risk associated with a baseline measure of intake is similar to a measure of average lifetime intake Ferrari et al. There is also very limited information on whether the frequency of drinking is an important determinant of risk.
The association of consumption of alcoholic beverages and cancer of the colorectum does not appear to differ by beverage type Ferrari et al. There is a causal association between cigarette smoking and risk for cancer of the colorectum see the Monograph on Tobacco Smoking in this volume. Most studies of consumption of alcoholic beverages have adjusted for smoking status.
In studies that statified the analysis by smoking status most found an increased risk among both never and current smokers, with the risk estimates slightly higher in current or ever smokers compared to never smokers Akhter et al.