酒精与癌症
这篇酒精与癌症（英语：Alcohol and cancer）用来讨论酒精和某些人类癌症间的关系。
酒精饮料被世界卫生组织（WHO）所属国际癌症研究机构(IARC)列为一类致癌物（对于人类）。IARC将摄取酒精饮料归类为乳癌（女性）、大肠癌、喉癌、肝癌、食道癌、口腔癌、和头颈癌的病因；并列为胰脏癌的可能原因。[2]
全世界3.6%的癌症病例和3.5%的癌症死亡归因于饮酒（特别是乙醇）。[3]而根据一篇发表在2020年刺胳针期刊的报导，全球增加的癌症病例中，可归因为饮酒的已占4.1%。[4]
有些国家导入酒精包装警告信息，告知消费者有关酒精和癌症间关联的资讯。[7]
酒精饮料相关产业除推动废除酒精饮料附加癌症警告标签的法律之外，[8]还积极运作，试图误导公众关于饮酒致癌的风险。[9]
由酒精相关癌症导致的死亡率[编辑]
澳大利亚：澳大利亚在2009年所做的一项研究发现，当地每年有2,100人死于与酒精有关的癌症。[10]
欧洲：在2011年所做的一项研究发现，男性癌症有10分之1，和女性癌症有33分之1，是由过去或当前的酒精摄取所引起。[11][12]
酒精作为致癌物和促进致癌物[编辑]
IARC把酒精与砷、苯、和石棉同样归类为一类致癌物。评估指出“有足够证据证明酒精饮料对人类有致癌作用。……酒精饮料对人类有致癌作用（一类）。” [13]
机制[编辑]
乙醛[编辑]
肝脏在分解乙醇后产生乙醛。肝脏通常可把99%的乙醛排除。肝脏平均每小时可处理7克乙醇。例如需要12个小时把一瓶葡萄酒中的乙醇排除，而导致饮者有12小时或更长时间接触到乙醛。一项针对818名重度饮酒者的研究发现，那些因醇脱氢酶基因缺陷，而比正常人接触到更多乙醛的人，他们罹患上消化道和肝癌的风险更大。[14]饮酒与不同类型的癌症之间存在许多关联。一份美国在2009年的数据显示，有3.5%的癌症死亡人数是源自饮酒的关系。[15]
评论[编辑]
G. Pöschl和H. K. Seitz两位研究者在2004年发表一篇评论中列出酒精作为致癌物的可能机制如下：[16]
- 酒精对局部的影响
- 代谢为乙醛（可能会具有生理意义的水准，达到导致基因突变的程度[17]）
- 细胞色素P-4502E1（CYP2E1）的诱导
- 营养缺乏
- 与类视色素的交互作用
- 酒精及甲基化
- 酒精和免疫监视（请参考免疫）
而研究学者Paolo Boffetta和Mia Hashibe也提出一个有重叠性质的清单：
- 乙醛的产生，乙醛是种弱突变剂和致癌物质
- 诱导细胞色素P-4502E1和相关的氧化应激，把前致癌物转化为致癌物质
- 耗尽S-腺苷甲硫氨酸，而诱导整体DNA低甲基化
- 诱导抑制性鸟嘌呤核苷酸交换因子调节蛋白，以及细胞外信号调节激酶(丝裂原活化蛋白激酶信号传导）组成的生产增加
- 铁的累积和相关的氧化应激
- 肿瘤抑制基因乳癌一号基因的失活，以及雌激素反应性的增加（主要在乳房中）
- 维生素A酸代谢障碍[18]
Paolo Boffetta和Mia Hashibe列出可能的机制，包括：
同时吸烟和饮酒的人罹患口腔癌、气管癌、和食道癌的风险会高得多。研究显示这类人罹患此类癌症的风险是既不吸烟也不饮酒人的35倍。这一证据可能表明酒精和烟草的相关致癌物之间，存在交互致癌的作用。[20][21]
乙醇的局部致癌作用[编辑]
与饮酒相关的癌症风险，发生在与酒精密切接触组织的几率更高，例如口腔、咽部、和食道。这是因为乙醇是种经证实的诱变剂，此外，肝脏产生的乙醇代谢物（乙醛）具有高度致癌性，从而解释局部（口腔癌、喉癌、食道癌）和远端移植癌症（皮肤、肝脏，乳癌）发生的原因。众人皆知酒精饮料中原本存有的酒精浓度就会导致细胞死亡。很少细胞能在细胞培养时暴露于5–10%的乙醇之下超过1小时，或是能暴露于30–40%的乙醇达到15秒，而能存活的细胞可能会发生基因变化，导致癌变。但最近的证据显示，乙醇对口腔、咽部、和食道内壁细胞的细胞毒性作用会激活位于粘膜深层干细胞的分裂，以取代死亡细胞。每次干细胞在分裂时，它们都有机会碰到与细胞分裂相关，但无法避免的错误（例如DNA复制过程中出现的突变，和有丝分裂过程中发生的染色体畸变），并且也变得非常容易受到DNA损伤剂（例如乙醛和烟草致癌物）的影响。饮酒促使干细胞为维持体内平衡而分裂，累积的结果会增加个人罹患口腔癌、咽癌、和食道癌的风险。因为乙醇的细胞毒性有浓度依赖性，这些癌症的风险不仅会随着乙醇摄取量的增加而增加，而且会随着浓度的增加而增加；饮用一盎司未稀释过的威士忌，会比混入非酒精饮料后再饮用更容易致癌。乙醇的局部细胞毒性作用也可用来解释那些已知的酒精和烟草，对这些癌症风险的协同作用。[22]
上皮细胞间质转化[编辑]
一项研究发现，酒精会刺激上皮细胞间质转化(EMT)，造成普通癌细胞变成更具侵袭性的形式，并开始扩散到全身。[23][24]
酒精对已发生癌症的影响[编辑]
一项关于酒精摄取对肝硬化患者的肝细胞癌(HCC)肿瘤生长影响的研究发现，酒精会影响肿瘤体积的倍增时间 (TVDT)[25]
一项对鸡胚胎的研究显示，酒精透过促进刺激肿瘤血管发育的生长因子，而刺激肿瘤的生长。[26]在2006年一项在实验小鼠的研究显示，适度饮酒会透过称为血管新生的过程导致肿瘤变得更大。[27][28]
一项让老鼠摄取大量酒精的研究显示，酒精会加速体内脂肪流失和抑制免疫活动，癌症得以加速生长。[29]
基因变异与癌症风险[编辑]
一项研究发现，“醇脱氢酶ADH1C等位基因和基因型ADH1C*1/1有更高的频率存在酒精相关癌症患者的体内……”[14]一项欧洲研究发现有两种基因变异针对口腔癌和喉癌可提供“显著”的保护。[30]酒精是一种已知的卟啉源化学物质。几项欧洲研究发现遗传性肝紫质症（卟啉症）与HCC的易感性有关联。HCC的典型危险因素不一定会与急性肝紫质症，特别是急性间歇性紫质症、异位型紫质症、和遗传性粪紫质症一起出现。缓发性皮肤病变紫质症也与HCC有关，但是种典型的风险因素，包括有肝炎病毒、血色沉着病、和酒精性肝硬化存在的证据。酪胺酸血症第一型是种影响血红素代谢途径中第二种酶酪氨酸代谢的遗传性疾病，与年轻人群（包括儿童）罹患HCC的高度风险有关。[31]
特定癌症的危险因素[编辑]
适度饮酒会增加风险[编辑]
一项研究发现，“女性增量，但仍是适度饮酒的模式被确定与罹患口腔癌和咽癌、食道癌、喉癌、直肠癌、乳癌、和肝癌的风险增加有关……”。[32]
口腔癌、食道癌、咽癌、和喉癌[编辑]
摄取任何数量的酒精都是口腔癌、食道癌、咽癌、和喉癌的危险因素。美国国家癌症研究所指出“饮酒会增加男性和女性罹患口腔癌、食道癌、咽癌、喉癌、和肝癌的风险，……总体而言，任何酒精摄入量（轻度；每人每周<2标准单位葡萄酒）都会增加高于基线的风险。而适度饮酒（每天1标准单位葡萄酒）会让风险显著增加，每周饮酒超过7标准单位的人的风险最高。（1标准单位酒的定义为12盎司普通啤酒、5盎司葡萄酒，或是1.5盎司80度的蒸馏酒。）…此外，把酒精与烟草一起使用，比单独使用任何一种都更危险，因为这样会进一步增加罹患口腔癌、喉癌、和食道癌的几率。“[33]2010年美国联邦膳食指南把适度饮酒定义为每天女性最多1标准单位，男性最多2标准单位。重度饮酒的定义是任何一天女性饮酒超过3标准单位，或每周饮酒超过7标准单位，任何一天男性饮酒超过4标准单位，每周饮酒超过14标准单位。
国际头颈癌流行病学联盟（(INHANCE)）就此问题协调进行一项综合分析 。[34]关于喉癌和饮料类型的研究所得的结论是：“这项研究显示，由于意大利人经常饮用葡萄酒，葡萄酒是与喉癌风险最密切相关的饮料。”[35]
对1966年至2006年之间所发表的流行病学文献做评论，得出的结论是：
- 戒酒后的头两年，罹患食道癌的风险几乎增加一倍，这种急剧增加的原因可能是因为有些人会在疾病症状出现时才停止饮酒。然而，在较长期的戒酒之后，发病的风险迅速且显著的降低。
- 头颈癌的风险仅在戒酒10年后会显著降低。
- 戒酒超过20年后，这两种癌症发病的风险与从来不喝酒的人相似。[36][37]
有项研究得出的结论是，每天每多喝一标准单位的酒精饮料，口腔癌和咽癌的发病率就会增加千分之1。食道癌和喉癌的发病率会增加千分之0.7。[32]
一项在2008年进行的研究显示乙醛与口腔癌有关联。[38][39]
乳癌[编辑]
每天平均饮用2标准单位的女性，与平均每天饮酒1标准单位的相比，罹患乳癌的风险高出8%。[43]有研究得出的结论是，每天每多喝1标准单位，乳癌的发病率就会增加千分之11。[32]英国的研究资料显示，如果饮酒量减少到非常低的水准（即每周少于1标准单位），每年可减少大约6%（3.2%至8.8%）的乳癌发生率。[43]中度至大量饮用酒精饮料（每周至少3至4标准单位）与乳癌复发风险增加1.3倍相关联。此外，任何数量的饮酒都与乳癌幸存者的复发风险显著增加有关联。[44][45]
大肠癌[编辑]
饮酒可能是大肠癌早期发病的原因之一。[46]酒精作为导致大肠癌的因素，对于男性而言是证据确凿，对女性而言则为具有可能性。[47]
美国国家卫生院、[48]美国国家癌症研究所、[49]英国慈善机构“癌症研究”（Cancer Research UK），[50]美国癌症协会、[51]梅奥医院、[52]美国癌症临床肿瘤学协会（American Society of Clinical Oncology）[53]和纪念斯隆-凯特琳癌症中心[54]均把酒精列为危险因素。世界国际癌症研究基金会（WCRF）的小组报告发现，每天摄入30克以上的纯酒精，会增加男性罹患直肠癌的风险，证据“令人信服”。[55]美国国家癌症研究所指出，“大量饮酒也可能增加罹患直肠癌的风险”[56]
在2011年所做的一项综合分析发现，饮酒与直肠癌风险增加有关联。[57]
肝癌[编辑]
酒精是肝癌的危险因素，通过肝硬化而形成。[58][59][60]“肝硬化是由肝脏内的疤痕堆叠所引起，最常见的原因是长期酒精不当使用，....。” [61]
“肝硬化患者中大约有5%会罹患肝癌。肝硬化是种因为酒精滥用，肝细胞坏死，被疤痕组织取代而发生的疾病，……”[62]
美国国家酒精滥用和酗酒研究所(NIAAA)报告说，“长期大量饮酒，在许多情况下与原发性肝癌有关联。”然而，无论是由酒精还是其他因素所引起的肝硬化，都被认为会诱发癌症。”[63][64]
“每天喝5标准单位或更多的酒，罹患肝癌的机会会显著增加”（国家癌症研究所）。
有项研究得出的结论是每天每多喝一标准单位的酒，肝癌的发病率就会增加千分之0.7。[32]
肝癌在美国相对不常见，每100,000人中罹患肝癌的约有2人，但有些研究人员发现其中多达36%的病例与过量饮酒有关联[20][65]“总体而言，罹患HCC的人之中，有61%是由HCV（丙型肝炎病毒）引起，有13%是由HBV（乙型肝炎病毒）引起，而有18%是因为大量饮酒所引起。“[66]意大利北部布雷西亚省的一项研究所得的结论是：“基于人群的归因风险（AR）分类，大量饮酒似乎是罹患HCC的唯一最相关原因（AR：45%），其次是感染到HCV（AR：36%）和HBV（AR：22%）。”[67]
肺癌[编辑]
每天饮酒超过2标准单位与罹患肺癌的风险略有增加有关联。[68]R. Curtis Ellison MD在评论Freudenheim等人所发表的研究作品时，写道：“这项研究与其他研究一样，显示大量饮酒（每天2标准单位以上）与肺癌风险之间存在微弱的正相关。”[69][70]
皮肤癌[编辑]
胃癌[编辑]
“饮酒对于胃癌、大肠癌、肝癌、女性乳癌、和卵巢癌的风险也会产生显著统计学上的增加。”[72] “虽然有把酒精作为胃癌的病因做过广泛的研究，但没确凿的证据显示风险会增加。但至少有三项研究的结果显示，大量饮酒可能会增加重度吸烟者罹患胃癌的风险。”[73][74][75]
在台湾的一项研究所得的结论是:“……吸烟可能在胃癌生成的最初期发挥危害最大的作用，而饮酒可能会促进这种发展。” [73]
在挪威有项研究发现，“没发现在不同程度的酒精暴露与胃癌风险之间存在统计学上的显著关联，但同时大量吸烟（每天>20次）和酒精（每14天>5次）会增加罹患胃癌的风险，而罹患非贲门胃癌的风险几乎是非使用者的5倍。”[75]
每天摄入50克或更多的酒精会增加风险[编辑]
子宫内膜癌[编辑]
酒精已被确定为罹患子宫内膜癌的危险因素。[76]然而，两者间关联的数据却相互矛盾。低至中度酒精摄取量关联的数据（每天少于2标准单位）与风险增加无关，但在高摄取量时则存在关联。[77][78] “我们的结果是每天摄取相当于2标准单位或更多的酒精，会增更年期后妇女罹患子宫内膜癌的风险。” [79] “总而言之，我们的结论显示低饮酒量（每天最多1标准单位），不太可能显著影响到罹患子宫内膜癌的风险。”[80]
胆癌[编辑]
酒精被认为是罹患胆癌的危险因素。[81]有证据显示大量饮酒与胆癌有关联。[82][83]男性罹患这种癌症的风险可能高于女性。[84]
卵巢癌[编辑]
“因此，这项研究的结果显示摄取相对较高的酒精（每天40克或是更多）可能会导致上皮性卵巢癌风险适度增加。” [85]“也发现饮酒与卵巢癌、和摄护腺癌之间存在关联，但仅限于每天摄入50克到100克的人。”[86]“也和罹患胃癌、大肠癌、肝癌、女性乳癌和卵巢癌的风险，有显著统计学上的增加。”[72]
“因此，这项汇总分析的结果并未支持适度饮酒与卵巢癌风险之间有关联。” [87]
摄护腺癌[编辑]
“来自相关医疗专业人员后续研究的数据显示，总体酒精摄取量与摄护腺癌风险之间只有微弱的关联，而红酒摄入量与前列腺癌风险之间根本没有关联。” [88]
根据一项在2001年发表的综合分析发现，男性每天饮酒超过50克酒精的风险，增加数字虽小，但够显著，男性每天饮酒超过100克的风险会略高。[89]自那项分析以来，美国的队列研究发现男性饮用适量的烈酒和“暴饮”会增加风险，[90]但适度饮用啤酒或是葡萄酒，与风险增加无关联。[91][92][93]
每天饮酒达到50克到100克也与卵巢癌和前列腺癌有关联。[86]然而有项研究的结论是适度饮酒会增加罹患摄护腺癌的风险。喝烈酒（而非葡萄酒或啤酒），与摄护腺癌呈正相关。“[91]
福瑞德哈金森肿瘤研究中心发现，每周喝4标准单位或更多红酒的男性患摄护腺癌的风险降低50%。他们“没发现饮用啤酒或烈酒有显著的影响 - 无论是积极性或是消极性 - 并且白葡萄酒不会持续性降低风险，这表示红酒中必有其他类型的酒类所缺乏的有益化合物质。而这种化合物或许是种叫做白藜芦醇的抗氧化剂，在红葡萄皮中含量丰富。”[92][94]
对2009年发表的研究所做的综合分析发现，每天仅饮用2标准单位的酒精饮料会让罹患摄护腺癌的风险增加20%。[95][96]
小肠癌[编辑]
一项针对小肠癌患者的研究报告称，饮酒与此部位的腺癌和恶性类癌有关联。[97]
“在男性和女性中，大量饮酒者 (每天超过80克)，相对于适度饮酒者和不饮酒者，风险会显著增加3倍。” [98]
“同时饮酒和吸烟，并不会增加小肠腺癌的风险......虽然目前所得的数据与烟草或酒精的主要影响不一致，但这些因素与小肠癌之间的适度关联可能被随机因素所掩盖。”[99]
证据混杂[编辑]
血友病[编辑]
孕产妇在怀孕期间饮酒与儿童血友病有关。[100]美国国家癌症研究所发表的一篇评论，把孕期饮酒归入“建议有可能”的类别，但所得结论是风险并不显著。[101]
- 急性淋巴细胞性白血病 (ALL)
对于儿童的ALL而言，怀孕时期的母亲饮酒“不太可能是造成ALL的重要危险因素”[101]
- 急性骨髓性白血病 (AML)
一项研究的结论是：“虽然我们的研究没显示酒精摄取量与血友病风险之间存在明确的关联，但某些风险估计模式（酒精摄入量与ALL、AML、和CLL（慢性淋巴细胞性白血症）可能发生剂量和反应风险的J型曲线表现，以及酒精与CML（慢性骨髓性白血病）之间的正相关）具有建议的价值。”[102]
- 儿童急性骨髓性白血病（AML）
“有三项研究报告称，在怀孕期间饮用酒精饮料的母亲，风险会增加（约1.5-2倍）。这类关联在3岁以下的儿童中的诊断出尤为明显。”[101] “孕妇在怀孕期间饮酒会增加婴儿罹患白血病的风险，尤其是AML。”[103]
- 急性非淋巴细胞性白血病 (ANLL)
一项研究发现胎儿在子宫内接触酒精会导致出生后发生ANLL的风险增加一倍。[104]
- 慢性淋巴细胞性白血病 (CLL)
一项研究的结论是：“虽然我们的研究没显示酒精摄取量与血友病风险之间存在明确的关联，但某些风险估计模式（酒精摄取量与ALL、AML、和CLL（慢性淋巴细胞性白血症）可能发生剂量和反应风险的J型曲线表现，以及酒精与CML（慢性骨髓性白血病）之间的正相关）具有建议的价值。”[102]
- 慢性粒细胞白血病 (CML)
一项在意大利进行以人群为基础的病例对照研究发现，饮酒与CML之间没有显著的正相关。[102]
- 毛细胞白血病
一项研究的结论是：“没发现吸烟、饮酒、或是喝咖啡与毛细胞白血病之间存在关联。”[105]
多发性骨髓瘤（MM）[编辑]
酒精被认为是多发性骨髓瘤（MM）的可能原因，[106]但有项对饮酒者和非饮酒者之间的比较研究中，发现饮酒和MM之间没有关联。[107]
胰脏癌[编辑]
虽然酒精滥用与胰脏炎之间的关联已被证实，但饮酒与胰脏癌之间的关联尚不清楚。总体而言，证据显示长期大量饮酒会略微增加罹患胰脏癌的风险，但证据互相冲突，有些研究发现并无关联。[108][109]但每天饮酒高达30克的风险并未增加。[110]
一般而言，这种关联一直很弱，大多数研究都没有发现有关联。[20][110][111]虽然过度饮酒是慢性胰脏炎的主要原因，而慢性胰脏炎又易导致胰脏癌，但与饮酒相关的慢性胰脏炎与其他类型的慢性胰脏炎相比，不太常成为胰脏癌的前兆。[112]
有些研究显示风险随着酒精摄取量的增加而增加。[113][114][115]重度饮酒者的风险最大，[108][109][116]主要是发生在那些每天喝4标准单位或更多的人。[117]人们每天摄取多达30克酒精（大约是每天2标准单位）的风险似乎没增加，[110][118][119]所以对大多数喝到这种数量的人而言“可能不是罹患胰脏癌的危险因素”。[109]一项汇总分析得出的结论是:“我们的研究结果是每天饮酒30克或更多的人罹患胰脏癌的风险会适度增加。”[119]
一些研究对这种发现提出警告，认为可能是由于混杂因素所造成。[108][120]即使存在连结，它“可能是由于某类酒精饮料的内容” [121]而不是酒精本身。一项在荷兰做的研究甚至发现，饮用白葡萄酒的人风险较低。[122]
“大约10分之7的慢性胰脏炎是由于长期大量饮酒所引起。慢性胰脏炎是胰脏癌的已知危险因素。但由酒精引起的慢性胰脏炎不会像其他类型的慢性胰脏炎那样增加罹患胰脏癌的风险。所以如果酒精和胰脏癌风险有联系，那种联系属于非常轻微。”[112]
“我们的研究结果显示，以美国普通人群通常饮酒水准，可能不是导致胰脏癌的危险因素。然而我们的数据显示，大量饮酒可能与胰脏癌风险有关联。”[109]
“在调整年龄、吸烟状况、和吸烟年数之后，胰脏癌的相对风险随着饮酒量的增加而增加。”[123]
“酗酒者罹患胰脏癌的风险只增加40%……酗酒者增加罹患胰脏癌的风险相对较小，可以想像是由于吸烟造成的混淆。”[108]
“研究显示，胰脏癌的相对风险随着脂肪和酒精的摄取而增加，……酒精可能与胰脏癌的病因没有直接关系：可能是由于某些酒精饮料的内含物所产生的影响。”[124]
“与不饮酒者的数据相比，以乙醇克数计算的所有类型酒精（啤酒、烈酒、红酒、和强化酒）的累积终生摄取数量……与风险无关。白葡萄酒的消费量与风险成反比…… . 白葡萄酒精饮料终生摄取数量的统一降低风险估计是基于较小的样本规模......“[125]
“在大多数情况下，酒精（葡萄酒、烈酒、和啤酒）的摄取量与胰脏癌无关。”[126]
“来自这两个大型队列研究的数据，不支持咖啡摄取量或酒精摄取量与胰脏癌风险之间有任何整体关联。”[110]
“我们的研究结果是胰脏癌的风险会适度增加，与那些每天饮酒30克或更多的人的结果一致。”[127]
不会对某些癌症增加风险[编辑]
本节列出已发表论文中未把酒精列为危险因素的癌症。
儿童星形细胞瘤[编辑]
有项研究的结论是胎儿接触酒精与儿童星形细胞瘤无关。[128]
胆管癌[编辑]
对文献的评论发现，饮酒与胆管癌之间没有关联。[129]
膀胱癌[编辑]
“关于饮酒和膀胱癌的流行病学数据，显示之间并无关联，但研究结果并不完全一致。在一些调查中观察到的膀胱癌的风险会适度增加，对此的解释或可归因于吸烟的残留混淆，或是酒精、咖啡、和尚未确定的膀胱癌危险因素之间的关联。”[130]
子宫颈癌[编辑]
一项研究的结论是“酗酒的女性罹患原发生和侵袭性子宫颈癌的风险很高”，但把饮酒归因为与生活方式相关的间接原因。[131]
乳腺导管原位癌（DCIS）[编辑]
“DCIS患者和对照受试者在口服避孕药的使用、激素替代疗法、饮酒或吸烟史、或是乳房自我检查方面的结果并无差异。在小叶原位癌(Lobular carcinoma in situ，LCIS)的关联相似。”[132]
室管膜瘤[编辑]
一篇对基础文献做的评论[133]发现，在一项研究[134]中，饮用啤酒与风险增加有关，但在另一项研究中则不然。[135]
眼内和葡萄膜黑色素瘤[编辑]
一项研究发现酒精和葡萄膜黑色素瘤之间没有关联。[136]
鼻咽癌（NPC）[编辑]
一项系统评价发现证据显示少量饮酒可能会降低患鼻咽癌的风险，而大量饮酒可能会增加风险。[137]
神经母细胞瘤[编辑]
一些研究显示，在怀孕期间饮酒会增加儿童罹患神经母细胞瘤的风险。[138]
唾液腺癌（SGC）[编辑]
饮酒与唾液腺癌风险增加有关联。[139]
睾丸癌[编辑]
一项评论得出的结论是“没有确凿的证据表明行为风险[烟草、酒精、和饮食]与睾丸癌之间存在因果关系。” [140]
甲状腺癌[编辑]
在2009年所做的一项评论发现，饮酒不会影响到罹患甲状腺癌的风险。[141]但同年有项针对490,000名男性和女性所做的研究，得到的结论是酒精可能会把罹患甲状腺癌的风险降低。[142]同一年另外一项对英国1,280,296名女性所做的研究的结论是：“我们发现饮酒与降低相关的甲状腺癌风险，与一些研究结果一致，但我们对10个病例对照研究，以及另外两个队列研究报告所做的综合分析，并没发现有统计上显著的关联。“[143]
阴道癌[编辑]
一项在丹麦进行的研究发现，“在我们的研究中，禁酒与阴道鳞状细胞癌和外阴鳞状细胞癌（VV-SCCvulva）的低风险相关联。”[144]
一项研究的结论是酗酒的女性有高风险罹患阴道癌。[131]在这两项研究中，与生活方式相关的间接原因都受到引用。
外阴癌[编辑]
一项研究报告称“牛奶、肉类、肝脏、酒精、和咖啡的摄取量与外阴癌风险之间没有一致的关联。”[145]但在丹麦的一项研究发现结果相反，饮酒与阴道鳞状细胞癌和外阴鳞状细胞癌显著相关。[144]在瑞典所做的一项研究的结论是酗酒的女性罹患外阴癌的风险并不高。[131]
可能可降低的风险[编辑]
霍奇金淋巴瘤（HL）[编辑]
有项研究的结论是：“这项大规模欧洲研究的结果……表明酒精对男性和非地中海国家的群组罹患霍奇金淋巴瘤（HL）具有保护作用。”[146]德国的一项针对人群的病例对照研究发现酒精把男性和女性罹患HL的风险降低，特别是对男性，风险降低53%。[147]
在意大利一项根据人群的病例对照研究中，提出饮酒对非吸烟者罹患HL风险有保护作用。[107]在意大利北部针对一批病例对照研究的数据分析显示，酒精对降低吸烟者和非吸烟者的HL风险有适度的正面效果。[148]
肾脏癌（肾细胞癌）（RCC）[编辑]
“在这项汇总分析中发现，适度饮酒与女性和男性罹患肾细胞癌的风险较低有关联”[149]“这项汇总分析发现饮酒与RCC之间存在负相关。纵然每天的酒精摄入量超过8标准单位（即>100克），风险仍会继续降低。“[150]
一项研究的结论是：“我们对中老年女性的前瞻性队列研究结果显示，适度饮酒可能与降低RCC风险有关联。”[151]在美国爱荷华州进行的一项研究的人员报告说，“在这个群组中针对病例对照调查，我们发现有进一步的证据显示饮酒会降低女性罹患RCC的风险，但不会降低男性罹患RCC的风险。我们在对几个新的混杂因素（即饮食、运动、家族史）进行多变量调整后，关联仍然存在，结果是更能支持真正有关联的结果。[152]
另一项研究发现，饮酒与肾脏癌风险，无论是对男性还是女性均没关联。[153]
在芬兰所做的一项研究的结论是：“这些数据显示饮酒与男性吸烟者罹患RCC的风险降低有关联。因为大多数风险降低是发生在那些摄取酒精的最高四分位数群组之中，而酒精是许多癌症的危险因素，尤其是针对吸烟者，应采取谨慎的态度来解释这些数据。”[154]“我们的数据显示，酒精摄取量与肾细胞癌风险呈负相关……”[155]对于161,126名夏威夷-洛杉矶多民族队列参与者所做的研究，每天喝1标准单位或更多的男性与不饮酒者相比，患肾癌的风险降低31%。[156]
非霍奇金淋巴瘤 (NHL)[编辑]
一项研究的结论是：“饮酒者与不饮酒者相比，前者罹患NHL的风险可能低于后者，这种风险可能因NHL的亚型而异。”[157]“饮酒者与不饮酒者相比，罹患NHL的整体风险较低。......包含NHL主要亚型。“[158]一项研究的结论是：“不饮酒者与饮酒者相比，罹患NHL的风险升高......“[159]
某些研究发现饮用某些形式的酒精饮料或某些群体的饮酒对NHL有保护作用。一项针对美国男性的研究发现，饮用葡萄酒（而非啤酒或是烈酒）与降低NHL风险有关联 [160]，有项大型欧洲研究发现，酒精对男性和非地中海国家的群组有保护作用。“[161]一项针对爱荷华州老年妇女的研究发现，酒精可降低罹患NHL的风险，同时是饮酒数量，而非酒精饮料的类型，似乎是降低风险的主要决定因素。”[162]有个解释这种现象的机制被提出。[163]
有些研究并没发现饮酒具有保护作用。英国的研究发现饮酒频率与NHL之间没有关联 [164]，瑞典的研究发现啤酒、葡萄酒、或烈酒的总摄取量与所检查的任何NHL主要亚型无关，但大量饮酒与慢性淋巴性白血病的增加有关联..”[165]
一项针对NHL患者的研究的结论是：“我们的研究结果强烈鼓励医生建议NHL患者戒烟，以及减少饮酒，以便在治疗NHL过程中得到改善。”[166]
建议最大酒精饮料摄取量[编辑]
如上所述，针对癌症风险，没有单一的建议酒精摄取量，因不同的癌症而有不同。有关不同政府所公布的指南，请参阅建议的最大酒精饮料摄取量。对于健康男性而言，每周的建议摄取数量为140–280克之间。有项综合分析提出罹患癌症的风险从低于推荐的摄取量即已开始。“饮酒者的风险与不饮酒者相比，从每天摄取25克（<2标准单位）开始，发生癌症的相对风险为：口腔癌和咽癌（相对风险（RR）1.9），食道癌（RR 1.4）、喉癌（RR 1.4）、乳癌（RR 1.3）、肝癌（RR 1.2）、大肠癌（RR 1.1）“[167][168]
世界国际癌症研究基金会建议人们将饮酒数量限制在男性每天少于2标准单位，女性每天少于1标准单位。它将“饮料”定义为每1标准单位含有约10-15克乙醇。[169]
酒精产业操纵有关酒精与癌症相关性的讯息[编辑]
在2017年发表的一项研究发现，世界领先的酒类公司所设立的掩护机构正在积极误导公众关于饮酒导致癌症相关风险的认知。这份研究报告把酒精产业的活动比拟为类似于烟草业的长期活动。报告声称业者特别着重在误导女性饮酒者，这些公司所制造与癌症相关的错误信息，大部分都集中在乳癌之上。[8]
世界各地的酒类产业也发起运动，企图把那些要求在包装贴上癌症警告标签的法律取消。[9]
参见[编辑]
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外部链接[编辑]
- International: International Agency for Research on Cancer home page
- International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 44 Alcohol Drinking: Summary of Data Reported and Evaluation
- IARC Alcoholic beverages (Group 1) Ethanol in alcoholic beverages (Group 1) VOL.: 96 5. Summary of Data Reported
- Australia: Cancer Control Bulletin Alcohol and cancer risk
- Australia: POSITION STATEMENT: Alcohol and Cancer Prevention
- Australia: Cancer Institute NSW: Alcohol as a cause of Cancer (PDF format)
- Canada: Public Health Agency of Canada / Agence de santé publique du Canada Review of Lifestyle and Environmental Risk Factors for Breast Cancer (Contents and Introduction) PDF (full report in PDF format)
- UK: Committee on Carcinogenicity of Chemicals in Food, Consumer Products Consumption of alcoholic beverages and risk of breast cancer
- UK: Committee on Carcinogenicity of Chemicals in Food, Consumer Products Evidence for association between consumption of alcoholic beverages and breast cancer
- UK: Cancer risk of drinking （页面存档备份，存于互联网档案馆）
- US: National Institute on Alcohol Abuse and Alcoholism Alcohol Alert No. 21-1993 Alcohol and cancer （页面存档备份，存于互联网档案馆）
- US: National Cancer Institute （页面存档备份，存于互联网档案馆）
- US: National Toxicology Program Report on Carcinogens, Eleventh Edition Alcoholic Beverage Consumption (PDF)
- US: Ohio Department of Health Alcohol and cancer (PDF format)
- Other sites
- Toronto Cancer Prevention Coalition Alcohol Work Group Report on the Links between Alcohol and Cancer (PDF format)
- Alcohol consumption and cancer risk
- Even small amounts of alcohol increase a woman's risk of cancer （页面存档备份，存于互联网档案馆）
- Science and medical sites
- Fred Hutchinson Cancer Research Center Alcohol Use Increases the Risk of Hormonally Sensitive Breast Cancers in Postmenopausal Women （页面存档备份，存于互联网档案馆）
- Alcohol, Cardiovascular Disease, and Cancer: Treat With Caution
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