Alcohol Leads to 740 Thousand New Cancer Diagnoses Worldwide Each Year

Alcohol consumption accounted for 4% of all cancers diagnosed worldwide in 2020, corresponding to approximately 740 thousand people, and three-quarters of these cancers occurred in men. Alcohol-related cancers most commonly arose in the esophagus, liver and breast.

These findings come from an analysis conducted by the International Agency for Research on Cancer (IARC), a body of the World Health Organization, published on July 13, 2021, in The Lancet Oncology.

We Urgently Need to Raise Awareness of the Link Between Alcohol and Cancer

There is a great deal of misinformation, some originating from the alcohol industry itself. Meanwhile, even though overt alcohol advertising is officially prohibited, promotional and partly covert alcohol advertisements are increasing on channels broadcasting online.

The public needs clear, independent information, and this large, robust study makes an important contribution to clarifying the risks. It provides further clear evidence that alcohol consumption contributes to a substantial cancer burden, particularly among heavy drinkers.

Details of the Study

To estimate the burden of cancer attributable to alcohol, the study’s first author, Harriet Rumgay and colleagues collected cancer-incidence data for several cancers and all cancers combined from GLOBOCAN 2020 (World Cancer Statistics) as their data source.

Assuming a 10-year interval (lag time) between alcohol consumption and cancer diagnosis, they examined per-capita alcohol-consumption estimates for 2010 from the Global Information System on Alcohol and Health. Estimates were stratified by age and sex.

Results

• Of all cancer cases in 2020, 741,300 (4.1%) could be attributed to alcohol consumption and 568,700 of these cases (76.7%) occurred in men.
• The age-standardized incidence (new cases each year) of alcohol-attributable cancer was 13.4 per 100,000 men and 3.7 per 100,000 women.
• The most common cancer types attributable to alcohol consumption were esophageal cancer (189,700 cases; 31.6%), liver cancer (154,700 cases; 17.3%) and breast cancer (98,300 cases; 4.4%).
• Heavy drinking (defined as >60 grams/day) accounted for 46.7% of alcohol-attributable cancers. Risky drinking (defined as 20–60 grams/day) accounted for 29.4% of alcohol-related cancers.
• Moderate drinking (<20 grams/day, equivalent to approximately two glasses daily) contributed to 13.9% of alcohol-attributable cancer cases.
• By region, the analysis found the largest proportions of cancer cases attributable to drinking in East Asia (5.7%) and Central and Eastern Europe (5.6%). The lowest proportions occurred in Western Asia (0.7%) and North Africa (0.3%).
• At the country level, the estimated proportion of alcohol-attributable cancer cases was highest in Mongolia (10%) and lowest in Kuwait (0%).
• In China, the estimated proportion of alcohol-related cancer cases was 6%. It was 5% in India and France, 4% in Germany, Brazil and the United Kingdom, and 3% in the United States.

Regarding sex differences in cancer rates, the team reported, "An increase in alcohol consumption among women has been reported as women take a greater share of paid employment," suggesting that the incidence of alcohol-related cancers in women will increase in the future.

Breast cancer ranking 3rd among alcohol-related cancers appears to reinforce this concern.

Measures of Alcohol Use Should Be Improved

Alcohol-use measurement in this study relied on self-reporting, raising questions about its objectivity. In the future, using biomarkers that measure alcohol intake more objectively will allow more accurate estimates.

Alcohol intake can be measured objectively through direct alcohol biomarkers such as phosphatidylethanol, an “abnormal” phospholipid formed in the presence of ethanol that binds to white blood cells (red blood cells).

Measuring a biomarker, together with careful questioning about past use, may help identify not only current but also past alcohol exposure.

A similar application is HbA1c (glycolyzed hemoglobin), measured for diabetes and now a universally accepted standard biomarker.

These results are consistent with previous findings, and we already know that alcohol causes seven types of cancer, including breast, esophageal, mouth and throat cancer.

However, this risk is not being communicated well to the public.

We must acknowledge in advance that, as with cigarettes, warnings about health harms on alcohol labels will not be sufficient. It is clear that we need smarter strategies.

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