1. Rutgers University
Primary Prevention on Binge Drinking: Efforts to Reduce the Incidence of Breast and Upper
Aerodigestive Tract Cancer
Betty Kui
Cancer and Society 10:832:405
Professor Abruzzi
May 6, 2016

2. Despite being a social custom, drinking alcohol is a behavior that can endanger one's
health by putting one at higher risk for developing certain cancers. This includes cancers of the
mouth, esophagus, larynx, pharynx, liver, colorectal and breast. Although in this paper, I will
analyze how binge drinking is a risk factor for developing breast and upper aero digestive tract
(UADT) cancer. I will present incidence data on alcohol intake raises the relative risk of breast
and UADT cancer and propose a primary prevention strategy to reduce the exposure of binge
drinking in New Jersey males and females18-24 years of age.
Alcohol abuse has been casually linked and most apparent in the development of UADT
cancers which are cancers of the oral cavity, esophagus, larynx, and pharynx. It has been
estimated that 25%–68% of all UADT cancers are attributed to alcohol and up to 80% of these
tumors can be prevented by abstaining from alcohol ("Alcohol and Cancer" 1). In particular,
there is a significant higher incidence found in men developing UADT cancers than women (1).
This is most apparent in older age groups such as from ages 30 and onward ("Oral Cancer
Incidence New Cases by Age, Race, and Gender" 1)
("Oral Cancer Incidence New Cases by Age, Race, and Gender" 1)

3. In this figure extracted from a larger table produced by the National Institute of Health (NIH),
the incidence of UADT cancer found in men compared to that found in women is 2.7 times
higher from ages 40-49 and 3.3 times higher from ages 50-59 (1). Surveys like the Behavioral
Risk Factor Surveillance Survey (BRFSS) even show higher rates of chronic drinking among
men 4.8% compared with women 0.7% (BRFSS Prevalence Index 1). With 6.9 times more men
chronic drinking than women, there is exists a correlation between the frequency and amount of
drinks one has and the risk of developing UADT cancer (1). Also, this figure indicates that there
is no apparent difference in the incidence of UADT between men and women in age groups 0-29
indicating latency period when symptoms of the cancer are not as apparent ("Oral Cancer
Incidence New Cases by Age, Race, and Gender" 1). In one study, the latency period for UADT
cancer was estimated to be 12.3 to 16.4 years ("Alcohol Use and Cancer" 1). These findings
support the data compiled by the NIH in Table 1 ("Oral Cancer Incidence New Cases by Age,
Race, and Gender" 1). The first significant difference in the incidence of UADT cancers in men
and women are shown in the age group 30 to 39 years of age (1). This would mean that
behaviors of binge drinking may have began around ages 14-27. A more recent study indicated a
significant dose-response relationship with 90% of all patients with UADT cancers consumed
alcohol regularly in quantities double the amount of a control group ("Alcohol Use and Cancer"
1). Assuming individuals consuming 25 grams of alcohol daily had a risk factor of 1, individuals
consuming 100 grams of alcohol or more daily had a risk factor that spiked to 32 (1). If this type
of behavior were to presume continuously, it would put one at great risk of easily developing
UADT cancer.
While the predicted breast cancer incidence within the U.S. due to alcohol intake, 4%, is
not as high as that of UADT cancer within the U.S. due to alcohol intake, 25%–68%, data

4. support that alcohol intake is a risk factor for breast cancer ("Alcohol and Cancer" 1). In one
meta analysis, 84% of 69 case–control and 76% of 21 cohort studies published data indicating a
positive association between ethanol intake and breast cancer ("Long-Term Alcohol
Consumption and Breast, UADT and Colorectal Cancer Risk" 1). From this study, it was
calculated that 4% of all newly diagnosed breast cancer cases in the US are primarily due to
alcohol (1). Much like the dose-response relation found in heavy drinkers who developed UADT
cancer, a dose-response relation is also found in women drinking more grams of alcohol
developing breast cancer. women involved. One study found a 9% increase in risk for each 10
grams of alcohol which is equivalent to one drink a day ("Alcohol and Cancer" 1). The same
study estimated the relative risk for breast cancer to be 1.24 among women consuming around 26
grams of alcohol per day and 1.41 for women consuming 30g to 59 g per day (1).
After examining the relation between alcohol consumption and risk in developing breast
cancer and UADT cancer, I would like to discuss plausible methods of primary prevention to
reduce the incidence of these cancers. Specifically, I would like to address the New Jersey
female and male population of 18-24 years of age as I believe this is the demographic that has
the highest chance of
developing binge drinking
habits putting them at
greater risk for
developing these cancers
later in life.
Table 2
(BRFSS Prevalence Index 1)

5. Table 2 illustrates that the age group most prone to binge drinking within New Jersey are
males and females that fall within the age 18-24 category (BRFSS Prevalence Index 1).
Considering that the latency period of UADT cancer and breast cancer are around 12.3-16.4
years and 8-15 years respectively and that relative risks of UADT increases significantly after 30
years of age in Table 1, there is strong evidence that habits of binge drinking begins within the
18-24 age group (1). Consequently , the method of primary prevention I would suggest to this
demographic is alcohol abuse and cancer education programs in high school and college. The
same kind of education should also be given by physicians as this is the age group when many
young adults in America can legally drink and consequently can develop an addiction to alcohol
as well as binge drink. Although, I would put more emphasis in supplying this education to
school institutions because drinking is social behavior of students particularly those who are in
environments such as college. According to the NIH, in 2014, 37% of college students ages 18-
22 binge drink within the past month compared with 33.5% of people of the same age ("Alcohol
Use and Cancer" 1). Consequently, educating young adults the potential dangers of binge
drinking can discourage them from following that behavior and drink in moderation. Another
method of primary prevention to reduce the incidence of UADT and breast cancer is to increase
the alcohol tax in New Jersey to discourage young adults from buying an abundance of alcohol.
Although the issue with this idea is that the public may protest against this. Commercial host
liability is another method which is holding an alcohol retail establishment liable for any harm
caused by the illegal selling of alcohol to under aged or intoxicated customers. However, the
issue with this idea is that there are under aged people who have access to a fake ID card or
friend of legal age to purchase alcohol.

6. As a result, no method of primary prevention is guaranteed to be highly effective.
However, considering that one of the most effective ways to combat cancer is to reduce one's
risk of developing it in the first place, primary prevention is essential. Early prevention is a key
component of public health and helps reduce the incidence of illnesses like cancer. Consequently,
to reduce the incidence of UADT and breast cancer, I would choose to implement a primary
prevention strategy geared towards the 18-24 years of age demographic even though this specific
population would not as frequently exhibit symptoms of these cancers. A primary prevention
strategy for this demographic within New Jersey would be highly beneficial as in 2013, 7,500
women were diagnosed with breast cancer and 1,492 men and women were diagnosed with
UADT in New Jersey alone (NJ Cancer Burden Report 2013 1). A good percentage of those who
developed UADT may have been able to prevent it if they changed regulated their drinking
habits which has shown to attribute to 25%–68% of all UADT cases in one meta analysis
("Alcohol and Cancer" 1). The same applies to those who developed breast cancer even though
only 4% of all new cases were attributed to binge drinking in another study. Consequently,
primary prevention represents the foundation of public health by promoting healthy behaviors
and lifestyle choices extending and saving lives.

7. Bibliography
1. "Alcohol and Cancer." Alcohol and Alcoholism. N.p., n.d. Web. 04 May 2016.
2. "Alcohol Consumption and Breast Cancer in the Epidemiologic Follow-up Study
of the First National Health and Nutrition Examination Survey NEJM."
New England Journal of Medicine. N.p., n.d. Web. 04 May 2016.
3. "Alcohol Use and Cancer." Alcohol Use and Cancer. N.p., n.d. Web. 04 May
2016.
4. BRFSS Prevalence Index. Centers for Disease Control and Prevention, 17 Mar.
2016. Web. 04 May 2016.
5. "Long-Term Alcohol Consumption and Breast, UADT and Colorectal Cancer Risk: A
Systematic Review and Meta-Analysis." Alcohol and Cancer. N.p., n.d. Web. 04
May 2016.
6. NJ Cancer Burden Report 2012 (n.d.): n. pag. Web. 4 May 2016.
7. "Oral Cancer Incidence New Cases by Age, Race, and Gender." N.p., n.d. Web. 04 May
2016.