Put in perspective – How the Mediterranean way of drinking may affect cancer risk

Barbería-Latasa M, Toledo E, Bes-Rastrollo M, Olmedo M, Pérez-Araluce R, Gea A, Martínez-González MÁ. Mediterranean Alcohol-Drinking Pattern and Alcohol-Related Cancer Incidence in the “Seguimiento Universidad de Navarra” (SUN) Cohort. Med Sci (Basel). 2025 Dec 31;14(1):20. https://doi.org/10.3390/medsci14010020.
Most people know that drinking alcohol can increase the risk of developing seven types of cancer, including cancers of the mouth, throat, oesophagus, liver, colon, and, in women, breast cancer, collectively referred to as alcohol-related cancers. Although more than 100 different cancers exist (over 200 when cell and molecular subtypes are included), alcohol is causally linked only to this specific group. This risk generally increases with the amount of alcohol consumed. Less often discussed is that drinking patterns, such as whether alcohol is consumed with meals or in large quantities in one sitting, may also influence that risk.
A Spanish research team explored this question using data from the SUN Cohort, a large, long-running health study that has followed university graduates since 1999. The cohort was originally established to investigate how the Mediterranean diet and other lifestyle factors relate to chronic diseases. Participants complete follow-up questionnaires every two years, and the study maintains an excellent retention rate of 90.6%. Building on this framework, the researchers examined whether a traditional Mediterranean drinking style, characterised by moderation, wine consumed with meals, and avoidance of binge drinking, might also influence the risk of developing alcohol-related cancers.
What is the Mediterranean Alcohol-Drinking Pattern?
This pattern of drinking has several key features:
Low to moderate amounts of alcohol
Wine, especially red wine, is the preferred drink
Alcohol is consumed with food, not on an empty stomach
Drinking is spread throughout the week, not saved for weekends
Binge drinking is avoided
Very few spirits are consumed
This pattern reflects everyday habits traditionally found in Mediterranean cultures, such as Spain, Italy, and Greece.
What did the study do?
Researchers followed 19,541 adults for nearly 14 years. Participants were grouped according to how closely their drinking habits matched the Mediterranean pattern, ranging from very little resemblance to very strong adherence. The team then documented who developed any of the seven cancers known to be caused by alcohol.
What did the study find?

1. In men, the drinking pattern made a difference
   Men who followed the Mediterranean drinking pattern most closely had a 56% lower risk of developing an alcohol-related cancer than those with the least Mediterranean pattern.
   This reduction was observed even though all men in the comparison groups consumed alcohol. The benefit appeared to stem from how they drank, not just how much.
2. In women, the pattern did not reduce cancer risk
   Women who followed the Mediterranean drinking pattern did not show a lower risk of cancer. This was expected, as most alcohol-related cancers in women are breast cancers, and even small to moderate amounts of alcohol will increase your breast cancer risk to some extent.
   Why might this pattern help men?
   Several factors may explain the reduced risk among men:
   Food helps reduce direct tissue exposure to alcohol
   Red wine contains polyphenols, natural plant compounds that may have anti-inflammatory or antioxidant effects
   Moderation avoids high-risk blood and tissue levels of alcohol
   Avoiding binge drinking prevents extreme spikes in harmful alcohol metabolites such as acetaldehyde, a known carcinogen
   Steady drinking over the week supports safer alcohol metabolism
   These effects may be particularly relevant for cancers such as colorectal cancer, which was the most common alcohol-related cancer in men in this study.
   What does this mean for the public?
   If you are a woman:
   This study reinforces existing advice that any amount of alcohol increases the risk of breast cancer.
   A Mediterranean drinking pattern does not remove this risk.
   If you are a man who chooses to drink:
   Adopting the Mediterranean way of drinking, that is, moderate amounts, wine with meals, no binge drinking, may reduce your risk of alcohol-related cancers.
   This does not mean drinking is risk-free, but it suggests that some ways of drinking are riskier than others.
   Conclusion
   Alcohol consumption is linked to seven alcohol-related cancers, and the risk generally rises with increasing intake. This study from the long-running SUN Cohort suggests that drinking patterns, not only the amount consumed, also influence risk, particularly for men. Among men who choose to drink, following a Mediterranean-style drinking pattern, which emphasises moderation, wine with meals, and the avoidance of binge drinking, may reduce the risk of developing one of these cancers. When in doubt, consult your country’s alcohol guidelines for evidence-based advice on reducing the health risks associated with alcohol consumption.