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Diet, alcohol and cancer in the UK

This page includes information on diet and cancer risk including alcohol, fruit and vegetables, salt, meat, fibre and other carbohydrates, dairy products and fat.

Tables 4.1 and 4.2 summarise what we know about diet and the risk of certain types of cancer.

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Alcohol and cancer risk

Alcohol is well established as a cause of cancer: Around 6% of UK cancer deaths could be avoided if people did not drink.1

Alcohol consumption increases the risk of oral (oral cancer includes cancers of the oral cavity, pharynx excluding nasopharynx and lip), laryngeal, oesophageal, breast, bowel and liver cancer. Risk of cancers of the upper aerodigestive tract (oesophagus, oral cavity, pharynx and larynx) increases linearly with quantity of alcohol consumed above 25g/day . Someone drinking 100 g/day has a 4–6-fold increased risk of these cancers compared to light or non-drinkers.2

Table 4.3 shows the alcohol content of some common drinks.

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Smoking and drinking heavily in combination increases risk of cancers of the upper aerodigestive tract up to 80-fold, and in developed countries, smoking and alcohol consumption combined have been estimated to account for 75% of all upper aerodigestive cancers.3

It takes up to 16 years for the risk of these cancers in a former drinker to fall to the level of someone who has never consumed alcohol.4

Long-term heavy alcohol consumption increases the risk of liver cancer, with a five-fold increase in risk for people drinking more than 80 g/day for 10 or more years.5 Light drinking may also slightly increase liver cancer risk.6

People drinking more than 30 g/day of alcohol have a 26% increase in risk of bowel cancer, and people drinking more than 60 g/day have a 64% increase in risk. The risk increase for rectal cancer is stronger than for colon cancer, with almost a doubling of risk for people drinking more than 60 g/day.7

There are various possible mechanisms for the carcinogenic effect of alcohol consumption at these cancer sites. Acetaldehyde, the primary metabolite of alcohol, has been shown to alter DNA and cause cell proliferation. Alcohol may act as a solvent for other carcinogens (for example tobacco smoke), may produce reactive oxygen species and nitrogen species and may interfere with metabolism of folate or other micronutrients.2

Risk of breast cancer increases by approximately 7% for every additional 10 g/day of alcohol.8 This association is probably mediated by an increase in oestrogen levels.2

There is some evidence that alcohol consumption protects against kidney cancer, with a 28% risk reduction for an intake of 15 g/day compared with non-drinkers reported in a pooled analysis.9

There is weaker evidence for a reduced risk of non-Hodgkin’s lymphoma in alcohol drinkers, with a pooled analysis showing a 27% risk reduction in current drinkers, but no trend of lower risk with increasing levels of alcohol intake.10

Setting safe limits for alcohol intake is complex. Among post-menopausal women and men aged 40- plus, drinking one to two units a day can reduce the risk of coronary heart disease by 30–50%.11

The Government’s current recommendation is that men should not regularly drink more than 3-4 units/day and women should not regularly drink more than 2-3 units/day. However, the European Code Against Cancer recommends no more than two and one units/day respectively to minimise the risk of cancer.

Thirty-one percent of men in Britain drink more than 21 units/week, and 8% drink more than 50 units. Twenty percent of women drink more than 14 units/week, and 5% more than 35 units.12

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Fruits and vegetables and cancer risk

Vegetables and fruits contain antioxidant nutrients such as vitamin C and carotenoids, folate and a range of phytochemicals (glucosinolates, dithiolthiones, indoles, chlorophyll, flavonoids, allylsulphides and phyytoestrogens).

The complex mixture of chemicals means it is difficult to pinpoint which ones can prevent cancer, and it is likely that the effects of fruit and vegetable consumption are due to the interactive effect of many different chemicals.13

Studies indicate that each daily portion - 80–100 grams- of fruit or vegetables halves the risk of oral cancer,14 reduces risk of squamous cell carcinoma of the oesophagus by approximately 20%,15 and of stomach cancer by about 30%.13

People with the highest intakes of fruit and vegetables have up to an 80% reduced risk of laryngeal cancer.16-18 An increase of one portion a day of fruit reduces lung cancer risk by up to 14%,13,19 and, according to a limited number of studies, reduces risk of bladder cancer by 20%.20

There is evidence that higher intake of carotenoids may protect against advanced prostate cancer21 and gastric cancer.22,23 There is some evidence that selenium protects against prostate and lung cancer and prevents bowel adenomas.24-26

High folate intake has been shown to reduce risk of breast cancer in moderate–heavy drinkers.27 Most of these studies are based on body levels or dietary intake rather than supplements.

There is good evidence that vitamin D protects against bowel cancer and weaker evidence for a protective effect against breast and prostate cancer.28-33 The main source of vitamin D for people is skin absorption from sunlight (see sunlight section.

Current government advice, in line with WHO recommendations, is that adults and children over five should have at least five 80g portions of fruits and vegetables a day. Men and women in Britain consume on average less than three portions of fruit and vegetables a day and just 14% consume the recommended amount.34

Figure 4.135 shows the sources of dietary energy in UK adults. Fruit and vegetables provide on average six percent of daily energy intake.

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Dietary fibre and risk of cancer

There is evidence that dietary fibre intake is protective against bowel cancer.13 Results from the European Prospective Investigation show that a high fibre intake (average of 27g/day) is associated with a 20% lower risk of large bowel cancer when compared with the lowest intake (average of 17g/day), after inclusion of covariates such as physical activity, alcohol, smoking, red and processed meat and folate.36

Fibre was found to be particularly protective in people who consumed high amounts of red and processed meat. 37

Fermentation of fibre (non-starch polysaccharides, NSP) in the bowel produces short-chain fatty acids, which have known anti-cancer properties. NSP also contributes to stool bulk and prevents constipation.

The average daily intake of fibre as NSP from dietary sources per person in the UK is 14g, while the Department of Health recommended average intake is 18g a day.38

Red and processed meat and risk of cancer

Red and processed meat increases the risk of bowel cancer.39 Risk estimates for an intake of 120 g of red meat (generally including processed red meat) per day are around 25–35%.

Risk estimates for processed meat vary more widely, from 9–36% for a daily intake of 30 g.39,40

While the mechanisms remain unclear, processed meat is relatively high in nitrosamines, which are linked to some cancers, and it is thought that consumption of red meat causes the body to increase its own production of nitrosamines.

In Britain adults get around 11% of their daily energy intake from red and processed meats.35 (Figure 4.1)

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Salt and nitrites and cancer risk

A high intake of salt and salt-preserved foods increases the risk of stomach cancer. People eating more than 16g/day of salt have two–three times the risk of people eating 10g/day or less.41 Most evidence comes from countries with higher salt consumption than the UK, and it is unclear to what extent salt causes stomach cancer here12.

Salt may increase cancer risk by increasing sensitivity of the lining of the stomach to carcinogens such as nitrates, or by directly causing mucosal damage and inflammation. On average, British men consume twice the recommended maximum (6 g/day for an adult) intake of salt and British women consume about 50% more than is recommended.35

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Dairy products and cancer risk

A recent pooled analysis of cohort studies found a 16% reduction in risk of bowel cancer in people with a higher consumption of milk, which remained after adjustment for total calcium and vitamin D intake.42

There is weaker evidence that a high intake of dairy foods causes a slight increase in prostate and ovarian cancer risk.13, 43-48 In British adults, dairy products contribute around 10% to the average daily total energy intake (Figure 4.1).

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Fat and risk of cancer

A recent cohort study of breast cancer in a group of mainly pre-menopausal women reported an increase in risk for a higher intake of animal fat, and a pooled analysis of nine breast cancer cohort studies reported a 9% increase in risk with each 5% increase in saturated fat.49,50

A study using a food diary found a more than two-fold increased risk of breast cancer in women who consumed more than 35g a day of saturated fat, compared with women who consumed low amounts. Intake recorded in a food frequency questionnaire by the same women did not correlate with breast cancer risk.

The authors of the paper interpreted the discrepancy between these results as evidence that the lack of association between fat and breast cancer in many cohort studies is due to inaccuracy in recording diet.51

British men eat an average of 84g fat per day and British women an average of 61g, meaning that on average British adults are getting around one-third of their daily energy intake from fat; around one quarter of this total is animal fat. However, there has been a fall in the proportions of energy derived from fat in British adults over the last 20 years.35

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References

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2. Boffetta, P. and Hashibe, M., Alcohol and cancer. Lancet Oncol, 2006. 7(2): p. 149-56
3. Franceschi, S., et al., Smoking and drinking in relation to cancers of the oral cavity, pharynx, larynx, and esophagus in northern Italy. Cancer Res, 1990. 50(20): p. 6502-7
4. Rehm, J., Patra,J. and Popova,S., Alcohol drinking cessation and its effect on esophageal and head and neck cancers: A pooled analysis. Int J Cancer, 2007. 121(5): p. 1132-7
5. Morgan, T.R., Mandayam,S., and Jamal,M.M., Alcohol and hepatocellular carcinoma. Gastroenterology, 2004. 127(5 Suppl 1): p. S87-96
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8. Collaborative Group on Hormonal Factors in Breast Cancer, Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer, 2002. 87(11): p. 1234-45
9. Lee, J.E., et al., Alcohol intake and renal cell cancer in a pooled analysis of 12 prospective studies. J Natl Cancer Inst, 2007. 99(10): p. 801-10
10. Morton, L.M., et al., Alcohol consumption and risk of non-Hodgkin lymphoma: a pooled analysis. Lancet Oncol, 2005. 6(7): p. 469-76
11. Sensible Drinking: The Report of an Interdepartmental Working Group. Department of Health, 1995.
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14. Pavia, M., et al., Association between fruit and vegetable consumption and oral cancer: a meta-analysis of observational studies. Am J Clin Nutr, 2006. 83(5): p. 1126-34
15. Freedman, N.D., et al., Fruit and vegetable intake and esophageal cancer in a large prospective cohort study. Int J Cancer, 2007
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21. Key, T.J., et al., Plasma carotenoids, retinol, and tocopherols and the risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition study. Am J Clin Nutr, 2007. 86(3): p. 672-681
22. Larsson, S.C., et al., Vitamin A, retinol, and carotenoids and the risk of gastric cancer: a prospective cohort study. Am J Clin Nutr, 2007. 85(2): p. 497-503
23. Jenab, M., et al., Plasma and dietary carotenoid, retinol and tocopherol levels and the risk of gastric adenocarcinomas in the European prospective investigation into cancer and nutrition. Br J Cancer, 2006
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25. Zhuo, H., Smith,A.H., et al Steinmaus, Selenium and lung cancer: a quantitative analysis of heterogeneity in the current epidemiological literature. Cancer Epidemiol Biomarkers Prev, 2004. 13(5): p. 771-8
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27. Larsson, S.C., Giovannucci,E., and Wolk, A., Folate and risk of breast cancer: a meta-analysis. J Natl Cancer Inst, 2007. 99(1): p. 64-76
28. Wu, K., et al., A nested case control study of plasma 25-hydroxyvitamin D concentrations and risk of colorectal cancer. J Natl Cancer Inst, 2007. 99(14): p. 1120-9
29. Wactawski-Wende, J., et al., Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med, 2006. 354(7): p. 684-96
30. Feskanich, D., et al., Plasma vitamin D metabolites and risk of colorectal cancer in women. Cancer Epidemiol Biomarkers Prev, 2004. 13(9): p. 1502-8
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32. Giovannucci, E., et al., Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst, 2006. 98(7): p. 451-9
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34. National Diet and Nutrition Survey: Adults aged 19 to 64 years. Office for National Statistics. 2002.
35. National Diet and Nutrition Survey: Adults aged 19 to 64 years. Office for National Statistics. 2002.
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45. Park, Y., et al., Calcium, dairy foods, and risk of incident and fatal prostate cancer: the NIH-AARP Diet and Health Study. Am J Epidemiol, 2007. 166(11): p. 1270-9
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49. Cho, E., et al., Premenopausal fat intake and risk of breast cancer. J Natl Cancer Inst, 2003. 95(14): p. 1079-85
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51. Bingham, S.A., et al., Are imprecise methods obscuring a relation between fat and breast cancer? The Lancet, 2003. 362(9379): p. 212-214