Alcohol-related Cancers in Mississippi, 2003-2019

Excess alcohol consumption is a modifiable risk factor that increases the risk of developing certain cancers. According to data from the Behavioral Risk Factor Surveillance System for 2020, 5.8% of Mississippi adults reported heavy drinking (men having more than 14 drinks per week and women having more than seven drinks per week). Mississippi is tied for the eighth lowest rate of heavy drinking.¹ Excessive alcohol use is associated with cancers of the lip, oral cavity, pharynx, colon and rectum, breast in females, esophagus, liver, and larynx.³ Below are graphs of the trends in alcohol-related cancers over the period 2003 to 2019 by race and sex with a description of the trends occurring in each group and a comparison of rates between groups for the most recent time period of 2015 to 2019. All analysis was done using SEER*Stat software².

While lip, oral cavity, and pharynx cancer is associated with excessive alcohol use, it is also associated with another modifiable risk factor, tobacco use. Cancers of the oropharynx may also be associated with Human Papillomavirus (HPV) infection. Males had significantly higher rates of lip, oral cavity, and pharynx cancers than females. Over the period from 2003 to 2019, only black males experienced a significant change in incidence rates. The rate for black males decreased annually by 1.76%. The rate for black females was also slightly decreasing at an observed rate of 0.08%. The rates for white males and white females were observed to be increasing. The rate for white males increased at a rate of 0.63% annually, and the rate for white females increased at a rate of 0.74% annually.

For the latest five-year time period of 2015 to 2019, black males and black females had a similar trend to that of the overall time period of 2003 to 2019. Though not statistically significant, the rate for black males was decreasing at a rate of 3.21% annually, and the rate for black females was decreasing at a rate of 2.00% annually. White males and white females had an opposite trend compared to the full time period of 2003 to 2019. Though not statistically significant, the rate for white males decreased at a rate of 0.95% annually, and the rate for white females decreased at a rate of 0.61% annually.

While colorectal cancer is associated with alcohol use, it is also associated with other modifiable risk factors, tobacco use (both colon and rectum cancers), obesity (both colon and rectum cancers) and lack of physical activity (only colon cancer). Black males had significantly higher rates of colorectal cancer than all other groups except for in years 2003 and 2004 where their rates were similar to those of white males. Colorectal cancer rates decreased significantly in all groups for the period between 2003 and 2019. Black females had a significant decrease of 1.86% annually, and black males had a significant decrease of 0.70% annually. White males had a significant decrease of 1.14% annually. Conversely, white females had a significant decrease between 2003 and 2011 of 2.24% and then experienced an observed increase of 0.83% annually between 2011 and 2019. This translate to an overall significant average annual decrease of 0.7% over the full time period for white females.

For the latest five-year period of 2015 to 2019, black males and black females had similar significant trends to those for the full time period from 2003 to 2019. For black males, the trend for the latest five year period was a decrease of 1.39% annually. For black females, the most recent trend observed was a decrease of 2.99% annually. White males experienced an observed decreasing trend between 2015 and 2019 of 0.74%. The trend for white females between 2015 and 2019 is similar to the trend between 2011 and 2019. The observed rate of increase for white females was 0.56%.

Overall, female breast cancer is associated with excessive alcohol use. In addition, post-menopausal breast cancer, which is defined as breast cancer diagnosed in women over the age of 50, is associated with both obesity and lack of physical activity. The rates of female breast cancer were similar between white and black females. Both white and black females had a statistically significant annual increase between 2003 and 2019. The annual percent increase over that period for white females was 0.67%, and the annual percent increase for black females was 0.78%. For the most recent five-year period between 2015 and 2019, white females had a significant increase in invasive breast cancer of 1.43% annually. Black females also saw an increase of 2.24% annually, though this was not a statistically significant trend.

While esophageal cancer is associated with excessive alcohol use, it is also associated with another modifiable risk factor, tobacco use. Additionally, adenocarcinoma of the esophagus can be associated with obesity. Males had significantly higher rates of esophageal cancer than females. The rates were similar by race for females and similar for males beginning in 2013. The annual percent change over the period from 2003 to 2019 for white males, white females, and black females was not statistically significant. For white males, the annual percent increase was 0.25% and for white females was 0.72%. Black females had an annual decrease of 0.87%. Black males had a statistically significant annual decrease of 3.33%.

For the latest five-year time period of 2015 to 2019, white males and black males had a similar trend to what was observed for the full time period of 2003 to 2019. The trend for 2015 to 2019 for white males was an annual increase of 1.79% and for black males was an annual decrease of 2.19%, neither of which were statistically significant. For white females and black females, the trend for the most recent time period was opposite of the full time period from 2003 to 2019, though neither of the trends for 2015 to 2019 were statistically significant. White females had a decreasing trend for 2015 to 2019 of 7.78% annually, and black females had an increasing trend of 9.84% annually.

While liver cancer is associated with excessive alcohol use, it is also associated with other modifiable risk factors, tobacco and obesity. Males had significantly higher rates of liver cancer than females. The rates were similar between the races for each sex group. For white males, the incidence rate increased significantly between 2003 and 2017 at a rate of 4.63% annually. Between 2017 and 2019, the rate for white males decreased at an observed rate of 8.73% annually. The rate for white females showed an annual decrease of 10.02% from 2003 to 2007, but then showed a significant increasing trend from 2007 to 2019 with an annual increase of 5.18%. The annual percent increase for black males was 1.13% and for black females was 1.42%.

For the latest five-year period of 2015 to 2019, trends were decreasing for all groups but white females. For white males, the trend for the last five year period was a decrease of 0.67% annually, and for black males, the most recent trend observed was a decrease of 10.03% annually. For black females, the decrease was a statistically significant 5.03% annually. In contrast to the other groups, white females had an observed increase of 4.25% annually between 2015 and 2019.

While laryngeal cancer is associated with excessive alcohol use, it is also associated with another modifiable risk factor, tobacco use. Laryngeal cancer is a relatively rare cancer. Thus, the rates could not be broken down by both race and sex. This graph only displays the rates by race. Over the period from 2003 to 2019, the significant annual decrease for the white population was 1.51%. For the black population, the significant annual percent change from 2003 to 2019 was a decrease of 1.31%. For the latest five-year time period of 2015 to 2019, the black populations saw a decreasing trend, while the white population had an increasing trend. These trends were not statistically significant. For the black population, the trend was an annual decrease of 1.11%, and for the white population, the trend was an annual increase of 0.54%.

Definitions

Age Adjusting: A statistical method that allows comparisons of populations that take into account age-distribution differences between the populations. The 2000 U.S. standard population is used and applied to all of the time periods being considered. This assures that the rates do not reflect differences in the age distribution of the population.

Annual Percent Change (APC): The average annual percent change over several years. It is used to measure the change in rates over time. Calculating the APC involves fitting a straight line to the natural logarithm of the data when it is displayed by calendar year.

Statistical Significance: This is a mathematical measure of the difference between groups. A difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone 95% of the time. Rate ratios were used to assess the statistical significance between groups.

Citations

¹ Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2020. [accessed Apr 5, 2020]. URL: https://www.cdc.gov/brfss/brfssprevalence/.

²Surveillance Research Program, National Cancer Institute SEER*Stat software (seer.cancer.gov/seerstat) version 8.3.9.1.

³Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. Alcohol and Cancer [online]. 2021. [accessed Jun 13, 2022]. URL: https://www.cdc.gov/cancer/alcohol/index.htm

Source of Data: SEER*Stat Database: MS0219. Created on 11/30/2021. Mississippi Cancer Registry 2021 Submission (2002-2019) to Centers for Disease Control and Prevention, National Program of Cancer Registries.

Acknowledgement

We acknowledge the Centers for Disease Control and Prevention for their financial support under a cooperative agreement awarded to the Mississippi Cancer Registry.