Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Alcohol and mouth cancer

Key Points

  • Highlights that it is not alcohol but rather the first metabolite of alcohol, acetaldehyde, which is the most important carcinogen.

  • Suggests that patients should be made aware of their alcohol unit intake (eg, consider keeping an alcohol diary or using an app).

  • Suggests alcohol containing mouthwashes are essentially safe (being associated with a slightly increased risk of mouth cancer if used more than twice a day and for greater than 35 years).

Abstract

There is now considered to be no safe limit for alcohol intake. Studies have shown that risk of mouth cancer increases with greater alcohol intake (in particular when associated with the use of tobacco). This paper reviews the role for alcohol in the aetiology of mouth cancer both in terms of how it may give rise to cancerous change and the relative risk it carries (arising from various systematic and meta-analyses reported over the last decade). While obtaining a reliable alcohol history can be problematic (with under reporting frequently suspected) greater awareness of the role of alcohol in both local and systemic disease (in particular that of cancer in an ever increasing number of sites) may serve as a motivator for behaviour change within our patients. To that end patients should be aware of the alcohol content in the drinks they consume and consider recording their alcohol intake over a defined period (eg, use of a diary or app over a two to four week period).

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. BBC. Adults in Scotland drink almost 20 units a week. 2018 Available at https://www.bbc.co.uk/news/uk-scotland-44533595 (accessed October 2018).

  2. Department of Health. Alcohol Guidelines review – Report from the Guidelines development group to the UK Chief Medical Officers. 2016. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545739/GDG_report-Jan2016.pdf (accessed October 2018).

  3. Varoni E M, Lodi G, Iriti M . Ethanol versus phytochemicals in wine: Oral cancer risk in a light drinking perspective. Int J Mol Sci 2015; 16: 17029–17047.

    Article  Google Scholar 

  4. Harada H, Shinohara S, Takebayashi S et al. Facial flushing after alcohol intake as a predictor for a high risk of synchronous or metachronous cancer of the upper gastrointestinal tract. Jpn J Clin Oncol 2017; 47: 1123–1128.

    Article  Google Scholar 

  5. Tramacere I, Negri E, Bagnardi V et al. A meta-analysis of alcohol drinking and oral and pharyngeal cancers. Part 1: Overall results and dose-risk relation. Oral Oncol 2010; 46: 497–503.

    Article  Google Scholar 

  6. Rosenberg G, Bauld L, Hooper L, Buykx P, Holmes J, Vohra J . New national alcohol guidelines in the UK: public awareness, understanding and behavioural intentions. J Public Health (Oxf) 2017; 18: 1–8.

    Google Scholar 

  7. Pettigrew S, Jongenelis M, Chikritzhs T et al. Developing cancer warning statements for alcoholic beverages. BMC Pub Health 2014; 14: 786.

    Article  Google Scholar 

  8. Nieminen M T, Salaspuro M . Local acetaldehyde—an essential role in alcohol-related upper gastrointestinal tract carcinogenesis. Cancers (Basel) 2018; 10: 10.3390/cancers10010011.

    Article  Google Scholar 

  9. Shepherd S, Ogden G R . Alcohol and the dental team: relevance, risk, role and responsibility. Dent Update 2017; 44: 495–501.

    Article  Google Scholar 

  10. World Health Organization. Global status report on alcohol and health 2014. Luxembourg, 2014.

  11. LoConte N K, Brewster A M, Kaur J S, Merrill J K, Alberg A J . Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. J Clin Oncol 2018; 36: 83–93.

    Article  Google Scholar 

  12. Bagnardi V, Rota M, Botteri E et al. Alcohol consumption and site-specific cancer risk: A comprehensive dose-response meta-analysis. Br J Cancer 2015; 112: 580–593.

    Article  Google Scholar 

  13. Wight A J, Ogden G R . Possible mechanisms by which alcohol may influence the development of oral cancer-a review. Oral Oncol 1998; 34: 441–447.

    Article  Google Scholar 

  14. Paiano V, Bianchi G, Davoli E, Negri E, Fanelli R, Fattore E . Risk assessment for the Italian population of acetaldehyde in alcoholic and non-alcoholic beverages. Food Chem 2014; 154: 26–31.

    Article  Google Scholar 

  15. Lachenmeier D W, Sohnius E M . The role of acetaldehyde outside ethanol metabolism in the carcinogenicity of alcoholic beverages: evidence from a large chemical survey. Food Chem Toxicol 2008; 46: 2903–2911.

    Article  Google Scholar 

  16. Reidy J M E, Stassen L F A . A review of the relationship between alcohol and oral cancer. Surgeon 2011; 9: 278–283.

    Article  Google Scholar 

  17. Committee on Mutagenicity. Mutagenicity of alcohol(ethanol) and its metabolite acetaldehyde. 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/490582/COM_2015_S2_Alcohol_and_Mutagenicity_Statement.pdf (accessed October 2018).

  18. Ratna A, Mandrekar P . Alcohol and cancer: Mechanisms and therapies. Biomolecules. 2017; 7: 10.3390/biom7030061.

    Article  Google Scholar 

  19. Anantharaman D, Chabrier A, Gaborieau V et al. Genetic variants in nicotine addiction and alcohol metabolism genes, oral cancer risk and the propensity to smoke and drink alcohol: A replication study in India. PLoS One 2014; 9: e88240.

    Article  Google Scholar 

  20. Squier C A, Cox P, Wertz P W . Lipid content and water permeability of skin and oral mucosa. J Invest Dermatol 1991; 96: 123–126.

    Article  Google Scholar 

  21. Winn D M, Lee Y C, Hashibe M et al. The INHANCE consortium: Toward a better understanding of the causes and mechanisms of head and neck cancer. Oral Dis 2015; 21: 685–693.

    Article  Google Scholar 

  22. Pelucchi C, Tramacere I, Boffetta P, Negri E, Vecchia C L . Alcohol consumption and cancer risk. Nutr Cancer 2011; 63: 983–990.

    Article  Google Scholar 

  23. Giraldi L, Leoncini E, Pastorino R et al. Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: A pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Ann Oncol 2017; 28: 2843–2851.

    Article  Google Scholar 

  24. Goldstein B Y, Chang S C, Hashibe M, La Vecchia C, Zhang Z F . Alcohol consumption and cancers of the oral cavity and pharynx from 1988 to 2009: An update. Eur J Cancer Prev 2010; 19: 431–465.

    Article  Google Scholar 

  25. Hahn J, Monakhova Y B, Hengen J et al. Electronic cigarettes: overview of chemical composition and exposure estimation. Tob Induc Dis 2014; 12: 23.

    Article  Google Scholar 

  26. Berthiller J, Straif K, Agudo A et al. Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis. Int J Epidemiol 2016; 45: 835–845.

    Article  Google Scholar 

  27. Salaspuro V, Salaspuro M . Synergistic effect of alcohol drinking and smoking on in vivo acetaldehyde concentration in saliva. Int J Cancer 2004; 111: 480–483.

    Article  Google Scholar 

  28. Boffetta P, Hayes R B, Sartori S et al. Mouthwash use and cancer of the head and neck: A pooled analysis from the International Head and Neck Cancer Epidemiology Consortium. Eur J Cancer Prev 2016; 25: 344–348.

    Article  Google Scholar 

  29. Ahrens W, Pohlabeln H, Foraita R et al. Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: The ARCAGE study. Oral Oncol 2014; 50: 616–625.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G. R. Ogden.

Ethics declarations

Competing interests

The author is a member of the Medical Advisory Panel for Drinkaware.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ogden, G. Alcohol and mouth cancer. Br Dent J 225, 880–883 (2018). https://doi.org/10.1038/sj.bdj.2018.921

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bdj.2018.921

Further reading

Search

Quick links