Several toxicological and epidemiological studies were published during the last five decades on non-sugar sweeteners (NSS) and cancer. Despite the large amount of research, the issue still continues to be of interest. In this review, we provided a comprehensive quantitative review of the toxicological and epidemiological evidence on the possible relation between NSS and cancer. The toxicological section includes the evaluation of genotoxicity and carcinogenicity data for acesulfame K, advantame, aspartame, cyclamates, saccharin, steviol glycosides and sucralose. The epidemiological section includes the results of a systematic search of cohort and case-control studies. The majority of the 22 cohort studies and 46 case-control studies showed no associations. Some risks for bladder, pancreas and hematopoietic cancers found in a few studies were not confirmed in other studies. Based on the review of both the experimental data on genotoxicity or carcinogenicity of the specific NSS evaluated, and the epidemiological studies it can be concluded that there is no evidence of cancer risk associated to NSS consumption.
A comprehensive quantitative review of toxicological and epidemiological data on the possible relation between low/no calorie sweeteners and cancer by Pavanello et al (2023) concluded that there is no evidence of cancer risk associated to low/no calorie sweeteners’ consumption.
The first section of the study presents toxicological evidence including genotoxicity and carcinogenicity data individually for each of the following sweeteners: acesulfame K, advantame, aspartame, cyclamates, saccharin, steviol glycosides and sucralose. The review considered all published data including from studies published after other recent reviews (such as by Chappell et al, 2020a; Chappell et al, 2020b; Wikoff et al, 2020; Chappell et al, 2021). The authors concluded that the overall weight of the evidence indicates that low/no calorie sweeteners are not genotoxic nor carcinogenic, which is in line with the conclusions of many regulatory bodies that evaluated these sweeteners over the years.
The second section presented the results of a systematic review of cohort and case-control observational studies evaluating the potential association between low/no calorie sweeteners and cancer incidence or mortality. Overall, 22 cohort and 46 case-control studies were included in the review, including 20 studies published after, or not considered in the WHO review by Rios-Leyvraz and Montez (2022). The majority of observational studies showed no associations between low/no calorie sweeteners’ intake and risk of cancer. Therefore, a consistent association between low/no calorie sweeteners’ intake and cancer risk can be excluded. Some risks for bladder, pancreas and hematopoietic cancers found in a few studies were not confirmed in others. Several factors including differences in the assessment of sweeteners’ intake were important sources of heterogeneity.
The authors stressed that low/no calorie sweeteners, like other food additives, are subjected to strict safety control, and explained that, based on the review of experimental data on genotoxicity and carcinogenicity and epidemiological studies, it can be concluded that there is no evidence of cancer risk associated to low/no calorie sweeteners’ consumption.