Prof Peter Anderson: Substance Use, Policy and Practice, Institute of Health and Society at Newcastle University and Professor, Alcohol and Health, Faculty of Health, Medicine and Life Sciences at Maastricht University, Netherlands.

1. Alcohol and cancer
Peter Anderson MD, MPH, PhD
Professor, Substance Use, Policy and Practice, Institute of
Health and Society, Newcastle University, England
Professor, Alcohol and Health, Faculty of Health, Medicine
and Life Sciences, Maastricht University, Netherlands
Dublin 29 May 2013

3. Overall evaluation
 Alcoholic beverages cause cancer in
humans (Group 1)
 Ethanol in alcoholic beverages causes
cancer in humans (Group 1)
 Acetaldehyde associated with alcoholic
beverages causes cancer in humans
(Group 1) (Vol 100E)

4. In this presentation, we will:
1.Look in more detail at what IARC said
2.Consider the importance of alcohol-related
cancers
3.Consider toxicological thresholds
4.Mention alcohol and heart disease, and thus
consider alcohol’s overall contribution to harm
5.Discuss actions to reduce the harm done by
alcohol, including alcohol-caused cancers

5. In this presentation, we will:
1.Look in more detail at what IARC said
2.Consider the importance of alcohol-related
cancers
3.Consider toxicological thresholds
4.Mention alcohol and heart disease, and thus
consider alcohol’s overall contribution to harm
5.Discuss actions to reduce the harm done by
alcohol, including alcohol-caused cancers

6. International Agency for Research on Cancer:
Alcohol is a causal agent for cancers of:
 Oral cavity, pharynx, and larynx
 Oesophagus
 Liver
 Colon
 Rectum
 Breast

7. 1
2
3
4
5
6
7
0 10 20 30 40 50 60 70 80 90 100
Relativerisk
Grams alcohol consumption per day (10 grams = 1 drink)
Oral cavity & Pharynx (86%)
Larynx (43%)
Oesophagus (39%)
Breast (25%)
Liver (19%)
Rectum (9%)
Colon (5%)
Source: Corrao et al 2009
In brackets, increased risk at 20g/day compared with not drinking

8. Decline in risk of oesophageal cancer after drinking cessation
Source: Jarl & Gerdtham 2012

9. Relative risk of breast cancer by alcohol consumption
Source: Allen et al 2009

10. 0.8
0.9
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Hazardratio
None
<6.0
≥6.0
Risk of death (HR) from breast cancer recurrence by alcohol
consumption (none, <6g/day, ≥6g/day)
Source: Kwan et al 2010

11. 6.1 Carcinogenicity in humans
1. There is sufficient evidence in humans for the carcinogenicity
of alcoholic beverages.
2. The occurrence of malignant tumours of the oral
cavity, pharynx, larynx, oesophagus, liver, colorectum and
female breast is causally related to the consumption of
alcoholic beverages.
3. There is substantial mechanistic evidence in humans who are
deficient in aldehyde dehydrogenase that acetaldehyde
derived from the metabolism of ethanol in alcoholic beverages
contributes to the causation of malignant oesophageal
tumours.

12. In this presentation, we will:
1.Look in more detail at what IARC said
2.Consider the importance of alcohol-related
cancers
3.Consider toxicological thresholds
4.Mention alcohol and heart disease, and thus
consider alcohol’s overall contribution to harm
5.Discuss actions to reduce the harm done by
alcohol, including alcohol-caused cancers

13. Alcohol-attributable deaths by disease groups for people aged
15-64 years living in EU in 2004. Total deaths: 138,000
Source: Rehm et al 2012
Cancer
19%
CVD
8%
Mental
Disorders
10%
Liver
cirrhosis
28%
Injuries
32%
Other
3%
26,000 deaths

14. Amongst people aged 15-64 years
living in the EU in 2004, 8% of all male
and 6% of all female cancer deaths
were due to alcohol.
Source: Rehm et al 2012

15. Number of alcohol-attributable cancers (95% CI) in women and men in
France, Italy, Spain, UK, Netherlands, Greece, Germany, Denmark in 2008.
Source: Schutze et al 2011
0
10
20
30
40
50
60
70
80
Women Men
Number(000s) >12/24g per day
Total

16. In this presentation, we will:
1.Look in more detail at what IARC said
2.Consider the importance of alcohol-related
cancers
3.Consider toxicological thresholds
4.Mention alcohol and heart disease, and thus
consider alcohol’s overall contribution to harm
5.Discuss actions to reduce the harm done by
alcohol, including alcohol-caused cancers

17.  The Margin of Exposure (MOE) compares a toxic
threshold of a substance with the exposure of the
substance.
 The European Food Safety Authority judges MOEs
for carcinogens above 1,000 as low priority for
public health when based on human data.
 This means that provided that the dose
consumed is 1,000 times less than the toxic
threshold, this is acceptable for public health
exposure (it does not mean that the consumption
is completely safe).

18. The toxic threshold of alcohol for human cancer is
about 50g alcohol (5 drinks a day). [This is based
on animal studies in which 10% develop cancer
from the equivalent dose].

19. Using European Food Safety Authority guidelines
on exposure to carcinogens in food and
drinks, exposure should be no more than one
thousandth the toxic dose, which works out at
50mg ethanol a day, about 20g alcohol (2 drinks)
a year.

20. EU adults who drink alcohol on average consume
about 30g (3 drinks) a day, 600 times more than
the exposure level set by the European Food
Safety Authority guidelines.

21. Based on one tenth the toxic dose, the
equivalent exposure for a non-carcinogenic
outcome, e.g. liver cirrhosis, should be no
more than about 3g (one third of a drink) a
day.
EU adults who drink consume 10 times this
amount.
Source: Lachenmeir et al 2011

22. In this presentation, we will:
1.Look in more detail at what IARC said
2.Consider the importance of alcohol-related
cancers
3.Consider toxicological thresholds
4.Mention alcohol and heart disease, and thus
consider alcohol’s overall contribution to harm
5.Discuss actions to reduce the harm done by
alcohol, including alcohol-caused cancers

23. Alcohol in small regular doses can reduce the risk
of ischaemic events, in particular ischaemic heart
disease.
This effect can be achieved at doses of 5g a day, is
moderated in overweight individuals, and
disappears with just one episode of binge drinking
(60g, six drinks, on one occasion) a month.
Source: Anderson 2013

24. Deaths prevented or caused by daily alcohol consumption for adults living in England
in 2006 compared to actual median alcohol consumption of 13g/day.
Source: Nichols et al 2012
-8000
-4000
0
4000
8000
12000
16000
20000
24000
28000
32000
1 2 3 4 5 6 7 8 12 16 20 24 32 40 48
Liver disease
Cancer
CVD
Deaths due to
decreasing
consumption
Deaths due to
increasing
consumption
Median consumption →

25. In this presentation, we will:
1.Look in more detail at what IARC said
2.Consider the importance of alcohol-related
cancers
3.Consider toxicological thresholds
4.Mention alcohol and heart disease, and thus
consider alcohol’s overall contribution to harm
5.Discuss actions to reduce the harm done by
alcohol, including alcohol-caused cancers

26. 0
500
1000
1500
2000
2500
Eur-A Eur-B Eur-C
DALYs/millionpeopleaverted
Increase tax by 20% Reduced access
Advertising ban Brief advice to 30% at risk
Source: World Health Organization 2009

27. In addition, consumers should be informed that
alcohol causes cancer through highly visible and
simple warning labels on all beverage containers.

28. And, we should encourage our friends and
colleagues to drink less.

29. Framingham Heart Study: Impact of fraction of
friends/family who abstained or drank heavily at one
examination on drinks/day at next examination.
Source: Rosenquist et al 2010

30. Conclusions:
1.Alcohol is a carcinogen, causing cancers of the
oral
cavity, pharynx, larynx, oesophagus, liver, colore
ctum and female breast.

31. 2. Adopting the standards of the European
Food Safety Authority for genotoxic
carcinogens, human exposure should be
no more than 50 milligrams of ethanol a
day. This is the same as about 20 grams
(2 drinks) a year.

32. 3. Alcohol should be strictly regulated with
price increases, reduced availability and
bans on all forms of commercial
communications.

33. 4. Brief advice (and treatment) should be
offered to all people with heavy drinking
(and alcohol use disorders).

34. 5. All alcohol beverage containers should
carry warning labels informing
consumers that alcohol causes cancer.

35. 6. We could all encourage each other to
drink less.