levels of insulin and inflammation, may also increase the risk of breast, colorectal, prostate, endometrial, liver, and ovarian cancers, regardless of an individual’s BMI (190). Continuing to understand the mechanisms by which diabetes contributes to cancer risk may help identify opportunities for intervention. Encouragingly, keeping blood sugars low through eating a healthful diet rich with vegetables, fruits, and whole grains; engaging in physical activity; reducing or eliminating alcohol consumption; and stopping smoking can significantly reduce the risk of cancer in people with diabetes. It is essential that patients with diabetes be aware of their increased cancer risk and undergo recommended age- and sex-appropriate cancer screenings. Limit Alcohol Consumption The consumption of alcohol is linked to more than 200 diseases and increases the risk of six different types of cancer including certain types of head and neck cancer, esophageal squamous cell carcinoma, and breast, colorectal, liver, and stomach cancers. Nearly four percent of cancers diagnosed worldwide in 2020 can be attributed to alcohol consumption (191). In the U.S., it is estimated that from 2013 to 2016, 75,000 cancer cases and 19,000 cancer deaths were linked to alcohol (192). All alcoholic beverages pose a risk for cancer development because they contain ethanol, which can modulate hormones, and its byproducts can damage DNA, which increases the risk of developing cancers (193). The greatest risks are associated with long-term alcohol consumption and binge-drinking, i.e., when large amounts of alcohol are consumed in a short period of time (194). Even light intake of alcohol can increase an individual’s risk for certain cancers, while moderate drinking can increase the risk of developing certain cancers of the head and neck, breast, and colon and rectum (195-198). Following guidelines for alcohol consumption (see Sidebar 13, p. 46) can help to lower the risk of developing alcohol-related cancers. Research indicates that those who reduce or stop drinking alcohol can decrease their risk of developing alcohol-related Guidelines for Alcohol Consumption The U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2020-2025, do not recommend that individuals who do not drink alcohol start drinking for any reason. There are also some people who should not drink at all, such as those who are pregnant or might be pregnant; are under the legal age for drinking; have certain medical conditions or are taking certain medications that can interact with alcohol; and if they are recovering from an alcohol use disorder or if they are unable to control the amount they drink. If adults age 21 and older choose to drink alcoholic beverages, drinking less is better for health than drinking more. The guidelines recommend (199): IF ALCOHOL IS CONSUMED, IT SHOULD BE DONE IN MODERATION. Moderate drinking Only by adults of legal drinking age ACCORDING TO THE NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM: Heavy drinking Binge drinking Excessive alcohol consumption Includes binge drinking, heavy drinking, and any drinking by pregnant women or those under 21 years of age. Adapted from (1). ≥ 3 drinks on any day or ≥ 7 drinks per week for women ≥ 4 drinks on any day or ≥14 drinks per week for men ≥ 4 drinks within 2 hours for women ≥ 5 drinks within 2 hours for men ≤ 1 drink per day for women ≤ 2 drinks per day for men The following are reference beverages that are one alcoholic drink-equivalent: 12 fl oz of regular beer (5% alcohol) 5 fl oz of wine (12% alcohol) 1.5 fl oz of 80 proof distilled spirits (40% alcohol) SIDEBAR 13 AACR Cancer Progress Report 2023 Reducing the Risk of Cancer Development 46
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