Alcohol consumption, even at low levels often considered ‘moderate’, has emerged as a significant risk factor for buccal mucosa cancer in India. A large multicentre study published in BMJ Global Health adds to growing evidence that there is no safe threshold of alcohol intake when it comes to oral cancers, particularly in populations with high tobacco use. The findings are especially relevant for India, where buccal mucosa cancer is the most common oral malignancy and affects a relatively younger population.
What the multicentre study examined
The study analysed data from over 3,700 men recruited between 2010 and 2021 across six cancer centres in India. It compared 1,803 men diagnosed with buccal mucosa cancer with 1,903 cancer-free controls. Researchers examined lifetime alcohol consumption patterns, covering both commercially produced beverages like beer and whisky, and locally brewed liquors such as desi daru, tharra, and mahua, which are widely consumed in rural and informal settings.
The analysis focused only on men because alcohol use among women in the study population was very low, making reliable risk estimation difficult.
Why even small amounts of alcohol matter
After adjusting for tobacco use and other confounding factors, the study found that men who had ever consumed alcohol faced a 68% higher risk of developing buccal mucosa cancer compared to non-drinkers. Crucially, even consumption below nine grams per day — less than one standard drink — was associated with a significantly increased risk.
This challenges the commonly held belief that low or occasional drinking is harmless, especially in the context of cancer risk.
Higher risks from locally brewed liquors
One of the striking findings was the particularly high risk associated with country liquors. Ever-users of locally brewed alcohol had nearly double the risk of buccal mucosa cancer compared to non-drinkers. Among these, tharra and desi daru showed the strongest associations.
Possible reasons include:
- Higher alcohol concentration and impurities
- Lack of quality control and regulation
- Patterns of consumption such as frequent sipping and prolonged mucosal contact
Commercial beverages like beer and whisky were also linked to increased risk, reinforcing that the carcinogenic effect is not limited to unregulated alcohol.
Alcohol–tobacco interaction: a compounding danger
The study highlighted a strong synergistic interaction between alcohol and tobacco use, especially smokeless tobacco such as gutkha and khaini. Men who both consumed alcohol and chewed tobacco had substantially higher risks than those exposed to either factor alone.
Researchers estimate that over 60% of buccal mucosa cancer cases in the study could be attributed to the combined use of alcohol and chewing tobacco, underlining how overlapping lifestyle risks magnify disease burden.
Implications for public health and regulation
At the population level, alcohol consumption alone accounted for about 11.3% of buccal mucosa cancer cases in India, with considerable variation across States. The disease also has a poor prognosis, with a five-year survival rate of around 43%, and a worrying proportion of cases occurring in men below 45 years of age.
The findings strengthen the case for:
- Integrated prevention strategies targeting both alcohol and tobacco together
- Stricter regulation and monitoring of locally brewed liquors
- Public messaging that clearly communicates the absence of a ‘safe’ drinking level for cancer risk
What to note for Prelims?
- Buccal mucosa cancer is the most common oral cancer in India.
- Alcohol consumption, even below one standard drink per day, increases cancer risk.
- Combined use of alcohol and smokeless tobacco accounts for a majority of cases.
- Locally brewed liquors show higher associated risks than commercially produced alcohol.
What to note for Mains?
- Discuss how lifestyle risk factors interact to worsen non-communicable disease burden in India.
- Analyse regulatory gaps in country liquor production and their public health implications.
- Examine the need for integrated alcohol–tobacco control policies rather than siloed interventions.
- Link early-age exposure to alcohol and tobacco with long-term cancer outcomes and health system costs.
