Jürgen Rehm (E-mail:, Kevin D. Shield


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

European Addiction Research
Release date

Alcohol Use and Cancer in the European Union

Review Article



Cancers constitute a major non-communicable disease category globally and in the European Union (EU).


Alcohol use has been established as a major cause of cancer in humans. Principal cancer agencies agree that the following cancer sites are causally impacted by alcohol:

  • lip and oral cavity,
  • pharynx (excluding nasopharynx),
  • oesophagus,
  • colon and rectum,
  • liver,
  • (female) breast, and
  • larynx.

For all of these cancer sites, there is a dose-response relationship with no apparent threshold: the higher the average level of consumption, the higher the risk of cancer incidence.

In the EU in 2016, about 80,000 people died of alcohol-attributable cancer, and about 1.9 million years of life were lost due to premature mortality or due to disability.

Key messages

Given the above-described impact of alcohol on cancer, public awareness about the alcohol-cancer link needs to be increased.

In addition, effective alcohol policy measures should be implemented.

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.

Key facts

  1. There were almost 80,000 alcohol-attributable cancer deaths in Europe in 2016.
  2. In terms of the burden of disease in the same year, the estimate was almost 1.9 million cancer disability-adjusted life years lost.
  3. Indeed, alcohol use is one of the main known risk factors for cancer in the EU; in a recent comprehensive study on risk factors for cancer in France, only tobacco smoking was reported to cause higher cancer incidence.
  4. While there is a clear dose-response relationship, with risks reported as lower at lower levels of alcohol consumption, there is no safe lower limit for alcohol use.
  5. All dose-response curves for the cancer types identified as causal show no protective effects at any level of alcohol use, and there is increasing risk with higher levels of consumption.

Alcohol use, cancer and the prevention paradox

A large part of the alcohol-related cancer burden occurs in light to moderate alcohol users, especially among women.

For instance, the two most frequent cancers in Germany are breast cancer and colorectal cancer. More than 20% of the alcohol-attributable cancer cases 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.

Source Website: Karger