Even a single daily glass of alcohol can significantly increase the risk of mouth cancer in India, particularly when paired with chewing tobacco, according to a major new study that calls into question long-held assumptions about "safe" drinking limits. 

The study, published in the open-access journal BMJ Global Health, focuses on buccal mucosa cancer, a type of oral cancer that affects the soft pink lining between the cheeks and lips. This is the second most frequent cancer in India, with an estimated 1.43 lakh new cases and approximately 80,000 fatalities per year. Less than half of individuals diagnosed live more than five years. 

Between 2010 and 2021, the study examined data from 1,803 individuals with proven buccal mucosa cancer and 1,903 participants who did not have the disease at five Indian sites. Researchers looked thoroughly at alcohol and tobacco usage, including both commercially available drinks and locally made spirits that are widely used in rural regions. 

The results are startling. People who drank alcohol were 68% more likely to acquire buccal mucosa cancer than those who did not drink. The risk increased to 87 per cent among people who mostly consumed locally made alcohol. Even consuming 9 grammes of alcohol each day—roughly one standard drink—was connected to a nearly 50% increase in risk. 

The danger increases when alcohol and chewing tobacco are combined. According to the study, the interaction between the two is responsible for 62% of all buccal mucosa cancer cases in India. Researchers explain that alcohol increases the permeability of the mouth lining, allowing cancer-causing chemicals from tobacco to flow through more easily and destroy cells. 

Local spirits appear to be particularly damaging. Toxin contamination, such as methanol and acetaldehyde, combined with extremely high alcohol levels, could explain the increased risk. The legal framework for alcohol limitation in India is complex, involving both central and state regulations. However, the locally made spirits business is unregulated, with some versions consumed by participants containing up to 90% alcohol," the researchers write. 

The condition is becoming more prevalent among working-age adults. Nearly half of the cases investigated were adults aged 25 to 45, highlighting the significant public health burden. Alcohol is projected to cause 11.5% of buccal mucosa cancers nationwide, with rates rising to 14% in high-burden areas such as Meghalaya, Assam, and Madhya Pradesh. 

Reputed surgical oncologist and Director of   Dr Bhubaneswar Borooah Cancer Institute. It is a unit of Tata Memorial Centre under the Department of Atomic Energy, Govt of India, Guwahati, Dr Bibhuti Bhusan Borthakur, says that the combination of alcohol and tobacco exacerbates their negative effects. "This is true for all locations, including the oesophagus, stomach, pancreas, and liver, and not just oral tumours. This also applies to tobacco-related cardiac disease," he said while replying to a question.

The study concludes that there is no safe level of alcohol consumption for preventing buccal mucosa cancer. With over two-thirds of cases linked to both alcohol and tobacco use, the data raise an urgent question: does India's cancer prevention messaging require a complete overhaul?