Introduction

The use of alcoholic beverages goes back thousands of years, and today they are widely consumed in many societies, although certain religious groups prohibit their use. Early societies largely drank natural fermented products from a wide variety of organic materials such as grain, fruit, sap, honey, etc. Beer is brewed by fermenting malted barley and occasionally other cereals to which hops are added. Wine is made by fermenting grape juice. For the fortified wines, such as sherry, distilled spirits are added. Such spirits are made from different sources of starch or sugar – cereals, molasses, sugar beet, grapes, potatoes, cherries and other fruits. The liquid is distilled when the sugar has fermented.

Although abuse of alcoholic beverages has long been associated with physical and social ill-health, it is comparatively recently that concern has become widespread regarding their carcinogenic effects. Only certain general considerations relevant to epidemiology are presented here and reference should be made to a recent IARC (1988) publication for more detailed discussion. Their specific role is further discussed under individual cancer sites. The terms ‘alcohol’ and ‘alcoholic beverages’ are often used interchangeably.

Trends in consumption

In the mid-nineteenth century, the intake of alcoholic beverages was high in most of Europe and North America. But a decline in consumption began at the beginning of the twentieth century, which continued until the period between the two World Wars.