Alcohol accounts for 4% of newly diagnosed cancers worldwide

Alcohol consumption accounted for 4% of all cancers diagnosed worldwide in 2020, with three quarters of these cancers occurring in men. The most frequent cancerous sites were the esophagus, liver and breast.

The result comes from an analysis carried out by the International Agency for Research on Cancer. It was published online in The Lancet Oncology July 13.

“We urgently need to educate policymakers and the general public about the link between alcohol consumption and cancer risk,” said lead author Harriet Rumgay, BSc, Cancer Surveillance Branch, International Agency for Research on Cancer , Lyon, France.

“Public health strategies, such as reducing the availability of alcohol, labeling alcohol products with a health warning, and marketing bans, could reduce rates of alcohol-related cancer,” said she added. She noted that taxation and pricing policies already in place in Europe could be implemented worldwide.

Commenting on the study, Mark Petticrew, professor of public health assessment at the London School of Hygiene and Tropical Medicine, London, UK, agreed that there was a need to educate the public about this risk. There is “a lot of misinformation, some coming from the alcohol industry itself.

“The public needs clear and independent information, and this large and robust study makes a significant contribution to clarifying the risks,” he added. It “provides further clear evidence that alcohol consumption contributes to a significant cancer burden, particularly excessive alcohol consumption.”

Study details

To estimate the cancer burden attributable to alcohol, Rumgay and colleagues gathered cancer incidence data from GLOBOCAN 2020 for a range of cancers and for all cancers combined.

Assuming a 10-year latency period between alcohol consumption and cancer diagnosis, they examined estimates of per capita alcohol consumption for 2010 from the Global Alcohol and Drug Information System. health. Estimates were stratified by age and sex.

The results suggest that 741,300 (4.1%) of all new cancer cases in 2020 were attributable to alcohol consumption, of which 568,700 (76.7%) occurred in men.

The age-standardized incidence rate of alcohol-attributable cancers was 13.4 per 100,000 in males and 3.7 per 100,000 in females.

The most common types of cancer attributable to alcohol use were esophageal cancer (189,700 cases; 31.6%) liver cancer (154,700 cases; 17.3%), and breast cancer (98,300 cases; 4.4%).

Excessive alcohol consumption (defined as> 60 g / d) accounted for 46.7% of alcohol-attributable cancers. Hazardous alcohol consumption (defined as 20 to 60 g / d) accounted for 29.4%.

Moderate consumption (<20 g / d, which is equivalent to about two drinks per day) contributed to 13.9% of cancer cases attributable to alcohol.

The analysis also found that by region, the highest proportions of cancer cases attributable to alcohol consumption were found in East Asia (5.7%) and Central and Eastern Europe (5.6%). The lowest were in West Asia (0.7%) and North Africa (0.3%).

At the country level, the estimated proportion of cancer cases attributable to alcohol was highest in Mongolia (10%) and lowest in Kuwait (0%).

In China, the estimated proportion of alcohol-related cancer cases was 6%. In India and France it was 5%; in Germany, Brazil and the United Kingdom, 4%; and in the United States, 3%.

Regarding gender differences in cancer rates, the team writes that “increases in alcohol consumption among women have been reported as women have taken on a greater share of paid jobs.

“This finding is clearly reflected in the highly indexed developing countries, where we saw the highest burden of alcohol-attributable cancers in women and the most similar male-to-female ratios of cancer rates attributable to alcohol. alcohol.

“In these regions, breast cancer was the main driver of the high rates of cancer incidence attributable to alcohol in women,” they add.

In an accompanying commentary, Amy C. Justice, MD, PhD, of the Department of Medicine and Health Policy and Management, Yale University, West Haven, Connecticut, said the results are “useful,” but questioned how alcohol consumption was measured. .

“Until we get to the limits of the measure, we might underestimate the health risks, especially cancer risks, associated with alcohol,” she warned.

The use of commercial alcohol sales to estimate consumption has “major limits”, and the use of self-report is “worse,” she said.

“Further, neither commercial sales nor the current self-report reflect past alcohol consumption,” which has “particularly important implications for genetic studies … and for understanding associations between alcohol consumption and cancers which generally have prolonged latency periods.

“Surely we can do a better job,” Justice said.

She suggests measuring the direct biomarkers of alcohol, such as phosphatidylethanol, which is an “abnormal” phospholipid that forms in the presence of ethanol and binds to red blood cells.

Measuring levels over time, “coupled with a careful history of use,” like that based on a biomarker, could help determine not only current but also past exposure to alcohol.

“We don’t ask people with diabetes what their glycosylated hemoglobin is, we are checking it, ”Justice pointed out.

“Next, we discuss their risk of adverse health effects informed by test results and their personal risk profile. We should use a similar approach to counsel patients about alcohol-related risks,” he said. she declared.

Commenting for the UK Science Media Center, Sadie Boniface, PhD, research manager at the Institute of Alcohol Studies, King’s College London, London, UK, described the new analysis as “comprehensive and well designed”.

She added that the results are “consistent with other studies, and scientists already knew that alcohol causes seven types of cancer,” including cancer of the breast, esophagus, mouth and throat.

However, this risk has not been well communicated to the general public, she said. In the UK, an upcoming alcohol labeling consultation represents a “real opportunity” to help consumers “make informed decisions about their consumption”.

Beyond labeling, the authors’ recommendations on policies to target the price, availability and marketing of alcohol are needed as part of “a comprehensive alcohol strategy in the aftermath of the pandemic “to combat the burden of alcohol,” she added.

No funding for the study was described. Boniface reports that he works at the Institute of Alcohol Studies, which receives funding from the Alliance House Foundation. No other relevant financial relationship has been reported.

Lancet Oncol. Published online July 13, 2021. Full Text

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