Nearly half of all deaths due to cancer worldwide are caused by so called modifiable risk factors. These cancer risk factors can be modified, meaning prevented by government policies that create healthier environments and reduce people’s exposure to the risk factors. The most common cancer risk factors – smoking, alcohol use, and obesity are all modifiable. At the global level, alcohol is among the leading risk factors for the global cancer burden. In fact, alcohol accounted for 7.4% of all cancer DALYs in males in 2019 – making it the second biggest risk factor after tobacco.
Alcohol use is a top-three risk factor for cancer across all three socio-demographic Index (SDI) levels as well as for age-standardised DALY rates.
Growing cancer burden in Uganda
These major risk factors are all present in the skyrocketing cancer burden in Uganda today.
New findings in Uganda show that the number of new cancer cases is growing at a rate never seen before. The number of new cancer cases is higher in the central region of the country, with women at a higher risk in two of the three affected regions.
According to the Uganda Cancer Institutes (UCI), cancer frequency is at 125.4 per 100,000 among males. The number among females is slightly higher at 134.6 per 100,000 women in the central region.
The geographical breakdown of cancer cases in Uganda is as follow:
Annual new cancer cases – 33,600 (approximate)
- The central region: 125.4 per 100,000 among males and 134.6 per 100,000 in females,
- The western region: 58.2 per 100,000 among males and 56.5 per 100,000 in females, and
- The eastern region: 46.5 per 100,000 in males and 53.7 per 100,000 in females.
- Aged 50 and above: 16,137
- 0-19 years: 3,084
- Most frequent cancer types in women: cervical, breast, esophagus, Kaposi’s sarcoma, stomach
- Most frequent cancer types in men: prostate, esophagus, Kaposi’s sarcoma, stomach, liver
Clear ceographical differences in frequency of cancer cases
The most frequently presented cancer types affecting women were found to be cervical, breast, stomach, oesophagus, and Kaposi’s sarcoma. The latter three, including prostate and liver cancer are among the cancer types found most often among men.
Dr. Annet Nakaganda, a cancer epidemiologist who led the study, emphasises that there may be a number of different factors that affect the difference between the numbers presented in the different regions in the country, as per Monitor reporting:
Several factors could explain this observation, including underutilisation and inaccessibility of cancer care facilities by other regions compared to central, under diagnosis of cancer cases in other regions compared to central, treatment based migration from other regions to central seeking cancer care.”
Dr Annet Nakaganda, cancer epidemiologist
However, he does not rule out the possibility of a true difference in the risk and the magnitude of exposure to cancer risk factors between the regions.
The Role of alcohol in skyrocketing cancer burden
Ethanol (alcohol) causes cancer through biological mechanisms as the compound breaks down in the body, which means that any beverage containing alcohol, regardless of its price and quality, poses a risk of developing cancer.”
World Health Organization
Carcinogens are substances capable of causing cancer in living tissue.
Alcohol is a toxic, psychoactive, and dependency-producing substance which has been classified as a Group 1 carcinogen. The International Agency for Cancer Research, which carried out this classification, defines Group 1 carcinogens as the highest risk group. It also includes asbestos, radiation, and tobacco.
Alcohol is found to be a direct causal factor for at least seven types of cancer. This includes the most common cancer types such as bowel cancer and female breast cancer.
Ethanol causes cancer through biological mechanisms that occur as the compound breaks down in the body. This means that alcohol consumption increases cancer risk irrespective of the beverage, price, and quality.
The Uganda study indicates that alcohol may be among the most important risk factors in rising cancer cases in the country. It is especially attributed to an increase in deaths from liver cancer in Uganda.
Earlier this year, the World Health Statistics revealed that Uganda tops African countries with the highest alcohol consumption. On average, each person in Uganda consumes 12.21 liters of alcohol per year.
This is much higher than the African region average of 6.3 liters, and the global average of 6.18 liters per person per year reflected in the WHO global status report on alcohol and health, 2018.
After Uganda, Seychelles and Tanzania are found to be countries with second and third highest alcohol use in Africa.
- The report also shows a difference in the alcohol consumption levels of men and women.
- Men use alcohol more than women in Uganda.
- On average, men consume about 19.93 liters of pure alcohol annually, while women consume 4.88 liters.
Uganda’s statistics are particularly worrying because alcohol causes a high burden of disease – including cancer – and has significant social and economic consequences in the country.
The UCI data shows that alcohol use disorder affects up to 26% of males in the country. This is a staggering number. With increasing life expectancy the cancer burden in Uganda is likely to further grow – if the government does not invest in preventive measures, such as alcohol policy solutions.
Uganda’s healthcare system is and will not be capable of coping with a further increase in the national cancer burden.
Alcohol policy solutions for cancer prevention
Alcohol policy solutions would be key in cancer prevention in Uganda. For example, reducing alcohol consumption by 10% is proven to lead to a 9% reduction in alcohol-related cancer deaths.
Movendi International maintains a rigorously updated resource page tracking the latest policy and scientific developments pertaining to the best buy solutions recommended by the World Health Organization.
The best buy solutions recommended by the Union for International Cancer Control for alcohol prevention are taxation, banning advertising, and limiting alcohol availability.
Contextualising “Harmful Use of Alcohol”
The present study makes reference to the flawed concept of “harmful alcohol consumption”. This flawed concept is increasingly rejected and increased by the scientific and NCDs prevention and control community. Especially in the context of cancer “harmful alcohol use” is a highly ambiguous term that leads people to think that there may be a level of use that is ‘harmless’.
But already low levels of alcohol consumption are linked to almost 23,000 new cancer cases per year in the EU.
Increasing awareness among all stakeholders on the role alcohol plays as driver of the cancer burden in Uganda is important to facilitate high-impact solutions.
For example:
- Alcohol is linked with 740,000 new cancer cases each year globally.
- In the EU, low dose alcohol use causes almost 23,000 cancer cases per year.
- Almost half of these 23,000 cases were female breast cancer cases.
- More than a third of cancer cases caused by low-dose alcohol use was linked to very small amounts of alcohol intake.
An overview of alcohol’s cancer burden in the European region alone would be a clear reflection of the role alcohol policy would play in cancer prevention in Uganda.
Similarly, the total health burden of alcohol also needs to be taken into account in Uganda.
For Further Reading
Uganda resource page with 60+ articles.
