Over the years, alcohol has been found to be an established cause of certain cancers, but the extent to which alcohol consumption contributes to cancer development remains unclear.¹ At the European Society of Medical Oncology (ESMO) Congress 2023, Professor Isabelle Soerjomataram presented data from a global population-cohort study that investigated the global burden of cancer associated with alcohol consumption, thereby illustrating the relationship between alcohol drinking patterns and risk of cancer, and highlighting the need for effective strategies to reduce alcohol consumption.¹

The results of the study indicated that approximately half (46.1%) of the global adult population consumed alcohol in the last year, with higher prevalence of alcohol consumption (≥70%) being observed in European and Eastern Asian countries, as well as the USA and Australia.¹. Alcohol consumption was more prevalent among men compared to women (53.8 vs. 38.3%), however, this difference was less noticeable in higher-income countries.¹ Based on these global statistics, the average alcohol drinker consumes a total of 6.2L pure ethanol annually, which is equivalent to approximately 52 bottles of wine per year.¹ In wine-producing countries such as France, each alcohol drinker consumed an average of 12.3L of ethanol per year.¹

Previous studies have identified 7 types of alcohol-attributable cancers, namely oral, pharyngeal, laryngeal, esophageal, colorectal, liver, and breast cancer.¹ Other cancers potentially attributable to alcohol consumption include stomach and pancreatic cancer.¹. The development of these cancers can be attributed to acetaldehyde, the metabolized form of ethanol,  which causes DNA damage and hormonal imbalance, promoting carcinogenesis.¹ Data from the global population-cohort study exhibited that 741,300 new cancer cases in 2020 were attributable to alcohol consumption, many of which were esophageal (26%) and liver (21%) cancers.¹ A similar observation was found in men (n=568,700), while 57% of all alcohol-attributable cancer cases in women (n=172,600) were breast cancer.¹ As expected, cancer cases attributable to alcohol were low in low-alcohol-consumption countries in North Africa and the Middle East.¹

Prof. Soerjomataram noted that it is possible to reduce alcohol consumption, as evidenced by the drastic reduction in alcohol consumption from 22.3L/year in 1920 to 9.8L/year in 2016 among the French population.¹ Similar trends were observed in Italy and Germany.¹ Organizations such as the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) have dedicated efforts to educating the public regarding the relationship between alcohol consumption and certain types of cancer, in an attempt to reduce alcohol consumption.¹ However, awareness of such links has remained low.¹ For instance, a survey conducted in the UK found that only 19% of women attending breast cancer screening were aware of alcohol as a risk factor for breast cancer.¹ In addition, commercial influences have posed a barrier to reducing alcohol consumption in recent years, with the alcohol industry seen targeting younger women, often promoting alcohol consumption together with messages related to female empowerment and freedom.¹

In conclusion, alcohol-attributable cancers constitute a significant burden with around 750,000 new cases globally per year.¹ European and East Asian countries had the highest prevalence of alcohol consumption, thus possessing a higher prevalence of alcohol-attributable cancer cases.¹ Large-scale campaigns for reducing alcohol consumption have proven to be viable but the current public awareness of the relationship between alcohol and cancer has remained low.¹ As such, implementation and research should continue and public education campaigns should be adapted in order to effectively reduce alcohol consumption and related cancer risks worldwide.¹