This week, we examine a landmark multicentric case-control study from India that fundamentally challenges the concept of "safe" alcohol consumption for buccal mucosa cancer (BMC) risk.

The Study

George GS et al. published in BMJ Global Health (December 2025) analyzed 1,803 BMC cases and 1,903 controls across five major cancer centres in India from 2010–2021.

What makes this study unique: it's the first to comprehensively examine both internationally-recognised liquors (IRLs) like beer and whisky, AND locally-brewed liquors (LBLs) like desi daru, tharra, and mahua—beverages consumed by millions in rural India but rarely studied.

Key Findings

Overall Alcohol Risk

• Ever-users vs never-users: OR 1.68 (95% CI 1.44–1.97)

• Even ≤9 g/day (less than one standard drink): OR 1.56 (95% CI 1.27–1.91)

• >9 g/day: OR 1.81 (95% CI 1.49–2.21)

The Tobacco Interaction

The study found a statistically significant synergistic effect (p=0.0053) between alcohol and chewing tobacco:

• Alcohol alone (>9 g/day): OR 2.66

• Chewing tobacco alone: OR 2.44

• Combined: OR 4.86 (greater than additive)

62.3% of cases were attributable to the combination of alcohol and chewing tobacco.

Clinical Takeaway

When counseling patients about oral cancer risk, the message is clear: there is no safe level of alcohol consumption for BMC prevention, especially when combined with tobacco use.

🎧 Listen to the full episode: https://hnoncology-journalclub.netlify.app/episode-005.html

📚 Reference: George GS, et al. BMJ Glob Health 2025;10:e017392.