Welcome to the Special Edition World Cancer Day 2024 of the Alcohol Issues Newsletter.
We curate state of the art information about the science of alcohol’s cancer burden, the potential of alcohol policy solutions for cancer prevention, the lack of public recognition of alcohol as cause of 7 types of cancer, and the strategies of the alcohol industry to keep people in the dark about the fact that their products are carcinogenic.

Special Alcohol Issues podcast episode

Cancer due to alcohol affects millions of people every year but the alcohol industry still keeps people in the dark about the fact that their products cause 7 types of cancer.

In a brand new podcast conversation for World Cancer Day 2024, we discuss an action agenda to address the link between alcohol and cancer: How can communities advance cancer prevention through awareness and policy action on alcohol.

We have invited four guests to discuss how the alcohol industry keeps people in the dark about alcohol and cancer and what we can do about it. And we explore insights and lessons from both science and community action in countries such as Sweden, Uganda, and Colombia to chart an ambitious way forward.

Growing recognition of the direct link between alcohol and cancer in 2023

On the Alcohol Issues News Center, we have so far published more than 240 resource articles about alcohol and cancer: science digests, alcohol policy news, revelations about how Big Alcohol attacks cancer prevention efforts, as well as community action stories and opinion columns.

Just last year, 2023, the global discourse about alcohol and cancer saw tremendous progress.

Cancer due to alcohol affects millions of people every year but the alcohol industry keeps people in the dark about the fact that their products cause 7 types of cancer. At the same time, we see that people and communities demand urgent action to prevent more cancer cases and effective policy solutions.

And in 2023 both policy and scientific developments advanced the public conversation about the carcinogenic effects of alcohol products. A great example is the WHO statement on alcohol and cancer and the risks linked to low-dose alcohol use. Another remarkable example is the new code against cancer for Latin America and the Caribbean. A third excellent example is the imminent introduction of cancer warning labels on alcohol products in Norway and Ireland.

But major challenges remain: lack of awareness among the public that the products of alcohol companies cause 7 types of cancer and lack of political action to protect people from alcohol’s carcinogenic effects.

State of the art information about the science of alcohol’s cancer burden

The risks and harms caused by alcohol have been systematically evaluated over the years and are well documented.

Based on this evidence, the World Health Organization published a statement in early 2023 in The Lancet Public Health synthesising the evidence into a clear statement: when it comes to alcohol consumption, there is no safe amount that does not affect health.

And in a widely noticed opinion column, Kristina Sperkova shared her analysis of the WHO statement and provided 6 reasons why this new WHO publication is a game changer.

Science knows about the link between cancer and alcohol since the 1980s. The International Agency for Research in Cancer (IARC), the WHO’s cancer research body, classified alcohol as class one carcinogen in 1988.

The IARC working group wrote: “There is sufficient evidence in humans for the carcinogenicity of alcohol consumption. Alcohol consumption causes cancers of the oral cavity, pharynx, larynx, esophagus, colorectum, liver (hepatocellular carcinoma) and female breast.”

World-class research report: Alcohol and cancer

International research has shown that alcohol causes cancer, even at low- and medium-consumption levels. This report includes estimates that almost 30% of the cases of alcohol-induced cancer in Sweden are due to small or low levels of alcohol consumption, and that the more alcohol the individual consumes, the greater the cancer risk is.

Additionally, the cost of hospital treatment of alcohol-induced cancer exceeded SEK 320 million in Sweden in 2014. The report also includes estimates of the percentage of Swedish deaths from cancer where alcohol was a factor, in order to highlight the importance of the issue and to intensify initiatives aimed at prevention and information provision.

The report’s key messages

  1. Alcohol causes cancer.
  2. Any alcohol consumption increases the risk of cancers. The higher the level of alcohol use, the bigger is the increase in cancer risk.
  3. There is no safe level of alcohol consumption.
  4. A considerable proportion of all cancer cases and deaths is caused by low levels of alcohol consumption.
  5. In recent years the evidence base has grown that alcohol is causally linked to an increasing array of cancer types.
  6. It is the responsibility of governments to ensure that people are made aware of the scientifically established fact that alcohol causes cancer.
  7. Information about alcohol and health is also a responsibility for medical practitioners.

5 Facts about Alcohol and Cancer

  1. Alcohol causes at least seven types of cancer.
  2. The most common types of cancer due to alcohol are different for men and women.
  3. The risk of cancer from alcohol consumption increases from the first alcoholic drink.
  4. Using tobacco as well as alcohol multiplies cancer risks.
  5. Cancers due to alcohol consumption are preventable.

No Safe or Healthy Amount of Alcohol Use

Evidence shows that, in general, the more alcoholic drinks people consume, the higher the risk of many cancers, according to the World Cancer Research Fund International’s Continuous Update Project (CUP).

For some cancers, there is an increased risk with any amount of alcohol consumed, whereas for other cancers the risk becomes apparent from a higher level of consumption.

Alcohol decreases the survival chances of cancer patients. A recent study of 2929 cancer patients, 552 (18.8%) patients engaged in alcohol consumption and 2377 (81.2%) patients had no alcohol history. The study showed that patients in the Alcohol Group had significantly shorter overall survival than patients in the Non-Alcohol Group.

New study revealed staggering amount of lost productivity from cancer deaths due to alcohol

  • An estimated 23,300 cancer deaths in people aged < 65 years in Europe in 2018 were due to alcohol.
  • Premature deaths from alcohol-attributable cancer cost €4.58 billion in productivity losses.
  • Productivity losses equalled 0.027 % of the total Gross Domestic Product of the 31 countries in 2018.
  • Public health officials must prioritise implementation of cost-effective policies to reduce alcohol consumption and prevent alcohol-attributable cancer deaths.
€4.6 Bn
Productivity loss from cancer deaths due to alcohol
Premature deaths from alcohol-attributable cancer cost €4.58 billion in productivity losses.

And in a recent study from Switzerland, scientists combined and weighed data from multiple sources to study a group of over 2000 people, representative of the target population. Results confirm a clear link between alcohol consumption and cancer mortality, also when people were consuming alcohol below recommended “safe” levels.

Alcoholic drinks are a cause of various cancers, irrespective of the type of alcoholic drink consumed. The causal factor is evidently the ethanol itself. The extent to which alcoholic drinks are a cause of various cancers depends on the amount and frequency of alcohol consumed.”

WCRF/ AIRC Continuous Update Project

A 2022 Global Burden of Disease study revealed alcohol is a leading risk factor for cancer.

The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI.
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 levels as well as for age-standardised DALY rates.

Similar efforts for alcohol policy as in tobacco control, including taxation and advertisement bans, have been recommended to help reduce exposure to alcohol.

And a 2021 study, published in The Lancet, found that alcohol caused over 740,000 cancer cases, worldwide in 2020. This translates to one in 25 cancers caused by alcohol. Men are the most affected, accounting for 77% of the cases (568,700) compared to 23% (172, 600) of women who were affected.

Cancer cases caused by alcohol globally
A new study finds alcohol caused 741,300 or 4% of all cancers in 2020, globally.

No level of alcohol consumption is safe, according to the study. While most cancers were caused by heavy (47%) or high risk (39%) alcohol use, even low-risk alcohol use led to cancer 14% of the time.

There’s strong evidence that [consuming] alcohol can cause seven types of cancer, and the more someone [uses alcohol] the greater their risk. There’s no safe level of [alcohol use], but whatever your [alcohol use] habits cutting down can reduce your risk of cancer,” said Michelle Mitchell, Cancer Research UK’s chief executive, as per The Guardian.

Michelle Mitchell, chief executive, Cancer Research UK

The largest proportion of new cancers caused by alcohol were cancers of the oesophagus (189,700 cases), liver (154,700 cases), and breast (98,300 cases).

Geographically, the largest number of alcohol caused cancers (6%) were from Eastern Asia, Central and Eastern Europe, while the lowest (1%) was found in Northern Africa and Western Asia.

Alcohol caused breast cancer cases
Breast cancer is strongly fueled by alcohol. in 2020, alcohol caused nearly 100.000 breast cancer cases globally.

In 2021, the World Health Organization Regional Office for Europe and the International Agency for Cancer Research released a factsheet about alcohol and cancer. It provides five important facts for policy makers, health professionals, and the general public about the links between alcohol consumption and a range of cancer types.

This affects not only people who consume alcohol but also their families, friends and communities.

  1. Alcohol causes at least seven types of cancer.
  2. The most common types of cancer due to alcohol are different for men and women.
  3. The risk of cancer from alcohol consumption increases from the first alcoholic drink.
  4. Using tobacco as well as alcohol multiplies cancer risks.
  5. Cancers due to alcohol consumption are preventable.

The potential of alcohol policy solutions for cancer prevention

Proven solutions are available for politicians to help raise awareness and prevent cancer cases and deaths due to alcohol.

Of 180,887 new alcohol-attributable cancer cases and 85,130 deaths in the WHO European Region in 2019, 5.9% and 5.7%, respectively, (or 10,700 cases and 4,850 deaths) could have been avoided by increasing excise duties by 100%.

According to the scientific model, alcohol-attributable female breast cancer and colorectal cancer contributed most to the avoidable cases and deaths.

Cancer cases from alcohol that can be prevented through doubling alcohol taxation
Increasing the alcohol excise tax by 100% would lead to a 5.9% reduction of cancer cases caused by alcohol and a 5.7% reduction of cancer deaths caused by alcohol – meaning 10,700 cases and 4,850 deaths could be prevented by doubling the alcohol excise tax.

Case study of alcohol taxation and cancer prevention in Lithuania

A total of 15,857 new cancer cases (8,031 in women and 7,826 in men) and 8,534 cancer deaths (3,757 in women and 4,777 in men) were recorded in Lithuania in 2018. Using the attributable fraction methodology, researchers estimated that 4.8% or 761 of these new cancer cases were attributable to alcohol use (284 in women; 477 in men), as well as 5.5% or 466 cancer deaths (115 in women; 351 in men). 

With the alcohol taxation increase of 2017, 45 new cases and 24 deaths will be averted over the next 10 years. Further taxation increases of 100% could double the number of new cancer cases averted or saved.

Economic benefit of alcohol taxation for cancer prevention

Using OECD’s SPHeP-NCD advanced system modelling tool, a 2020 study estimated the health and economic impact of interventions targeting three preventable risk factors with a known link to cancer – unhealthy diets, physical inactivity and alcohol consumption.

Results from the model indicate each of the six interventions lead to a reduction in the number of new cancer cases. Interventions targeting the price of alcohol, namely through a higher tax and alcohol floor price, are estimated to yield the greatest health impact by reducing the number of new related cancer cases by 174,193 and 141,175 over years 2020–2050, respectively.

Consequently, demand for disease treatment will fall leading to a reduction in costs and an improvement in the financial sustainability of the health system. These results highlight the health and economic benefits associated with primary prevention interventions, especially alcohol policy, targeting cancer.

Sugar, rum and tobacco are commodities which are nowhere necessary for life, which have become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.”

Smith A. An Inquiry into the Nature and Causes of the Wealth of Nations, McMaster University Archive for the History of Economic Thought, 1776

New Latin America and the Caribbean Code Against Cancer includes recommendations on alcohol avoidance and alcohol taxation

In October 2023, PAHO and IARC launched the Latin America and Caribbean Code against Cancer. It recommends avoiding alcohol to people and advises governments to use alcohol taxation, other alcohol policy best buys, and alcohol warning labels to prevent cancer.
A consortium comprising experts and civil society delegates hailing from Latin America and the Caribbean crafted a new set of preventive measures for cancer. These recommendations draw from the latest scientific insights and have been tailored to address prevalent situations in the subregion.

Lack of public recognition of alcohol as cause of 7 types of cancer

Awareness about the carcinogenic nature of alcohol is low around the world. Attempts to increase awareness have been limited and constitute a significant public health need.

For example, research in Europe has shown that 1 in 10 Europeans are not aware of the link between alcohol and cancer, and that one in five do not believe there is a connection between cancer and alcohol.

Part of the reason is the alcohol industry (see below).

Another reason is media reporting – often also influenced by the alcohol industry.

For example, in a 2021 study, researchers found the portrayal of the alcohol-cancer link to be conflicting and unbalanced at times and that it tended to emphasise individual choice and responsibility in modifying health behaviours – meaning a framing the benefits the alcohol industry and harms public health.

Research shows that half of smokers would quit cigarettes if they knew the increased risk of mouth cancer that smoking causes. And 40% of alcohol users would quit alcohol consumption if they knew the increased cancer risks due to alcohol.

Evidence shows that informing people, increasing awareness and understanding of alcohol’s cancer risks leads to bigger support for alcohol policy solutions.

In a 2022 study researchers showed that U.S. Americans who believed that alcohol had no effect/decreased cancer risk had lower odds of support for advertising ban, warning labels, and guidelines than U.S. Americans aware of the alcohol–cancer link. Moreover, those who used alcohol heavily had lower odds of support for advertising ban, warning labels, and guidelines than those who did not use alcohol.

Awareness of the alcohol–cancer link was associated with policy support. Increasing public awareness of the alcohol–cancer link may increase support for alcohol policy solutions.

Be Loud For Change campaign

The Be Loud For Change campaign is an initiative to increase awareness and drive policy change regarding the link between alcohol and cancer. The focus is on engaging people and communities in the topic and in the advocacy for policy change and raising awareness.

The campaign highlights the need for policy action and exposes the role of the alcohol industry in keeping people in the dark about the alcohol-cancer link.

2018 review of 32 studies examining ordinary people’s awareness of alcohol as a risk factor for cancer in 16 countries showed that awareness is low internationally.

In general, people are more likely to endorse alcohol as a risk factor when presented with a list of possible risk factors than when asked to list risk factors in an open-ended format.” 

Jennifer K. Scheideler and William M.P. Klein, in: “Awareness of the Link between Alcohol Consumption and Cancer across the World: A Review” (2018)

​Attempts to increase public recognition of alcohol’s carcinogenicity, especially through public policy action, have been limited and constitute a significant public health need. 

The campaign Be Loud For Change is going to change that.

Strategies of the alcohol industry to keep people in the dark about the fact that their products are carcinogenic

Alcohol companies and their front groups hide the fact that their products cause cancer.

Alcohol’s cancer risk is well known and documented across the world. Nevertheless, the public remains largely unaware of this risk. Evidence shows that Big Alcohol is doing everything they can from muddying the science to propagating myths to keep people in the dark.

Big Alcohol influence and legal threats to shut down some of the studies and distorting and denying of data show that Big Alcohol hides the fact that “alcohol causes cancer” from the public.

For example, a 2021 study exposed in total 3284 respondents to industry-sponsored messaging about product-related risks and compared their responses to in total 3297 people who were exposed to non-industry messages. 

Across all industries, exposure to industry-sponsored messages led to greater reported uncertainty or false certainty about risk, compared to non-industry messages.

For instance, the alcohol industry deploys Alternative Causation arguments and they generated significantly greater uncertainty about harms of tobacco, alcohol, sugar sweetened beverages and fossil fuel harms.

Alcohol and breast cancer“It’s important to put the risks from drinking alcohol into context. There are many other factors that increase the risk of developing breast cancer, some of which we can’t control, like:
– Age: you’re more likely to develop it as you get older
– A family history of breast cancer 
– Being tall 
– A previous benign breast lump
However, in addition to alcohol, other lifestyle factors such as being overweight and smoking are thought to increase your risk of developing breast cancer.”

Source: Petticrew et al, 2017 (Drinkaware, UK)
“Alcohol is a Group 1 Carcinogen.
Like Tobacco.”

Source: Balance North East

Special Feature for World Cancer Day: Tackling Alcohol As Major Cause of Cancer

For World Cancer Day 2024, Movendi International produced a Special Alcohol Issues Feature, raising awareness about the link between alcohol and cancer and outlining state of the art evidence about the need and potential for policy change.