Alcohol Accounts for 4% of Newly Diagnosed Cancers Worldwide

Liam Davenport

July 14, 2021

Alcohol consumption accounted for 4% of all cancers diagnosed worldwide in 2020, with three quarters of these cancers occurring in men. The most common cancer locations were the esophagus, liver, and breast.

The finding comes from an analysis carried out by the International Agency for Research on Cancer. It was published online in The Lancet Oncology on July 13.

"We urgently need to raise awareness about the link between alcohol consumption and cancer risk among policymakers and the general public," said lead author Harriet Rumgay, BSc, Cancer Surveillance Branch, the International Agency for Research on Cancer, Lyon, France.

"Public health strategies, such as reduced alcohol availability, labeling alcohol products with a health warning, and marketing bans, could reduce rates of alcohol-driven cancer," she added. She noted that taxation and pricing policies already in place in Europe could be implemented worldwide.

Commenting on the study, Mark Petticrew, professor of public health evaluation at the London School of Hygiene and Tropical Medicine, London, United Kingdom, agreed that there is a need to raise public awareness about this risk. There is "a lot of misinformation out there, some from the alcohol industry itself.

"The public needs clear, independent information, and this large, robust study makes a significant contribution to clarifying the risks," he added. It "provides further clear evidence that alcohol consumption contributes to a significant burden of cancer, particularly heavy drinking."

Study Details

To estimate the burden of alcohol-attributable cancer, Rumgay and colleagues gathered cancer incidence data from GLOBOCAN 2020 for a range of cancers and for all cancers combined.

Assuming a 10-year latency period between alcohol consumption and cancer diagnosis, they examined per capita alcohol consumption estimates for 2010 from the Global Information System on Alcohol and Health. The estimates were stratified by age and sex.

The results suggested that 741,300 (4.1%) of all incident cancer cases in 2020 were attributable to alcohol consumption, with 568,700 (76.7%) of those cases occurring in men.

The age-standardized incidence rate of alcohol-attributable cancer was 13.4 per 100,000 in men and 3.7 per 100,000 in women.

The most common types of cancer attributable to alcohol consumption were esophageal cancer (189,700 cases; 31.6%), liver cancer (154,700 cases; 17.3%), and breast cancer (98,300 cases; 4.4%).

Heavy drinking (defined as >60 g/d), accounted for 46.7% of the alcool-attributable cancers. Risky drinking (defined as 20–60 g/d), accounted for 29.4%.

Moderate drinking (<20 g/d, which is the equivalent of around two daily drinks) contributed 13.9% of cases of alcohol-attributable cancers.

The analysis also found that by region, the largest proportions of cancer cases attributable to drinking were in eastern Asia (5.7%) and in central and eastern Europe (5.6%). The lowest were in western Asia (0.7%) in northern Africa (0.3%).

At the country level, the estimated proportion of cancer cases attributable to alcohol was highest in Mongolia (10%) and lowest in Kuwait (0%).

In China, the estimated proportion of cancer cases linked to alcohol was 6%. In India and France, it was 5%; in Germany, Brazil, and the United Kingdom, 4%; and in the United States, 3%.

Regarding gender differences in cancer rates, the team writes that "increases in alcohol consumption in women have been reported as women have taken on a larger share of paid employment.

"This finding is clearly reflected in countries highly indexed in development, where we saw the highest burden of alcohol-attributable cancers in women and the most similar male-to-female ratios of alcohol-attributable cancer rates.

"In these regions, breast cancer was the main driver of the high alcohol-attributable cancer incidence rates among women," they add.

In an accompanying comment, Amy C. Justice, MD, PhD, from the Department of Medicine and Health Policy and Management, Yale University, West Haven, Connecticut, said that the results are "useful," but she questioned how alcohol consumption was measured.

"Until we address limitations in measurement, we might be underestimating health risks, especially cancer risks, associated with alcohol," she warned.

The use of commercial alcohol sales to estimate consumption has "major limitations," and the use of self-report is "worse," she said.

"Furthermore, neither commercial sales nor current self-report reflect past alcohol consumption," which has "especially important implications for genetic studies...and for understanding associations between alcohol use and cancers that commonly have extended latency periods.

"Surely, we can do a better job," said Justice.

She suggests measuring direct alcohol biomarkers, such as phosphatidylethanol, which is an "abnormal" phospholipid that forms in the presence of ethanol and bonds to red blood cells.

Measuring levels over time, "coupled with a careful history of use," such as one based on a biomarker, could help determine not only current but also past alcohol exposure.

"We do not ask people with diabetes what their glycosylated hemoglobin is, we check it," Justice pointed out.

"Then we discuss their risk of adverse health outcomes informed by the test results and their personal risk profile. We should use a similar approach to counseling patients regarding risk from alcohol," she said.

Commenting for the UK Science Media Center, Sadie Boniface, PhD, head of research at the Institute of Alcohol Studies, King's College London, London, United Kingdom, described the new analysis as "comprehensive and well-designed."

She added that the results are "in line with other studies, and scientists already knew that alcohol causes seven types of cancer," including cancer of the breast, esophagus, mouth, and throat.

However, this risk has not been well communicated to the general public, she said. In the United Kingdom, a forthcoming consultation on alcohol labeling represents a "real opportunity" to help consumers to "make fully informed decisions about their drinking."

Beyond labeling, the authors' recommendations on policies to target alcohol pricing, availability, and marketing are needed as "part a comprehensive alcohol strategy in the wake of the pandemic" to address the burden of alcohol, she added.

No funding for the study has been described. Boniface reports working at the Institute of Alcohol Studies, which receives funding from the Alliance House Foundation. No other relevant financial relationships were reported.

Lancet Oncol. Published online July 13, 2021. Full text

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