BEER, WINE, SPIRITS AND HOW THEY INFLUENCE
THE RELATIVE RISK OF DEVELOPING COLORECTAL
“HOW MUCH IS TOO MUCH?”
1. A Pedersen, C Johansen, M Grønbæk (Copenhagen, 2002)
Randomly selected sample of 15491 men & 13641 women.
Assessment of weekly intake of beer, wine, and spirits.
Development of colorectal cancer during follow-up
o JC Anderson, et.al (New York, 2005)
Hand-picked samples of 2291 patients presenting for
Known risk factors for colorectal neoplasia & alcohol
2. CR Sharpe, J Seimiatycki, B Rachet (Montréal, 2002)
Hand-picked samples of 585 patients with diagnosed
Information obtained as soon as possible after
Assessing alcohol drinking pattern.
l A Moskal, et.al. (Lyon, 2006)
Journal articles published between 1990 and 2005.
Analysing association between relative risk and various
alcohol intake levels.
1 in 8 Australian adults drank at a high risk level (ABS, 2005)
LOW MODERATE HIGH
<3 daily 4 - 6 daily >7 daily
A standard drink : +/- 10g of pure alcohol
Most men prefer : beer
Most women prefer : wine
Annual consumption in average:
– Beer : 4.6L per person
– Wine : 3.1L per person
– Spirits : 2.1L per person
QUANTITY RR (COLON) RR (RECTUM)
Low 1.1 1.2
Moderate 1.1 1.4
High 1.2 1.8
Low 0.9 0.9
Moderate 0.9 0.9
High 0.5 0.9
Low 1.1 1.0
Moderate 1.3 1.3
High 1.5 1.4
– In heavy alcohol consumption, the association between
alcohol and rectal cancer is more prominent in
comparison with colon cancer.
– Risk of developing colon cancer is not much different
among different types of alcohol.
– Heavier beer and spirits intake is associated with an
increase in the relative risk of developing rectal cancer.
– Slight decrease in relative risk of developing rectal cancer
associated with wine consumption.
– Those who include wine in their alcohol intake have
significantly reduced relative risk of developing rectal
QUANTITY RR (COLON + RECTUM)
– Wine in moderate quantity may decrease the likelihood
of developing colorectal cancer up to half compared to
– Beer and spirits in high quantity may increase the
likelihood of developing colorectal cancer by more than
twofold compared to lower quantity.
QUANTITY RR (COLON) RR (RECTUM)
Low 1.0 1.1
Moderate 1.4 1.7
High 2.4 1.5
Low 0.9 1.1
Moderate 0.8 1.5
High 0.9 0.2
Low 1.1 1.4
Moderate 1.6 1.5
High 1.6 1.9
Distal colon is more likely to get affected than proximal
colon with any alcohol type.
– In relation to alcohol, the distal colon is more likely to
develop neoplasia in comparison with the proximal
– Heavy beer consumption has the strongest relationship
with cancer of the distal colon and rectum.
– Risk of developing colorectal cancer increases with
longer period of alcohol consumption (ie. start drinking
at earlier age) regardless the alcohol type.
– Wine consumption relates to a decrease in relative risk
of developing rectal cancer.
Comparison between high and low alcohol intake.
16 studies with more than 6,300 patients included.
– Positive association to colon cancer in men (RR 1.64)
and women (RR 1.23)
– Positive association to rectal cancer in men (RR 1.79)
and women (RR 1.39)
– Ethanol in alcoholic beverages is the significant factor,
not the type of the beverages itself.
BEER & SPIRITS
30g of alcohol daily is the maximum safety limit in relation
to the relative risk of developing colorectal cancer.
Consumption above that level may increase the relative
risk of developing colorectal cancer significantly (up to
WINE (especially RED)
10g - 30g of alcohol daily is believed to be the optimum
quantity to get the benefit of wine in reducing the relative
risk of developing colorectal cancer (up to half).
Consumption above that level is not proven to be
Low to moderate consumption of alcohol in general does
not increase the relative risk of developing colorectal
Low to moderate consumption of wine (especially red) in
general may lower the relative risk of developing colorectal
High consumption of alcohol in general may increase the
relative risk of developing colorectal cancer (especially
Beer is associated with significantly higher relative risk of
developing colorectal cancer in high quantity drinkers, men
It is generally safe to drink up to 30g of alcohol daily,
although the lesser the better.
Drink red wine!
Administration of 50mg/kg red wine polyphenols to rats
Induction of colon carcinogenesis
Polyphenol-treated rats had lower tumour yield in
comparison with control rats
Chemopreventive against colon cancer ?
DOWN-REGULATED GENES AFTER
CELL SURFACE ANTIGENS
GENE EXPRESSION CONTROL
RECEPTORS & SIGNAL TRANSDUCTION
TRANSPORT & BINDING PROTEINS
DAMAGE & STRESS RESPONSE
CHOLESTEROL & LIPID METABOLISM
INFLAMMATORY & IMMUNE RESPONSES
Courtesy of Dolara, P, et al. (2004)
Anderson, JC, et al. (2005) Prevalence and Risk of Colorectal Neoplasia in
Consumers of Alcohol in a Screening Population. American Journal of
Gastroenterology. Vol.100. pp.2049-2055.
Australian Bureau of Statistics (2006) Alcohol Consumption in Australia: A
Snapshot, 2004-05. Commonwealth of Australia. Available from <http://
www.abs.gov.au/ausstats/abs@.nsf/mf/4832.0.55.001/> Accessed on 12
Bongaerts, BWC, et al. (2007) Alcohol consumption and distinct molecular
pathways to colorectal cancer. British Journal of Nutrition. Vol.97.
Dolara, P, et al. (2005) Red wine polyphenols influence carcinogenesis,
intestinal microflora, oxidative damage and gene expression profiles of
colonic mucosa in F344 rats. Journal of Mutation Research. Vol.591.
Moskal, A, et al. (2006) Alcohol intake and colorectal cancer risk: A dose-
response meta-analysis of published cohort studies. International
Journal of Cancer. Vol.120. pp.664-671.
Pedersen, A, et al. (2003) Relations between amount and type of alcohol
and colon and rectal cancer in a Danish population based cohort study.
Gut: International Journal of Gastroenterology and Hepatology.