酒精致癌研究盘点| 注意:女性饮酒易引发乳腺癌
2015/11/26
1988年,国际癌症研究机构(IARC)宣布酒精是一种致癌物质;2014年发布的全球癌症报告特别指出,因酒精致癌的比例高达3.5%。而且,因为饮酒人数增多、饮酒量增加,酒精致癌人数呈现上升趋势。


中国人讲究“无酒不成席”,逢年过节、聚会应酬,都离不开各类酒水陪衬。现在,酒产业的工艺越发精进,清香白酒、干爽啤酒、浓郁红酒……各类酒类产品可谓琳琅满目。但是,酒多伤身。据世界卫生组织统计,约有60种疾病与酒精相关联。同时,酒精也是生物医学界公认的美味致癌物。

其实,酒精与癌症的渊源颇久:1988年,国际癌症研究机构(IARC)宣布酒精是一种致癌物质;2014年发布的全球癌症报告特别列出酒精增加患癌率的内容,报告指出,因酒精致癌的比例高达3.5%,且呈现上升趋势。2015年,因酒精致癌的患者占所有癌症患者的5.5%,同时死亡人数占所有因癌症去世的患者总人数的5.8%。比例上调主要因为饮酒人数增多、饮酒量增加,特别是女性人数。

多伦多精神健康中心的社会流行病学研究部门主任Jürgen Rehm博士认为酒精致癌已是科学研究板上钉钉的研究事实,不要再花费时间去证实是否问题。他强调,酒精是一种致癌物质,且已经被明确证实。Rehm指出,酒精致癌的癌症种类大致包括口腔癌、咽喉癌、食道癌、乳腺癌、结肠癌、直肠癌、肝癌等。同时,最近有研究团队证实,过度饮酒会增加包括胃癌、肺癌、前列腺癌、黑色素瘤在内的癌症风险。

2015年内,关于酒精与癌症关联性的新研究

BMJ:女性饮酒易引发乳腺癌,男性饮酒易引发肠癌(文献

2015年8月18日,英国医学杂志(BMJ)发表一篇关于饮酒模式对癌症影响的学术文章。来自于哈佛陈曾熙公共卫生学院研究团队选取88,084个女性和47,881个男性进行长期随访(30年),数据显示总计有19,269个女性和7571个男性被诊断出癌症(排除前列腺癌)。证实,饮酒与患癌风险之间存在线性剂量效应关系。

为探究酒精对女性、男性患癌概率的影响,研究团队将癌症范围缩小至为5大类“酒精相关联癌症”(肠癌、女性乳腺癌、口腔癌、咽喉癌、肝癌、食道癌),以9016个患上述癌症的女性患者和1611位同样条件的男性患者为调研对象。数据显示,女性饮酒与患癌相对风险值为1.13,而男性饮酒与患癌相对风险值为1.26。而且,对于女性而言饮酒最易引发乳腺癌;男性饮酒易引发肠癌。

值得注意的是,研究人员还考虑了吸烟因素。结果表明,从不吸烟的男性,其轻中度酒精致癌的风险没有显著增加。但是,对于从不吸烟的女性而言,轻中度酒精致癌(主要是乳腺癌)的风险会增加。

Permanente:重度饮酒者患癌概率显著增加 (文献

奥克兰医学中心的心脏病专家、凯撒医疗机构高级顾问Arthur Klatsky教授带领团队对癌症风险与饮酒轻重程度的关系进行了列队研究。研究团队选取了一个数量多、多民族的成年人群体为调查对象(无患癌史)。随访调查持续17.8年,据统计约囊括了2,216,631个人。相关研究成果于2015年5月1日发表在《Permanente》期刊。

研究发现,与从未饮酒的人相比,重度饮酒者(每天饮酒超过3次)会增加5大类癌症的患病概率:食道癌、肺癌、女性乳腺癌、肠癌和黑色素瘤。而轻中度饮酒者(少量、适度)的患癌风险除了肺癌之外,也呈增加趋势,这可能受其他因素影响。但是数据结果分析中并没有看出其他12类癌症(胃癌、胰腺癌、肝癌、脑癌、甲状腺癌、肾脏癌、膀胱癌、前列腺癌、卵巢癌、子宫癌、宫颈癌和血液类疾病)受饮酒量影响的趋势。

研究人员分析:重度酗酒会增加一些癌症的患癌概率,当对其他癌症没有明显影响。而对于少量或适度饮酒的人而言,其患癌的概率与饮酒的关系仍不清楚。

BJC:重度饮酒者患口腔癌、食道癌概率显著增加(文献

2015年9月29日,米兰比可卡大学研究团队在英国癌症期刊(BJC)发表一篇关于饮酒量与癌症风险的全面分析文章。研究人员对572份研究报告(486,538例癌症患者)进行了分析,以获得23类癌症与饮酒之间的关系。结果表明,重度饮酒者患癌风险增加,部分数据如下表:


IJC:饮酒越多,女性患乳腺癌概率越高 (文献

国际癌症期刊(IJC)10月15日发表一篇关于饮酒与乳腺癌的研究文章,文章证实饮酒会增加女性患乳腺癌的风险,且随着饮酒量增加而增加。

国际癌症研究机构与多个研究院所合作专注对饮酒量与女性患乳腺癌概率的研究。研究团队选取来自于10个欧洲国家的334,850个女性(35-70年龄)进行11年的随访调研,调查记录共计有11,576个女性被诊断出患乳腺癌。由此可见,饮酒会显著增加患乳腺癌的概率:每天饮10g酒会增加4.2%的概率;与每天喝0-5g酒相比,每天酒量超6-15g的人患乳腺癌的风险会显著增加5.9%。

酒精如何致癌?

通常,摄入体内的酒精除了极少量经呼吸和尿排出体外,95%以上的乙醇会在体内分解代谢。IARC将乙醇和第一个代谢物——乙醛归为“1类致癌物质”。但是目前对癌症的研究还未彻底,且癌症作为异质性疾病,酒精致病的机理会因癌症类别不同而不同。

肝脏作为乙醇代谢的重要器官,乙醇首先会被氧化成乙醛(有毒),脱氢后转变为乙酸。形成肝癌的过程,乙醇常会先导致肝硬化。除了分解成乙醛,乙醇还会促进含氧自由基的产生,通过蛋白甲基化、乙酰化作用对人体细胞造成损伤。乙醇在唾液中转化为乙醛,导致唾液中的乙醛含量比血液中的乙醛含量高出10-100倍。这种弊端容易引发呼吸道癌的发生。此外,乙醇也会影响体内激素的含量,例如增加雌二醇水平,有研究表明它很可能与乳腺癌相关。

当然,基因对酒精引发癌症也起着关键作用。乙醇被吸收后在乙醇脱氢酶的作用下产生乙醛,乙醛受乙醛脱氢酶催化降解为酸。酶反应过程中,脱氢酶基因的表达会直接影响乙醛的含量。受基因调控,乙醛含量的异常增加会显著增加患癌风险。

安全的饮酒量是多少?

很多人会疑惑,饮酒的安全范围是多少? 遗憾的是,目前的研究还没有一个明确的安全剂量。我们一直知道,过度饮酒会增加患病的概率,但是轻、中度饮酒对疾病影响是什么,一直不清楚。

首先,很难建立关于“安全饮酒”和癌症风险的明确指导方针。科学家已经尝试将饮酒者根据日常饮酒量进行分类,划分为轻度、中度、重度(男性每天超过3次,女性每天超过2次)。研究普遍证实,重度饮酒会增加某些癌症的患癌率。

那么,少量饮酒(例如每天一杯葡萄酒或者更少)是否会增加癌症风险?Rehm博士认为对于乳腺癌而言,答案是肯定的。研究证实,女性饮酒量越多,患乳腺癌风险越高。对于其他癌症,目前研究还没有明确证据。事实上,“越少越好”正成为一个越来越常见的说法。

癌症概率作为一个函数,与你吸收的酒精总量相关。如果你今天不幸被诊断出癌症,很可能预示着你15-20年前就开始接触酒精。人们相信,除了少数例外,与酒精有关的癌症主要是由于长期大量饮酒而不是偶尔酗酒。

酒的种类是否会影响致癌率?

现在市面上充斥着各种酒精饮品。过去的研究中认为白兰地酒会增加食道癌的患病率,而啤酒会增加直肠癌概率。但是,研究并没有成一体系,而且并没有研究直接证实,不同的酒品种致癌概率不同。相反,有科学家认为所有酒种类致癌的风险都一样,因为都含有乙醇,而它正是致癌的罪魁祸首。

心血管益处是否大于癌症风险?

凡事没有绝对。酗酒会导致心肌病、高血压、心律失常、出血性中风等疾病和政治,但是,少量或适量饮酒会降低冠状动脉类疾病、心肌梗死、缺血性中风和心力衰竭。

不过,科学家还是提醒各位,少量或适量饮酒者一定程度上会有益于心血管健康,但是这并不能掩饰酒精对癌症的风险。少量或适量饮酒可以减少死于心脏病和冠状动脉疾病的风险,但是请注意,这个适量还需要建立在健康的饮食结构和生活习惯上,例如搭配食物饮用葡萄酒。如果一个老年人想降低心血管疾病的概率,除了酒精之外,还需要控制其他因素,包括控制吸烟、保持体重、积极锻炼等等。

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  • Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies

    Objectives To quantify risk of overall cancer across all levels of alcohol consumption among women and men separately, with a focus on light to moderate drinking and never smokers; and assess the influence of drinking patterns on overall cancer risk. Design Two prospective cohort studies. Setting Health professionals in the United States. Participants 88 084 women and 47 881 men participating in the Nurses’ Health Study (from 1980) and Health Professionals Follow-up Study (from 1986), followed until 2010. Main outcomes and measures Relative risks of cancer. Results 19 269 and 7571 (excluding non-advanced prostate cancers) incident cancers were documented among women and men, respectively, over 3 144 853 person years. Compared with non-drinkers, light to moderate drinkers had relative risks of total cancer of 1.02 (95% confidence interval 0.98 to 1.06) and 1.04 (1.00 to 1.09; Ptrend=0.12) for alcohol intake of 0.1-4.9 and 5-14.9 g/day among women, respectively. Corresponding values for men were 1.03 (0.96 to 1.11), 1.05 (0.97 to 1.12), and 1.06 (0.98 to 1.15; Ptrend=0.31) for alcohol intake of 0.1-4.9, 5-14.9, and 15-29.9 g/day, respectively. Associations for light to moderate drinking and total cancer were similar among ever or never smokers, although alcohol consumption above moderate levels (in particular ≥30 g/day) was more strongly associated with risk of total cancer among ever smokers than never smokers. For a priori defined alcohol related cancers in men, risk was not appreciably increased for light and moderate drinkers who never smoked (Ptrend=0.18). However, for women, even an alcohol consumption of 5-14.9 g/day was associated with increased risk of alcohol related cancer (relative risk 1.13 (95% confidence interval 1.06 to 1.20)), driven by breast cancer. More frequent and heavy episodic drinking was not further associated with risk of total cancer after adjusting for total alcohol intake. Conclusion Light to moderate drinking is associated with minimally increased risk of overall cancer. For men who have never smoked, risk of alcohol related cancers is not appreciably increased for light and moderate drinking (up to two drinks per day). However, for women who have never smoked, risk of alcohol related cancers (mainly breast cancer) increases even within the range of up to one alcoholic drink a day.

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  • Alcohol Intake, Beverage Choice, and Cancer: A Cohort Study in a Large Kaiser Permanente Population

    Context: Heavy intake of alcoholic beverages is associated with an increased risk of developing several types of cancers at specific body sites. However, evidence is conflicting regarding alcohol-associated cancers in other sites of the body as well as the role played by choice of wine, liquor, or beer. Results: With lifelong abstainers as referent, heavy drinking (≥ 3 drinks per day) was associated with increased risk of 5 cancer types: upper airway/digestive tract, lung, female breast, colorectal, and melanoma, with light-to-moderate drinking related to all but lung cancer. No significantly increased risk was seen for 12 other cancer sites: stomach, pancreas, liver, brain, thyroid, kidney, bladder, prostate, ovary, uterine body, cervix, and hematologic system. For all cancers combined there was a progressive relationship with all levels of alcohol drinking. These associations were largely independent of smoking, but among light-to-moderate drinkers there was evidence of confounding by inferred underreporting. Beverage choice played no major independent role. Conclusion: Heavy alcohol drinking is related to increased risk of some cancer types but not others. Because of probable confounding, the role of light-to-moderate drinking remains unclear.

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    A total of 572 studies, including 486 538 cancer cases, were identified. Relative risks (RRs) for heavy drinkers compared with nondrinkers and occasional drinkers were 5.13 for oral and pharyngeal cancer, 4.95 for oesophageal squamous cell carcinoma, 1.44 for colorectal, 2.65 for laryngeal and 1.61 for breast cancer; for those neoplasms there was a clear dose–risk relationship. Heavy drinkers also had a significantly higher risk of cancer of the stomach (RR 1.21), liver (2.07), gallbladder (2.64), pancreas (1.19) and lung (1.15). There was indication of a positive association between alcohol consumption and risk of melanoma and prostate cancer. Alcohol consumption and risk of Hodgkin’s and Non-Hodgkin’s lymphomas were inversely associated. Conclusions: Alcohol increases risk of cancer of oral cavity and pharynx, oesophagus, colorectum, liver, larynx and female breast. There is accumulating evidence that alcohol drinking is associated with some other cancers such as pancreas and prostate cancer and melanoma.

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  • Alcohol intake and breast cancer in the European prospective investigation into cancer and nutrition

    Alcohol intake has been associated to breast cancer in pre and postmenopausal women; however results are inconclusive regarding tumor hormonal receptor status, and potential modifying factors like age at start drinking. Therefore, we investigated the relation between alcohol intake and the risk of breast cancer using prospective observational data from the European Prospective Investigation into Cancer and Nutrition (EPIC). Up to 334,850 women, aged 35–70 years at baseline, were recruited in ten European countries and followed up an average of 11 years. Alcohol intake at baseline and average lifetime alcohol intake were calculated from country-specific dietary and lifestyle questionnaires. The study outcomes were the Hazard ratios (HR) of developing breast cancer according to hormonal receptor status. During 3,670,439 person-years, 11,576 incident breast cancer cases were diagnosed. Alcohol intake was significantly related to breast cancer risk, for each 10 g/day increase in alcohol intake the HR increased by 4.2% (95% CI: 2.7–5.8%). Taking 0 to 5 g/day as reference, alcohol intake of >5 to 15 g/day was related to a 5.9% increase in breast cancer risk (95% CI: 1–11%). Significant increasing trends were observed between alcohol intake and ER+/PR+, ER−/PR−, HER2− and ER−/PR−HER2− tumors. Breast cancer risk was stronger among women who started drinking prior to first full-time pregnancy. Overall, our results confirm the association between alcohol intake and both hormone receptor positive and hormone receptor negative breast tumors, suggesting that timing of exposure to alcohol drinking may affect the risk. Therefore, women should be advised to control their alcohol consumption.

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