Even Just One Drink a Day May Raise Risk for Oral Cancer
New research from India discovered that even low daily alcohol intake is associated with a much higher risk of mouth cancer. Consuming just 9 grams of alcohol daily (roughly one standard drink) was linked with a 50% increased risk. Consumers of locally brewed alcoholic drinks showed the strongest link. The study published in the open access journal BMJ Global Health.
When alcohol was paired with chewing tobacco, the impact was even more severe. Researchers note this combination could be responsible for 62% of all cases of mouth cancer in India.
Mouth Cancer Rates are High in India
Rates of mouth cancer are high in India, ranking as the second most common type with an estimate of nearly 144,000 new diagnoses and close to 80,000 deaths annually. Researchers note that incidence rates have regularly climbed and amount to just below 15 cases per 100,000 men in India.
Buccal mucosa, the soft pink tissue lining the lips and cheeks are most impacted with survival outcomes being poor. Roughly 43% of patients survive five years or more after diagnosis.
Understanding the Roles of Alcohol and Tobacco
Tobacco and alcohol use often co-exist, making it hard to parse out their individual impacts on mouth cancer risk. This is especially true in India because smokeless tobacco use is so common. The use and health effects of locally brewed alcohol has been ignored and is more commonly consumed in rural areas of India.
The researchers compared 1,803 individuals diagnosed with buccal mucosa cancer with 1,903 randomly chosen individuals without this cancer (controls). Subjects were recruited from five study centers from 2010 to 2021. Participants were between 35 and 54 years old, and almost 46% of cancer cases happened in individuals aged 25 and 45.
Following Drinking Habits and Tobacco Usage
Subjects offered detailed information about how long they’d been consuming alcohol, how frequently they drank, and the types of alcohol they consumed. This included 11 globally recognized drinks, including beer, whisky, vodka, rum and flavored alcoholic drinks(known as breezers), plus 30 locally brewed options including apong, bangla, chulli, desi daru, and mahua.
Participants were also asked about their tobacco use, including length and type, allowing researchers to evaluate how alcohol and tobacco interact to affect mouth cancer risk.
In those with cancer, 781 reported drinking alcohol, while 1,019 said they abstained. In the control group, 481 consumed alcohol and 1,420 did not.
Higher Exposure Linked to Higher Risk
Individuals with buccal mucosa cancer relayed longer average tobacco usage, roughly 21 years compared with nearly 18 years in the control group. They were also more likely to dwell in rural areas and to consume higher amounts of alcohol daily, nearly 37 g compared with about 29 g.
Frequent alcohol intake was strongly linked with increased cancer risk, with locally brewed drinks showing the greatest impact.
Compared with people who abstained from alcohol, those who drank had a 68% higher risk of developing buccal mucosa cancer. The risk increased to 72% among people who favored globally recognized drinks and jumped to 87% in those who drank locally brewed alcohol.
No Safe Threshold Found
Even very small amounts of alcohol appeared made a difference. Consuming less than 2 g of beer per daily was still linked to a higher risk of buccal mucosa cancer. Drinking 9 g of alcohol each day, roughly one standard drink, was linked with a nearly 50% higher risk.
Pairing alcohol and tobacco at the same time led to a dramatic effect. The combined exposure was associated with a more than fourfold increase in risk. The researchers estimate that 62% of buccal mucosa cancer cases in India are attributable to the mingling of alcohol and chewing tobacco, based on their estimates.
How Alcohol May Increase Risk
Regardless of how long a person used tobacco, alcohol raised mouth cancer risk. According to the researchers, ethanol may alter the fat content of the mouth's inner lining, making it more permeable and more susceptible to carcinogens in chewing tobacco products.
The analysis suggests that over one in ten buccal mucosa cancer cases in India, nearly 11.5%, can be attributed to alcohol intake. In states with particularly high disease rates, including Meghalaya, Assam, and Madhya Pradesh, that proportion increases to almost 14%.
Concerns About Local, Unregulated Alcohol
The higher risk linked with locally brewed alcohol may be partially due to contamination with toxins like methanol and acetaldehyde. According to the researchers, the production of these drinks is primarily unregulated.
"The current legal framework for alcohol control in India is complex and involves both central and state laws. Central legislation provides protection of citizens where alcohol is included in the State List under the Seventh Schedule of the Indian Constitution, giving states the power to regulate and control alcohol production, distribution and sale. However, the locally-brewed liquor market is unregulated, with some forms used by participants containing up to 90% alcohol content," they point out.
Implications for Prevention
The researchers conclude that there is “no safe limit of alcohol consumption for buccal mucosa cancer”. They advise public health education on how alcohol and tobacco avoidance could potentially eliminate this cancer in India.
How Can You Lower Your Risk of Mouth Cancer?
· Avoid tobacco products, including cigarettes, chewing tobacco, dip, snuff, and vaping.
· Reduce alcohol intake to less than 3 drinks per week. This also lowers the risk of breast cancer in women.
· Choose mocktails or other beverages in place of alcoholic drinks.
· Maintain healthy oral hygiene and regular dental visits.
· Be preventative about the HPV virus through vaccination and avoiding those who are infected.
· Eat plenty of fruits and vegetables to prevent overall cancer.
Lisa Andrews, MEd, RD, LD
Reference:
Grace Sarah George, Aniket Patil, Romi Moirangthem, Pravin Narayanrao Doibale, Ankita Manjrekar, Shruti Vishwas Golapkar, Nandkumar Panse, Manigreeva Krishnatreya, Aseem Mishra, Arjun Singh, Harriet Rumgay, Bayan Hosseini, Anil Chaturvedi, Preetha Rajaraman, Ann Olsson, Isabelle Soerjomataram, Pankaj Chaturvedi, Rajesh Dikshit, Sharayu Mhatre. Association of alcohol and different types of alcoholic beverages on the risk of buccal mucosa cancer in Indian men: a multicentre case-control study. BMJ Global Health, 2025; 10 (12): e017392 DOI: 10.1136/bmjgh-2024-017392