UB researcher contributes to National Academies report on alcohol and health outcomes

BUFFALO, N.Y. – A University at Buffalo researcher was part of a committee writing a report outlining linkages between low to moderate alcohol consumption and health outcomes.

The report was released last month by the National Academies of Sciences, Engineering, and Medicine, and came out just weeks before U.S. Surgeon General Vivek Murthy released a new advisory on the direct link between drinking alcohol and increased cancer risk.

The surgeon general’s advisory calls for updating the health warning labels on alcoholic beverages to include the greater cancer risk.

In addition to the relationship between moderate alcohol consumption — defined as two drinks in a day for men and one drink for women — and certain types of cancer, the National Academies report also examined linkages to seven other health outcomes, including cardiovascular disease, weight changes, all-cause mortality, and neurocognitive health.

Jo L. Freudenheim, PhD, SUNY Distinguished Professor in the Department of Epidemiology and Environmental Health in UB’s School of Public Health and Health Professions, served on the 15-member Committee on the Review of Evidence on Alcohol and Health, which wrote the report at the request of Congress.

The report will help inform the next edition of the U.S. Dietary Guidelines for Americans, which was last updated in 2020. The next update of the guidelines, which are revised every 5 years, is expected to be released in the next few months.

The review on alcohol consumption and cancer — Freudenheim’s area of expertise — is a big part of the National Academies’ latest report.

“Within the research community, it has long been known that alcohol causes seven different kinds of cancer, and that there is a wealth of information about the impact of alcohol on breast cancer,” Freudenheim says. Past research, she notes, has found a linear association between alcohol use and breast cancer, meaning that drinking in low amounts has been shown to lead to a small increase in risk, while heavy drinking is linked to a proportionately larger increase in breast cancer risk.

“But there is less awareness within the general population of the relationship of alcohol to cancer, even though it’s been established for a long time,” Freudenheim adds. “That is beginning to change, people are becoming more aware of the health effects of alcohol. Understanding the role of alcohol in cancer is important.”

There is growing concern around the globe about the health effects of alcohol. In June, the World Health Organization issued a statement saying that “There is no form of alcohol consumption that is risk-free.”

While the WHO provided more of a blanket statement, Freudenheim said she finds Canada’s guidance on alcohol and health to be more useful in that these guidelines outline the continuum of risk associated with alcohol use, breaking that risk down by the amount of drinks consumed per week.

“The Canadian guidelines say that there is no amount without risk, but if you drink, here is the impact,” Freudenheim says. “There are things we do every day, like driving, that entail risk. The question with alcohol consumption is, what level of risk are we comfortable with, and how do we handle that?”

Freudenheim also co-authored a paper published last month in the journal Breast Cancer Research that examined the effects of quitting drinking compared to continuing drinking alcohol on breast cancer risk according to hormone receptor status: estrogen receptor positive (ER+) and estrogen receptor negative (ER-).

There are several different subtypes of breast cancer, Freudenheim explains, and there is evidence that there are differences in what causes these subtypes. “Alcohol is generally found to be more associated with ER positive than ER negative breast cancer,” she says.

The study suggests that alcohol cessation, compared to continuing to drink, is associated with lower risk of ER+ breast cancer and but not ER- breast cancer. One of the strengths of the meta-analysis conducted by the researchers is that the assessment of breast cancer risk for alcohol cessation was compared to that for continuing consumption rather than to abstention from drinking.

“The higher risk for cessation compared with abstention may be due to longer term effects related to prior alcohol consumption,” the researchers say.

In 2023, Freudenheim was a co-author on a report in the New England Journal of Medicine in which the International Agency for Research on Cancer (IARC) issued a summary review of alcohol reduction or cessation and cancer risk.

Freudenheim was part of a working group of 15 scientists from eight countries that reviewed published studies and evaluated the strength of epidemiologic evidence on the potential for alcohol reduction or cessation to reduce alcohol-related cancer risk.

“We found that for some kinds of cancer there’s not enough research yet, but for oral and esophageal cancer, there is strong research that if you cut down or stop drinking it will reduce your risk,” Freudenheim says.