Cancer Causes & Control

, Volume 25, Issue 6, pp 693–699 | Cite as

Moderate alcohol intake and cancer: the role of underreporting

  • Arthur L. Klatsky
  • Natalia Udaltsova
  • Yan Li
  • David Baer
  • H. Nicole Tran
  • Gary D. Friedman
Original paper



There is compelling evidence that heavy alcohol drinking is related to increased risk of several cancer types, but the relationship of light–moderate drinking is less clear. We explored the role of inferred underreporting among light–moderate drinkers on the association between alcohol intake and cancer risk.


In a cohort of 127,176 persons, we studied risk of any cancer, a composite of five alcohol-associated cancer types, and female breast cancer. Alcohol intake was reported at baseline health examinations, and 14,880 persons were subsequently diagnosed with cancer. Cox proportional hazard models were controlled for seven covariates. Based on other computer-stored information about alcohol habits, we stratified subjects into 18.4 % (23,363) suspected of underreporting, 46.5 % (59,173) not suspected of underreporting, and 35.1 % (44,640) of unsure underreporting status.


Persons reporting light–moderate drinking had increased cancer risk in this cohort. For example, the hazard ratios (95 % confidence intervals) for risk of any cancer were 1.10 (1.04–1.17) at <1 drink per day and 1.15 (1.08–1.23) at 1–2 drinks per day. Increased risk of cancer was concentrated in the stratum suspected of underreporting. For example, among persons reporting 1–2 drinks per day risk of any cancer was 1.33 (1.21–1.45) among those suspected of underreporting, 0.98 (0.87–1.09) among those not suspected, and 1.20 (1.10–1.31) among those of unsure status. These disparities were similar for the alcohol-related composite and for breast cancer.


We conclude that the apparent increased risk of cancer among light–moderate drinkers may be substantially due to underreporting of intake.


Cancer Risk factors Alcohol drinking Underreporting Epidemiology 



The research was performed at the Division of Research of the Kaiser Permanente Medical Care Program, Oakland CA with support by a Community Budget grant from the Kaiser Foundation Research Institute to Yan Li, MD, PhD as Principal Investigator. Data collection in 1978–1985 was supported by a grant to Dr. Arthur L. Klatsky from the Alcoholic Beverage Medical Research Foundation of Baltimore, MD. We are grateful to Cynthia Landy for assistance with data collection.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Arthur L. Klatsky
    • 1
  • Natalia Udaltsova
    • 1
  • Yan Li
    • 2
  • David Baer
    • 2
  • H. Nicole Tran
    • 3
  • Gary D. Friedman
    • 1
    • 4
  1. 1.Division of ResearchKaiser Permanente Medical Care ProgramOaklandUSA
  2. 2.Department of Hematology and OncologyKaiser Permanente Medical Care ProgramOaklandUSA
  3. 3.Department of Internal MedicineKaiser Permanente Medical Care ProgramOaklandUSA
  4. 4.Department of Health Research and PolicyStanford University School of MedicineStanfordUSA

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