Alcohol

It is estimated that 5.6% of cancer cases in Australia each year are attributable to long-term chronic use of alcohol.⁶⁶ Recent data from eight European countries in the EPIC study indicated that 10% of cancers in men and 3% of cancers in women were attributable to current and former alcohol consumption, a substantial proportion of which was associated with consumption above recommended upper limits.⁶⁷ The increased risk of cancer commenced at a low level and increased with higher levels of alcohol consumption.⁶⁷ WHO has estimated that excess alcohol consumption is responsible for 351,000 cancer deaths internationally each year.⁴

Alcohol consumption in Australia

Around one fifth of Australian adults consumed more than two standard drinks daily in 2011–12 and 44.7% consumed in excess of four standard drinks at least once a year.⁶⁸ Alcohol is the second greatest preventable cause of drug-related death and hospitalisation in Australia following tobacco.⁶⁹

Alcohol and cancer

A 2012 IARC Monograph on alcohol reviewed the evidence and concluded that alcohol is a Group 1 carcinogen, which causes oral cavity, pharyngeal, laryngeal, oesophageal, colorectal, liver (hepatocellular carcinoma) and female breast cancers.⁵ A positive association between alcohol and pancreatic cancer was also identified.⁵ A recent meta-analysis including 572 studies has confirmed that alcohol increases the risk of these cancers.⁷⁰

The IARC Monograph and WCRF and AICR report both reported that total alcohol consumption affects the risk of cancer, independent of the type of alcohol.⁵,⁸ The IARC Monograph also classified both ethanol and acetaldehyde associated with alcohol consumption as Group 1 carcinogens.⁵ The WCRF and AICR 2007 report recommends limiting alcohol consumption, based on the evidence that even small amounts of alcohol increase cancer risk.⁸ The WCRF and AICR report recommends if alcoholic drinks are consumed,  limiting consumption to no more than two drinks a day for men and one drink a day for women.⁸

Together, tobacco smoking and alcohol consumption interact synergistically to increase the incidence of cancers of the upper aerodigestive tract (i.e. oral cavity, pharyngeal, laryngeal and oesophageal cancers) beyond the single effects of tobacco smoking or alcohol (see Appendix 2 for explanation).⁵ Alcohol consumption also contributes to greater energy intake, and the Australian Dietary Guidelines suggest limiting alcohol intake (and therefore energy intake) in the context of growing levels of obesity.⁵¹

Reducing individual risk of cancer and staying healthy

The Australian Guidelines to Reduce Health Risks from Drinking Alcohol provide the following guideline on reducing the risk of alcohol-related harm over a lifetime⁶⁹:

• The lifetime risk of harm from drinking alcohol increases with the amount consumed.
• For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.

There are few studies on the effects of cessation of alcohol consumption on cancer risk. The available data suggest that former drinkers have lower risks than current drinkers after 5-10 years’ cessation for certain cancers, including oesophageal, oral and pharyngeal cancers.⁵

Cancer Australia recommendations for individuals

The lifetime risk of harm from drinking alcohol increases with the amount consumed.⁶⁹

For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.⁶⁹

On the basis of international evidence specific to cancer,⁸ it is recommended that if alcoholic drinks are consumed, women further limit alcohol consumption to one standard drink, to reduce cancer risk.

Table 5: Summary of evidence for alcohol and cancer sites

Risk factor	Source	Evidence	Cancer site
Alcohol consumption	IARC 20125	Sufficient evidence (highest IARC classification of carcinogenicity)	Oral cavity, pharynx, larynx, oesophagus, colorectum, liver (hepatocellular carcinoma), female breast
		Limited evidence (positive association)	Pancreas

See Appendix 1 for explanation of evidence.