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Introduction While a large proportion of buccal mucosa cancer (BMC) is attributed to tobacco use, the contribution of alcohol is little-known. In India, alcohols include internationally-recognised (IRL) and locally-brewed liquor (LBL) types, which might contribute differently to the risk of BMC. We conducted an observational study to evaluate the association of local and foreign alcoholic beverage use on the risk of developing BMC.Methods Data from 1803 BMC cases and 1903 visitor controls from a multicentric case-control study was analysed for 11 IRLs and 30 LBLs. Healthy visitor controls were randomly sampled from the source population of the study centres which enrolled the cases. Quantitative data on the amount, the number of times consumed per day or week, and the lifetime duration of consumption for each of the alcoholic beverages were collected using an interviewer administered standardised questionnaire, which was then used to estimate the grams per day consumption of alcohol. Odds ratios (OR) and 95% CI were estimated after adjustment for potential confounders, including tobacco use. The joint effect of tobacco and alcohol on BMC risk, the attributable fraction (AF) of cases and state-wise population attributable fraction (PAF) were estimated.Results An increased risk of 1.68 (95% CI=1.44–1.97), 1.72 (95% CI=1.46–2.04), and 1.87 (95% CI=1.46–2.39) was observed for ever-users of any alcohol, IRLs and LBLs, respectively for BMC. The findings show 9 grams/day of alcohol increased the risk of BMC by approximately 50%, and 62% of cases could be attributed to alcohol drinking and chewing tobacco, with an overall PAF of 11.3% for India.Conclusion This study shows that alcohol, even in low quantities, increases the risk for BMC. Prevention of consumption of tobacco and alcohol together could substantially reduce the incidence of BMC.