This Notice highlights interest in receiving investigator-initiated grant applications addressing the effects of alcohol on human health across the cancer control continuum.

Alcohol is classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC). Worldwide, 5.5% of newly diagnosed cancer cases and 5.8% of cancer deaths are attributable to alcohol use, including 5.6% of cases and 4.0% of deaths in the United States (U.S.). Epidemiological and biological research has established that alcohol consumption increases the risk of at least seven different cancers in humans, including mouth and oropharyngeal, laryngeal, esophageal, female breast, colorectal, stomach, and liver cancer. Alcohol use is estimated to be the third largest contributing risk factor for cancer in women and the fourth largest for men in the U.S., following cigarette smoking, ultraviolet (UV) radiation exposure (men), and excess body weight.

Renewed global attention to these risks and a 2018 statement from the American Society of Clinical Oncology support efforts to place alcohol as a behavioral risk factor into the cancer control research agenda. Research is vital to addressing this major modifiable risk factor across the cancer control continuum, notably in studies focused on prevention, treatment, and survivorship. Further research is also needed to clarify dose-response relationships between alcohol and cancer risk, especially at low alcohol doses, and to better understand genetic and epigenetic variation in alcohol-induced carcinogenesis.

Topics of particular interest include communication about and awareness of alcohol as a risk factor for cancer, research on the biological and behavioral mechanisms through which alcohol affects cancer risk, research on the interaction between alcohol use and other health risk behaviors relevant to cancer, alcohol consumption and outcomes in cancer patients and survivors, studies of alcohol-related policy and its influence on cancer and the cancer burden, and methodological research supporting better understanding links between alcohol and cancer. A preponderance of past research has focused on heavy drinkers and alcohol use disorder; this Notice encourages research addressing light and moderate alcohol consumption, including studies of light and moderate drinkers with any other contributing risk factors, such as smoking and environmental exposures. Addressing alcohol consumption is important given that the large proportion of light and moderate drinkers contribute substantially to the population burden of alcohol-related carcinogenesis, such as the development of breast and colorectal cancers in human.

Research encouraged through this notice includes, but is not limited to, studies that:

• Address communicating uncertainty and complexity in relation to alcohol, cancer, and health outcomes at multiple levels;
• Understand and improve patient-provider communication, including identification of barriers, with patients regarding alcohol and cancer in both primary and specialty care;
• Address effects of warning labels on all alcohol-containing products in relation to alcohol and cancer prevention;
• Improve estimates of dose-response relationships between alcohol consumption and cancer in humans and/or animal models;
• Examine alcohol effects alone and in concert with other risk factors in humans such as tobacco use on cancer comorbidities, quality of life, and mortality to improve intervention efforts;
• Develop and improve measures of alcohol-related behaviors and attitudes as they relate to cancer over the life course;
• Examine effects of light and moderate alcohol consumption on aging trajectories and diagnosis and treatment of cancer in the elderly to identify strategies to limit alcohol exposure;
• Examine interactions between alcohol consumption and energy balance as it relates to cancer prevention and control;
• Evaluate and model effects of alcohol-related policy on the cancer burden in diverse populations;
• Examine disparities in alcohol consumption patterns and the relationship to cancer in humans by race/ethnicity, socioeconomic factors, and sexual and gender minority status;
• Test innovative approaches to the dissemination and implementation of proven alcohol cessation interventions in diverse cancer survivor populations and settings;
• Examine risk of cancers following drinking reduction or cessation;
• Explore decision-making processes regarding alcohol consumption by patients and caregivers before and along the cancer care continuum;
• Increase understanding of mechanisms linking alcohol consumption, cancer treatment effectiveness, and risk of recurrence or second cancers to identify targets for intervention; and
• Examine alcohol use post-diagnosis in relation to cancer treatment, prognosis, recurrence, and second primary tumors to identify targets for interventions.

Application and Submission Information

This Notice applies to due dates on or after June 5, 2020, and subsequent receipt dates through September 8, 2023.

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcement through the expiration date of this notice.

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

• For funding consideration, applicants must include NOT-CA-20-034 in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.

Although the NCI and the NIAAA are is not listed as a Participating Organization in all the FOAs listed above, applications for this initiative will be accepted.