WHO: Raising awareness of the link between alcohol and cancer

The WHO European Region has the highest level of alcohol consumption in the world. However, the level of awareness of the link between alcohol consumption and increased risk of cancer remains low. World Cancer Day on 4 February 2018 is an opportunity to reinforce the important message that alcohol use is associated with an increased risk of cancer, and to call for the implementation of effective measures to reduce the overall use of alcohol.

Established link between alcohol and 7 types of cancer

It has been established that drinking alcohol can cause at least 7 types of cancer, those of the:

• bowel (colon and rectum)
• breast
• gullet (oesophagus)
• larynx
• liver
• mouth
• upper throat.

The main carcinogenic component of alcohol is ethanol, which is contained in every type of alcoholic drink. Ethanol damages cells in a way that makes them more prone to becoming malignant. It also affects female hormones, stimulating cell proliferation and increasing the risk of breast cancer. When combining alcohol with smoking tobacco, the rate of tissue damage is multiplied and, as a result, the risk of cancer is increased.

Reduced consumption, reduced risks

The dose–effect relationship between alcohol and cancer is clear: the higher the alcohol consumption, the higher the risk of cancer. For example, a woman increases her risk of breast cancer by 50% when drinking 4 glasses of wines per day and by 130% when drinking 8 glasses per day. There is no identified lower threshold, meaning that even small amounts of alcohol increase the risk of cancer.

However, the dose–effect relationship also holds true in reverse: any reduction in alcohol consumption reduces the risk of developing alcohol-linked cancer.

Link often overlooked

A study in the United Kingdom, published by the British Medical Journal in 2016, revealed that, unprompted, only 13% of respondents identified cancer as a potential health outcome of alcohol consumption. Knowledge of the link between alcohol and specific cancers ranged from 18% for breast cancer to 80% for liver cancer, demonstrating a lack of knowledge in the general population. And yet, cancer accounts for 12% of all alcohol-attributable deaths in the Region.

Effective measures and policies needed

Effective measures and policies exist to reduce harms from alcohol and improve population health. The European Action Plan to Reduce the Harmful Use of Alcohol 2012–2020 outlines a range of evidence-based policy options.

Three of the most cost-effective policy areas (the “best-buys”) are:

• increasing price via taxation
• restricting access to retail alcohol
• imposing a ban on alcohol advertising.

Another important policy option, relevant in terms of reinforcing the health system response, is the implementation of brief intervention programmes in primary care settings for individuals with hazardous or harmful alcohol consumption. Screening and brief interventions (SBIs), as they are known, for alcohol are an evidence-informed approach to addressing the needs of the many patients presenting in primary care who may benefit from reducing their alcohol consumption. In 2017, the WHO Regional Office for Europe published a training manual for SBIs, designed to equip health-care professionals with adequate skills in supporting patients to change their drinking behaviour.

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