Alcohol has been labeled a carcinogen by a growing number of agencies across the globe, after years of scientific and policy debate. But just how much of the cancer burden is it responsible for?
Some 4.2% of all cancer deaths were caused by alcohol consumption, according to the third edition of Cancer Altas, a report co-penned by the American Cancer Society (ACS), the Union for International Cancer Control (UICC), and the International Agency for Research on Cancer (IARC). That number continues to grow, in virtually every corner of the globe, said Lindsey Torre, MSPH, an epidemiologist with the ACS, in an interview with CancerNetwork®.
“There’s increasing alcohol use pretty much around the world,” said Torre.
The Atlas points to the percentage of deaths from particular types of tumors among the 7 that the IARC has classified. The proportion of cancer deaths attributable to alcohol by site in 2016 were led by 31% of all cases of pharynx cancers (not nasopharynx), followed by roughly 20% each of lip and oral cavity, larynx, and esophageal cancers, according to the report.
Smaller proportions of colon and rectum, liver, and breast cancers were attributable to alcohol, according to the Atlas. But even smaller proportions of those huge categories of tumor types mean a huge effect at a population level, said Torre.
“It is helpful to contrast the percentage of deaths attributable to alcohol with the absolute numbers,” she said. “For instance, when you look at liver, you might say, ‘That looks kind of low.’ But liver actually makes up a pretty large proportion of worldwide cancer cases.”
Torre cited numbers from the Institute for Health Metrics and Evaluation (IHME), centered at the University of Washington in Seattle. According to worldwide statistics from the IHME, in 2017 alone, alcohol was responsible for an estimated 129,000 liver cancer deaths; 139,000 esophageal cancer deaths; 126,000 colorectal cancer deaths; 78,000 lip and oral cavity cancer deaths; 59,000 breast cancer deaths; 52,000 other pharynx cancer deaths; and 38,000 laryngeal cancer deaths.
“If we are just looking at the public health burden, even that low percentage of liver cancer cases attributable to alcohol is a very large number,” said Torre. “And the same goes with breast, because breast is the leading cancer in women. Even a small percentage equates to a very large number of cases and deaths.”
The American Society of Clinical Oncology concluded in a statement published in their Journal of Clinical Oncology in November 2017 that alcohol was a carcinogen.
“The more that a person drinks, and the longer the period of time, the greater their risk of development of cancer, especially head and neck cancers,” the authors wrote in a review of evidence. “Alcohol is a cause of cancers of the oral cavity, pharynx, larynx, esophagus, colorectum, liver and female breast.”
Torres said it’s possible to curb alcohol use, pointing to an editorial published this month in The Lancet on the “continuing success story” of Russia’s alcohol policies and how they pushed life expectancies higher than ever before: 68 years of age for men and 78 years of age for women, according to the latest World Health Organization statistics. Tactics used over the last 15 years include: marketing restrictions, increased monitoring of alcohol production, increased excise taxes, raising the minimum price of drinks, and substantially reducing alcohol’s retail availability.
“Russia-historically considered one of the heaviest-drinking countries in the world-now stands as an example of how a long-term strategy using stringent policy reforms targeting both alcohol production and individual consumption can reverse the devastating effects of alcohol on a nation,” concluded the journal.
Jemal A, Torre L, Serjomataram I, Bray F (Eds). The Cancer Atlas. Third Ed. Atlanta, GA: American Cancer Society, 2019. Published online at http://canceratlas.cancer.org.
LoConte N, Brewster A, Kaur J, Merrill J, Alberg A. Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. J Clin Oncol. 2018 Jan 1;36(1):83-93. doi: 10.1200/JCO.2017.76.1155.
Russia’s alcohol policy: a continuing success story. Lancet. 2019 Oct 5;394(10205):1205. doi: 10.1016/S0140-6736(19)32265-2.