A recent study published in BMJ Global Health has found that even low daily alcohol consumption, equivalent to about one standard drink or 9 grams, is linked to a 50% increased risk of mouth cancer (specifically buccal mucosa cancer) in India. The research also indicates that the highest risk is associated with locally brewed alcoholic beverages.
Researchers analyzed data from 1,803 individuals diagnosed with buccal mucosa cancer and compared them with 1,903 control participants without the disease. The study spanned five centers across India between 2010 and 2021. Most participants were aged between 35 and 54 years, and nearly half of the cancer cases occurred among those aged 25 to 45.
Participants provided detailed information about their alcohol consumption habits—including frequency, duration, and type of beverage consumed—as well as tobacco use. Among those with cancer, more reported drinking alcohol (781 cases) compared to the control group (481 controls). Cases also had a longer average history of tobacco use—about 21 years versus 18 years for controls—and tended to live in rural areas where locally brewed drinks are more common.
The findings show that frequent alcohol intake increases the risk of buccal mucosa cancer by 68%, compared to non-drinkers. This risk rises further for those who consume internationally recognized types of alcohol (72%) and is highest among those who favor locally brewed drinks (87%). Even small amounts—less than two grams per day of beer—were linked to increased risk.
The combined use of alcohol and chewing tobacco was associated with a more than fourfold increase in mouth cancer risk. Researchers estimate that this interaction accounts for approximately 62% of all buccal mucosa cancer cases in India. Alcohol was found to be a contributing factor regardless of how long someone had used tobacco products.
The researchers suggest that ethanol may alter the fat content lining the mouth’s interior, making it more susceptible to carcinogens present in chewing tobacco products. They also note possible contamination with substances like methanol and acetaldehyde in locally brewed drinks could explain their higher associated risks due to lack of regulation.
According to their calculations, over one in ten cases (11.5%) of buccal mucosa cancers can be attributed directly to alcohol consumption—a figure rising as high as 14% in certain states such as Meghalaya, Assam, and Madhya Pradesh.
Discussing regulatory issues around alcohol production and sale in India, researchers stated: "The current legal framework for alcohol control in India is complex and involves both central and state laws. Central legislation provides protection of citizens where alcohol is included in the State List under the Seventh Schedule of the Indian Constitution, giving states the power to regulate and control alcohol production, distribution and sale. However, the locally-brewed liquor market is unregulated, with some forms used by participants containing up to 90% alcohol content."
They concluded: "In summary, our study demonstrates that there is no safe limit of alcohol consumption for [buccal mucosa cancer] risk…Our findings suggest that public health action towards prevention of alcohol and tobacco use could largely eliminate [buccal mucosa cancer] from India."
