Even low alcohol intake raises oral cancer risk in Indian men: study

Alcohol consumption, even in small amounts, significantly increases the risk of buccal mucosa cancer (BMC), a common and aggressive form of oral cancer in India, according to a large multicentre study published in BMJ Global Health.

The study analysed data from 1,803 men diagnosed with buccal mucosa cancer and 1,903 cancer-free controls recruited from six cancer centres across India between 2010 and 2021. Researchers assessed the impact of both internationally recognised liquors such as beer and whisky, and locally brewed alcohols including desi daru, tharra, and mahua — varieties often consumed in rural and informal settings.

The analysis was restricted to men, as very few women in the study reported alcohol consumption, limiting reliable risk estimates among females.

After adjusting for tobacco use and other confounding factors, men who had ever consumed alcohol had a 68% higher risk of developing buccal mucosa cancer compared with non-drinkers. Importantly, even alcohol intake below nine grams per day — less than one standard drink — was also associated with a significantly increased risk, indicating that there is no safe threshold for consumption.

Locally brewed liquors showed particularly elevated risks. Ever-users of country liquor had nearly double the risk of buccal mucosa cancer compared with non-drinkers, with tharra and desi daru emerging as the highest-risk beverages. Beer and whisky were also consistently associated with increased risk, even at lower levels of intake.

The study found a strong interaction between alcohol and tobacco use, especially smokeless tobacco. Men who consumed alcohol and chewed tobacco faced substantially higher risks than those exposed to either factor alone. Researchers estimate that more than 60% of buccal mucosa cancer cases in the study could be attributed to the combined use of alcohol and chewing tobacco. At the population level, alcohol consumption alone accounted for an estimated 11.3% of buccal mucosa cancer cases in India, with wide variation across States.

Buccal mucosa cancer is the most common form of oral cancer in India and has a poor five-year survival rate of about 43%. The study also highlights that a substantial proportion of cases occurred in men below 45 years of age, pointing to early exposure and long-term health consequences.

The findings challenge the perception that low or ‘moderate’ drinking is safe. The authors call for integrated prevention strategies addressing alcohol and tobacco together, and for stronger regulation of locally brewed liquors, which often fall outside formal licensing and quality-control systems.