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Alcohol consumption linked to 4% of global cancer cases – WHO study

Alcohol consumption appeared linked to more than 740,000 new cancer diagnoses in 2020 – equivalent to 4% of cases worldwide – according to a World Health Organization study conducted by an international team of researchers and published in The Lancet Oncology, writes Mark Leiser for Healio.

Heavy alcohol consumption contributed to a high number of cancer cases. However, moderate drinking – defined as up to two alcoholic drinks per day – contributed to more than 103,000 cancer cases last year, or nearly one in seven alcohol-associated malignancies.

“We urgently need to raise awareness about the link between alcohol consumption and cancer risk among policy-makers and the general public,” said Harriet Rumgay, a doctoral student in cancer surveillance with WHO's International Agency for Research on Cancer in Lyon, France.

“Public health strategies – such as reduced alcohol availability, labelling alcohol products with a health warning, and marketing bans – could reduce rates of alcohol-driven cancer.

“Tax and pricing policies that have led to decreased alcohol intake in Europe, including increased excise taxes and minimum unit pricing, could also be implemented in other world regions,” Rumgay added. “Local context is essential for successful policy around alcohol consumption and will be key to reducing cancer cases linked to drinking.”

Other researchers are from the Centre for Addiction and Mental Health in Toronto, Canada; the Centre for Research and Information on Substance Abuse in Uyo, Nigeria; the American Cancer Society in Atlanta; and the Netherlands Comprehensive Cancer Organisation in Utrecht.

Prior research has established links between alcohol use and development of multiple cancers, according to the Healiostory published on 14 July 2021.

Rumgay and colleagues conducted a population-based modelling study to provide global, regional and national estimates of the alcohol-attributable cancer burden in 2020 in hopes of informing alcohol policy and cancer control in various settings.

They used data on alcohol exposure from nearly all countries – both surveys and sales figure – as well as the most recent relative risk estimates for cancer based on alcohol consumption levels.

They calculated how various types of alcohol consumption – moderate (< 20 g, equivalent to about two drinks per day), risky (20 g to 60 g per day, equivalent to two to six drinks per day) or heavy (> 60 g per day, or more than six drinks) – contributed to the total alcohol-attributable cancer burden, Healio continued.

Rumgay and colleagues determined that 741,300 new cancer cases – 4.1% of all newly diagnosed patients worldwide – were attributable to alcohol consumption. Men accounted for more than three-quarters of all alcohol-attributable cancer cases.

The most common malignancies included cancers of the esophagus (189,700 cases), liver (154,700 cases) and breast (98,300 cases).

Population-attributable fractions appeared highest in eastern Asia (5.7%) and central/eastern Europe (5.6%) and lowest in northern Africa (0.3%) and western Asia (0.7%). North America had the fourth-lowest population-attributable fraction of 17 regions assessed.

Heavy drinking accounted for the largest burden of alcohol-attributable cancers (46.7%), followed by risky drinking (39.4%) and moderate drinking (13.9%).

Mark Leiser continues in Healio that the results demonstrate the need for interventions and effective policy to raise awareness about alcohol consumption’s effect on cancer risk, researchers concluded.

“Alcohol consumption causes a substantial burden of cancer globally,” said Dr Isabelle Soerjomataram, deputy branch head of the cancer surveillance branch at International Agency for Research on Cancer, in a press release.

“Yet the impact on cancers is often unknown or overlooked, highlighting the need for implementation of effective policy and interventions to increase public awareness of the link between alcohol use and cancer risk, and decrease overall alcohol consumption to prevent the burden of alcohol-attributable cancers.”

Limitations of the data used in the analysis must be acknowledged, Amy C Justice, professor of medicine and professor of public health policy at Yale School of Medicine, wrote in an accompanying comment.

Approximately one-quarter of global alcohol consumption occurs outside government-controlled channels and, therefore, is not included in sales data, Justice wrote. Self-report also can underestimate alcohol use among heavy drinkers and those with health conditions that are exacerbated by alcohol use, she added. Also, neither commercial sales nor current self-report reflect past alcohol consumption, which might be as influential as current use.

Direct alcohol biomarkers are available. These include phosphatidylethanol, an abnormal phospholipid formed in the presence of ethanol. While phosphatidylethanol is detectable only within 28 days of exposure, it could provide a useful measure of alcohol exposure and enable more accurate estimation of health risks.

See link to the full Healio article below.

 

Study details

Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study

Harriet Rumgay, Kevin Shield, Hadrien Charvat, Pietro Ferrari, Bundit Sornpaisarn, Isidore Obot, Farhad Islami, Valery EPP Lemmens, Jürgen Rehm and Isabelle Soerjomataram

Author affiliations: International Agency for Research on Cancer in Lyon, France; Centre for Addiction and Mental Health in Toronto, Canada; Centre for Research and Information on Substance Abuse in Uyo, Nigeria; the American Cancer Society in Atlanta, United States; and the Netherlands Comprehensive Cancer Organisation in Utrecht.

Published in The Lancet Oncology on 13 July 2021.

 

Summary

Alcohol use is causally linked to multiple cancers. We present global, regional and national estimates of alcohol-attributable cancer burden in 2020 to inform alcohol policy and cancer control across different settings globally.

Methods

In this population-based study, population attributable fractions (PAFs) calculated using a theoretical minimum-risk exposure of lifetime abstention and 2010 alcohol consumption estimates from the Global Information System on Alcohol and Health (assuming a 10-year latency period between alcohol consumption and cancer diagnosis), combined with corresponding relative risk estimates from systematic literature reviews as part of the WCRF Continuous Update Project, were applied to cancer incidence data from GLOBOCAN 2020 to estimate new cancer cases attributable to alcohol.

We also calculated the contribution of moderate (<20 g per day), risky (20–60 g per day), and heavy (>60 g per day) drinking to the total alcohol-attributable cancer burden, as well as the contribution by 10 g per day increment (up to a maximum of 150 g). 95% uncertainty intervals (UIs) were estimated using a Monte Carlo-like approach.

Findings

Globally, an estimated 741,300 (95% UI 558,500–951,200), or 4·1% (3·1–5·3), of all new cases of cancer in 2020 were attributable to alcohol consumption. Males accounted for 568,700 (76·7%; 95% UI 422,500–731,100) of total alcohol-attributable cancer cases, and cancers of the oesophagus (189,700 cases [110,900–274,600]), liver (154,700 cases [43,700–281,500]), and breast (98,300 cases [68,200–130,500]) contributed the most cases.

PAFs were lowest in northern Africa (0·3% [95% UI 0·1–3·3]) and western Asia (0·7% [0·5–1·2]), and highest in eastern Asia (5·7% [3·6–7·9]) and central and eastern Europe (5·6% [4·6–6·6]).

The largest burden of alcohol-attributable cancers was represented by heavy drinking (346,400 [46·7%; 95% UI 227,900–489,400] cases) and risky drinking (291,800 [39·4%; 227,700–333,100] cases), whereas moderate drinking contributed 103,100 (13·9%; 82,600–207,200) cases, and drinking up to 10 g per day contributed 41,300 (35,400–145,800) cases.

Interpretation

Our findings highlight the need for effective policy and interventions to increase awareness of cancer risks associated with alcohol use and decrease overall alcohol consumption to prevent the burden of alcohol-attributable cancers.

 

Healio story – Alcohol consumption linked to 4% of global cancer cases (Open access)

 

The Lancet Oncology article – Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study (Open access)

 

See also from the MedicalBrief archives

 

Light to moderate alcohol may reduce risks of cancer, CVD and mortality

 

Alcohol consumption associated with nearly 5% of US cancer cases

 

Cancer Research UK wants action on alcohol ignorance

 

Link between alcohol and 7 cancers is 'strongly causal'

 

 

 

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