artifact produced by converting consumption data (for example, alcohol intake per week) into daily averages. Unfortunately, very few cohort studies have information about drinking patterns, so it is not known whether a consumption of, say, 70g alcohol per week is consumed as one drink per day spread over six or seven days, or as binge drinking on weekends. There is no empirical justification for the practice of converting consumption data into daily averages, and study results suggest that the harm associated with relatively low weekly volumes of consumption may be largely attributable to the contribution of just a few heavy drinking days.7 “Patterns of alcohol consumption are hypothesized to modify the risk relationship between alcohol consumption and breast cancer,” Shield et al wrote in a review of alcohol and breast cancer.8
“However, only
a few drinking-pattern studies exist, and epidemiological evidence on this effect modification is limited and inconsistent.” Shield et al presented six studies in the review, but three other published studies were not noticed by the authors, and since then, four new studies with data on drinking pattern and cancer risk have been published. Overall, the findings provide evidence for an increased risk associated with heavy episodic drinking, especially among moderate lifetime drinkers. For example, Ma et al defined a healthy drinking habit score (DHS) by regular drinking (frequency of alcohol intake three times per week) and by consuming alcohol with meals.9
One point was
given for each favorable drinking habit (range of 0–2). After adjustment for potential confounders and amount of alcohol consumed, regular drinking was associated with an 8% lower risk of cancer mortality as compared with non-regular drinking. Compared with participants who consumed alcohol outside meals and those who had
varying patterns, participants who consumed alcohol with meals had a 10% lower risk of cancer mortality. A positive linear association of alcohol intake and cancer mortality was observed in participants with an unfavorable DHS, whereas a U-shaped association was observed in participants with favorable DHS. A moderate alcohol intake (50–200g per week) was not associated with cancer mortality in participants with a favorable DHS.
Underreporting of alcohol intake Self-reported information on alcohol consumption is known to underestimate true consumption. Systematic underreporting of consumption by both cases and controls would result in an overestimation of the relative risk of breast cancer for a given level of alcohol consumption. Moreover, the shape of the dose-response relationship could be changed if heavy drinkers were more likely to underreport intake than moderate drinkers. Taken together, these reporting errors imply that some uncertainty remains about the true quantitative effect of an intake of a fixed amount of alcohol on the risk of developing cancer. In a cohort study of cancer risk in participants reporting light to moderate drinking, the increased risk of cancer was concentrated in the stratum suspected of underreporting.10
The WHO warning has an absurdity to it, and the evidence base for a signifi cant association between light drinking and risk of cancer is fraught with weak associations and methodological issues
Conclusion
Recommendations from the WHO and other health authorities use several uncertain consensus statements to guide us to a healthy lifestyle. The WHO warning of “no safe level of alcohol consumption” has an absurdity to it, and the evidence base for a significant association between light drinking ( 10g alcohol per day) and risk of cancer is fraught with weak associations and methodological issues. The WHO statement is more political than medical, and that’s a disservice to sensible, moderate wine drinkers.
NOTES 1. H Bastide, Population 9 (1954), p.13. 2.
who.int/europe/news/item/04-01-2023- no-level-of-alcohol-consumption-is-safe- for-our-health
3. P Rovira and J Rehm, “Estimation of Cancers Caused by Light to Moderate Alcohol Consumption in the European Union,” European Journal of Public Health 31 (2021), pp.591–96.
4. H Hendriks and W Calame, “The Contribution of Alcohol Consumption to Overall Cancer Incidence in the Western World: A meta- analysis,” Journal of Nutritional Health Science 5 (2018), p.308.
5. JP Higgins, SG Thompson, JJ Deeks, DG Altman, “Measuring Inconsistency in Meta-Analyses,” British Medical Journal 327 (2003), pp.557–60.
6. B Løyland, IH Sandbekken, EK Grov, I Utne, “Causes and Risk Factors of Breast Cancer— What Do We Know for Sure? An Evidence Synthesis of Systematic Reviews and Meta- Analyses,” Cancers 16 (2024), p.1583.
7. G Knupfer, “Drinking for Health: The daily light drinker fi ction,” British Journal of Addiction 82 (1987), pp.547–55.
8. KD Shield, I Soerjomataram, J Rehm, “Alcohol Use and Breast Cancer: A critical review,” Alcohol: Clinical Experimental Research 40 (2016), pp.1166–81.
9. H Ma, X Li, T Zhou, D Sun, I Shai, Y Heianza, et al, “Alcohol Consumption Levels as Compared with Drinking Habits in Predicting All-Cause Mortality and Cause-Specifi c Mortality in Current Drinkers,” Mayo Clinic Proceedings 96 (2021), pp.1758–69.
10. AL Klatsky, N Udaltsova, Y Li, D Baer, et al, “Moderate Alcohol Intake and Cancer: The role of underreporting,” Cancer Causes Control 25 (2014), pp.693–99.
THE WORLD OF FINE WINE | ISSUE 87 | 2025 | 91
Illustration by Dan Murrell
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