Alcohol use behind six in ten mouth cancer cases in India, study finds

A large Indian study finds no safe level of alcohol for mouth cancer risk, especially when combined with smokeless tobacco, with locally brewed drinks posing the highest danger

Mouth cancer in India has long been blamed on tobacco use. But a major new study suggests alcohol plays a significant role as well.

 

Researchers analysing data from across the country found that even low levels of drinking, below what many consider “moderate”, can raise the risk of buccal mucosa cancer, which affects the soft, moist lining of the inner cheeks and lips.

 

The study, Association of alcohol and different types of alcoholic beverages on the risk of buccal mucosa cancer in Indian men, published in BMJ Global Health, reports that alcohol, particularly when combined with chewing tobacco, may be responsible for over six in ten cases of the disease nationwide.

 

 

According to the researchers, buccal mucosa cancer is the most common form of oral cancer in India. Around 1,40,000 new cases are diagnosed every year, and survival remains poor, with fewer than half of patients living beyond five years.

 

What is especially concerning is that many patients are diagnosed in their most productive years. In this study, nearly half the cases were among men aged 25–45, highlighting a major public health and economic burden.

How was the study conducted?

 

Researchers from the Centre for Cancer Epidemiology and the Homi Bhabha National Institute analysed data from 1,803 men with confirmed buccal mucosa cancer and 1,903 cancer-free controls across five major centres in India between 2010 and 2021.  ALSO READ | Early cancer detection improving but treatment costs drain savings: Report 

Unlike earlier research, this study examined not only internationally marketed alcohol types such as beer, whisky and vodka, but also locally brewed drinks including desi daru, mahua, apong, bangla and tharra, which are often produced in unregulated settings.

Does alcohol increase mouth cancer risk even at low intake?

 

The study found that, compared with non-drinkers, men who consumed alcohol had a 68 per cent higher risk of developing buccal mucosa cancer. Even less than nine grams of alcohol a day, roughly one standard drink, was linked to about a 50 per cent increase in risk.

 

These findings challenge the belief that light or occasional drinking is harmless when it comes to mouth cancer.

Are some alcoholic drinks more dangerous than others?

All types of alcohol were associated with increased risk, but locally brewed drinks showed the strongest link. Men who consumed locally made alcohol had an 87 per cent higher risk of buccal mucosa cancer compared with non-drinkers.

 

Internationally recognised drinks such as beer and whisky were also linked to a significantly elevated risk. Researchers suggest that contamination with toxins such as methanol and acetaldehyde in unregulated local brews may explain their stronger association with cancer.  ALSO READ | Scientists edge closer to a universal cancer vaccine using nanoparticles

What happens when alcohol and chewing tobacco are used together?

According to the study, alcohol and smokeless tobacco products such as gutkha, khaini and paan interact in a way that is more harmful than either exposure alone.

 

The researchers estimate that 62 per cent of buccal mucosa cancer cases in India can be attributed to the combined use of alcohol and chewing tobacco. Alcohol may increase the permeability of the mouth lining, allowing carcinogens from tobacco to penetrate more easily.

How large is alcohol’s contribution to mouth cancer nationally?

The researchers report that about 11.5 per cent of buccal mucosa cancers in India are attributable to alcohol use alone. In high-burden states such as Meghalaya, Assam and Madhya Pradesh, this figure rises to around 14 per cent or more, reflecting regional drinking patterns.

Is there really no safe limit of alcohol?

Ethanol is classified as a Group 1 carcinogen by the International Agency for Research on Cancer. Its by-product, acetaldehyde, can damage DNA and promote cancer development.

 

The study observed increased cancer risk even at very low consumption levels, lower than what many guidelines describe as moderate. As the authors note, there appears to be no safe level of alcohol use when it comes to buccal mucosa cancer.