A large comparative study published online in the open access journal BMJ Global Health has found that even low daily alcohol consumption is linked to a much higher risk of mouth cancer in India. Drinking just 9 g of alcohol per day, about the amount in one standard drink, was associated with a 50% increase in risk. The strongest link was seen among people who consumed locally brewed alcoholic beverages.

When alcohol use occurred alongside chewing tobacco, the combined effect was especially severe. Researchers estimate that this pairing may be responsible for 62% of all mouth (buccal mucosa) cancer cases in the country.

Mouth Cancer Rates Continue to Climb in India

Mouth cancer ranks as the second most common cancer in India, with an estimated 143,759 new diagnoses and 79,979 deaths each year. According to the researchers, incidence rates have steadily increased and now sit just below 15 cases per 100,000 Indian men.

The most common form affects the soft pink tissue lining the cheeks and lips (buccal mucosa). Survival outcomes remain poor, with only 43% of patients living five years or longer after diagnosis.

Untangling the Roles of Alcohol and Tobacco

Alcohol use and tobacco consumption frequently occur together, making it difficult to separate their individual effects on mouth cancer risk. This is particularly true in India, where smokeless tobacco use is widespread, the researchers note. They also point out that the health effects of locally brewed alcohol, which is especially common in rural areas, have received little attention until now.

To better understand these risks, the researchers compared 1,803 people diagnosed with buccal mucosa cancer with 1,903 randomly selected individuals without the disease (controls). Participants were recruited from five study centers between 2010 and 2021. Most were between 35 and 54 years old, and nearly 46% of cancer cases occurred among people aged 25 to 45.

Tracking Drinking Habits and Tobacco Use

Participants provided detailed information about how long they had been drinking alcohol, how often they drank, and the types of alcohol they consumed. This included 11 internationally recognized drinks such as beer, whisky, vodka, rum and breezers (flavored alcoholic drinks), along with 30 locally brewed options including apong, bangla, chulli, desi daru, and mahua.

They were also asked about their tobacco use, including duration and type, allowing researchers to examine how alcohol and tobacco interact to influence mouth cancer risk.

Among those with cancer, 781 reported drinking alcohol, while 1,019 said they did not. In the control group, 481 drank alcohol and 1,420 did not.

Higher Exposure Linked to Greater Risk

People with buccal mucosa cancer reported longer tobacco use on average, about 21 years compared with roughly 18 years among the control group. They were also more likely to live in rural areas and to consume larger amounts of alcohol each day, nearly 37 g compared with about 29 g.