This story provides a state of the art evidence overview of the direct link between alcohol and breast cancer.
And it illustrates how alcohol policy in general, and alcohol taxation in particular can help prevent and reduce breast cancer cases and deaths.

Alcohol is a major risk factor for the most common cancer among women, breast cancer.

In fact, a 2024 study showed that alcohol is the biggest risk factor for breast cancer in Europe. In 2019, results of risk factors attributable to breast cancer revealed that the proportion of DALY for

  • Tobacco were 22.2%,
  • Alcohol use were 33.1%,
  • High fasting plasma glucose were 17.4%,
  • High body-mass index were 10.9%,
  • Diet high in red meat were 13.0%, and
  • Low physical activity were 3.4% in Europe.
33%
Alcohol is the biggest risk factor for breast cancer burden in Europe
In 2019, alcohol caused 33.1% of DALYs lost due to breast cancer.

Alcohol use emerged as a primary risk factor for the burden of breast cancer in Europe, with proportions exceeding 30% in both Eastern and Western Europe. 

Yu S, Cai X, Wang X, Lin X and Cai S (2024) Disease burden of breast cancer and risk factors in Europe 44 countries, 1990-2019: findings of the global burden of disease study 2019. Front. Endocrinol. 15:1405204. doi: 10.3389/fendo.2024.1405204

But low awareness of this link is a significant barrier to cancer prevention and a threat to women’s health across Europe, according to the World Health Organization Regional Office for Europe.

As the world marks Breast Cancer Awareness Month, it is worth noting that according to a recent study, only 21% of women across 14 European countries were aware of the direct link between alcohol use and the risk of developing breast cancer – a risk that starts already with low levels of alcohol consumption.

Awareness was even lower among men – just 10% of the men surveyed knew of this link.

21%
Many more women need to be informed about the direct links between alcohol and breast cancer
Only 21% of women across 14 European countries were aware of the link between alcohol use and the risk of developing breast cancer.

This fact is even more worrying given that the biological mechanisms linking alcohol to cancer are well-established and substantiated by decades of evidence from across the world.

How does alcohol cause breast cancer?

The biological mechanisms through which alcohol causes cancer are complex and varied. The most important one involves the metabolism of ethanol into acetaldehyde, a metabolite that causes DNA damage and mutations that potentially result in cancer.

In the case of breast cancer, alcohol consumption also affects estrogen levels. Estrogen plays a significant role in the development and progression of many breast cancers, and alcohol’s impact on these hormone levels could partly explain the heightened risk.

Additionally, substances often affect men and women differently due to differences in metabolism and body composition between the sexes. These distinctions underscore the need for gender-specific approaches in public health strategies related to alcohol consumption and reducing cancer risk.

A study published in June 2024 showed that each additional alcoholic drink per day is linked with a 10% higher rate of total breast cancer in a linear manner. 

Clearly, alcohol use is linked with a linear dose–response increase in breast cancer cases already for low dose alcohol consumption.

10%
Rising breast cancer risk with each additional alcoholic drink
Each additional alcoholic drink per day is linked with a 10% higher rate of total breast cancer in a linear manner. 

More than half of all breast cancer cases due to alcohol in Europe are not due to heavy alcohol use, and about one third of new cases every year are due to alcohol intake to the equivalent of up to 2 small glasses of wine per day.

Alcohol use, cancer and the prevention paradox

A large part of cancer burden due to alcohol occurs in low dose alcohol users, especially among women.

For instance, the two most frequent cancers in Germany are breast cancer and colorectal cancer. More than 20% of cancer cases due to alcohol in these categories are seen in women who consume less than two alcoholic drinks a day. For men, 8% of all alcohol-attributable colorectal cancer cases fall into these categories.

This is another example of the so-called prevention paradox, which can be characterized by increasing dose-response relationships (the higher the alcohol use, the higher the risk of cancer), but still a large part of cancer cases are in relatively low alcohol consuming categories because there are so many more people consuming alcohol in this way – as illustrated with the example of Germany.

Breast cancer cases in Europe higher than ever

Breast cancer represents a major health concern for women across the WHO European Region, with more than 600,000 cases in 2022. The role of alcohol as a preventable risk factor for breast cancer is critical. For women in Europe, breast cancer is the primary cancer caused by alcohol, making up 66% of all cases of alcohol-attributable cancers.

Countries of the WHO European Region must protect their populations from alcohol-attributable cancers as the deadline to achieve the global targets for noncommunicable diseases (NCDs) is closing fast, according to WHO Europe.

Investing in breast cancer prevention means investing in women’s health and future well-being

Countries have committed to reducing premature mortality from cancer and other NCDs by 25% by 2025 from the 2010 levels through measures to strengthen health system response and to address NCD risk factors, including alcohol consumption.

But there have been no changes in population-level alcohol consumption in the European Union since 2010, and countries are not on track to reach their NCD targets. Therefore, there is an increasing urgency for governments to act immediately to implement evidence-based public health alcohol policy and legislation to reduce the burden of preventable cancers such as alcohol-attributable breast cancer.

A landmark study published in 2020 found:

As a large part of alcohol-attributable cancers are in low and moderate alcohol users, in particular for females, general population measures such as increases in alcohol taxation, restrictions on alcohol availability, and bans on marketing and advertisement are best suited to reduce the alcohol-attributable cancer burden.

Rehm J, Shield K, D: Alcohol Use and Cancer in the European Union. Eur Addict Res 2020. doi: 10.1159/000507017

Investing in cancer prevention, as outlined in Europe’s Beating Cancer Plan, includes raising alcohol taxes and awareness of the health risks due to alcohol consumption.

In 2021, a modeling study showed that doubling current alcohol excise taxes in the WHO European region could avoid almost 6% of new cancer cases and cancer deaths caused by alcohol (180,900 cases and 85,100 deaths) in the region.

The findings are particularly important for Member States of the European Union where excise duties are in many cases very low.

85,000
Avoidable deaths thanks to doubling of alcohol taxes
Doubling current alcohol excise taxes in the WHO European region could avoid 85,100 cancer deaths due to alcohol in the region.

Another example is better labelling regulations for alcoholic beverages: Health warning labels that inform consumers about cancer risks are a standard practice for tobacco products. Considering that both alcohol and tobacco, have been classified as Group 1 carcinogens by the International Agency for Research on Cancer since the 1980s, there are several lessons to be learned from tobacco control. Women across Europe have the right to know about the link between alcohol and cancer, especially breast cancer, so that they can make informed and healthier decisions.

Healthier behaviours could prevent up to 4 in 10 new cancer cases. However, collective action and commitment to public health beyond the individual level are needed to change the course of cancer incidence and ensure that future generations are better informed, healthier, and less exposed to the risks posed by alcohol consumption.


Source Website: WHO Europe