Why doesn’t the person next to me know that alcohol causes cancer?

Despite its prevalence, the belief that alcohol poses minimal risk persists in many circles. This viewpoint overlooks several crucial considerations. Notably, alcohol is identified as one of the top three causes of preventable cancer, alongside tobacco and obesity. This is particularly significant given that lifestyle choices can prevent up to 50% of cancers, emphasising the critical role of alcohol as a modifiable risk factor.

Is the risk really that high?

The interplay between alcohol and other risk factors further amplifies its danger. The synergistic effect of combining smoking and drinking, for instance, intensifies the carcinogenic potential of both substances. This increases the risk for those who engage in both habits. Additionally, the link between alcohol and obesity introduces another dimension to the risk, considering the established connection between obesity and various cancers.

The general lack of awareness about this risk further underscores the necessity of highlighting the alcohol-cancer link. Despite the prevalence of alcohol consumption, most people remain uninformed about its carcinogenic effect, often convinced by myths that portray alcohol in a misleadingly positive light. This lack of awareness not only exposes people to risks, but also hinders their ability make informed choices about drinking.

As the body of evidence grows, the need to elevate public awareness becomes clear. By debunking myths and shedding light on alcohol’s role as a significant risk factor for cancer, we can help individuals to make better choices and significantly reduce the incidence of preventable cancers.

Another important cost

A pivotal study published in Cancer Epidemiology by Rumgay et al. (2023) has shed light on the significant economic impact of alcohol consumption on cancer mortality across the EU, Iceland, Norway, Switzerland, and the UK. In 2018, alcohol was linked to more than 23,300 premature cancer deaths, with an associated economic toll of €4.58 billion in lost productivity. This translates to an average cost of €196,000 per death. This research stresses the profound economic and human costs of alcohol-related cancer, emphasising the importance of effective alcohol control policies.

Norway and Sweden demonstrated a lower economic impact from alcohol-related cancer deaths, amounting to just 0.011% of their GDP. This is attributed to their successful maintenance of lower alcohol consumption levels. Robust alcohol policies have the potential to mitigate both health and economic losses stemming from alcohol-attributable cancer deaths. However, the study also highlights that these figures underestimate the total productivity losses, as they don’t account for unpaid employment, temporary work absences, or diminished working capacity due to cancer.

In contrast, the research identifies a more pressing concern in other parts of Europe. Particularly Hungary, Romania, Latvia and Lithuania face the highest cost of productivity lost as a share of national GDP, ranging between 0.045 per cent and 0.069 per cent. These regions suffer from higher rates of alcohol consumption and, consequently, elevated rates of premature cancer deaths attributable to alcohol, identifying an urgent need for targeted alcohol control measures.

“Shouldn’t we know this already?“

A recent study published in BMC Research Notes, conducted by Maria Neufeld and colleagues, revealed a notable gap in awareness among Europeans about the link between alcohol consumption and cancer. This study surveyed over 19 000 individuals from 14 European countries, including Norway, Sweden, and the Baltic nations and was designed to evaluate public knowledge about the health risks posed by alcohol, particularly about cancer. The findings indicate that although the majority are informed about alcohol’s contribution to liver disease, just slightly more than half are aware of its link to cancer in general. This awareness decreases further when considering specific cancers: under half of the participants knew about alcohol’s connection to colon cancer, less than a third to oral cancer, and merely 15% were aware of its tie to female breast cancer.

Country by country

• In Norway, 48 % of those surveyed acknowledged the risk of cancer associated with alcohol. Only 10 % believed there was a risk for female breast cancer, 42 % for liver cancer, 34 % for colon cancer, 15 % for oral cancer, and 2 % for skin cancer.
• Sweden reported that 52 % of respondents recognise alcohol as a cancer risk factor. Detailed awareness levels were 15 % for female breast cancer, 47 % for liver cancer, 38 % for colon cancer, 20 % for oral cancer, and 6 % for skin cancer.
• In Lithuania, 41 % of participants admitted a general risk of cancer due to alcohol. The specifics were 13 % for female breast cancer, 56 % for liver cancer, 46 % for colon cancer, 33 % for oral cancer, and 7 % for skin cancer.
• From Latvia, 26 % correlated alcohol consumption with a risk of cancer. Specific cancer links were identified by 7 % for female breast cancer, 25 % for liver cancer, 20 % for colon cancer, 21 % for oral cancer, and 3 % for skin cancer.
• Finally, in Estonia, 43 % recognised alcohol’s role in increasing cancer risk. In more detail, 13 % noted a link with female breast cancer, 41 % with liver cancer, 29 % with colon cancer, 18 % with oral cancer, and 6 % with skin cancer.

In this comparison, it is concerning that among the 14 countries surveyed, Norway and Sweden display lower overall awareness of the link between alcohol and cancer compared to most of the countries, with the exception of the Baltic nations, Portugal, and Slovenia. This is unexpected and troubling, given that the Nordic countries have more comprehensive alcohol policies and have long approached alcohol consumption as a public health issue rather than an economic or agricultural concern, as it is often seen in these other European nations.

Let’s also add here that the Finnish Institute for Health and Welfare’s 2018 report titled Näin Suomi juo (“This is how Finland drinks“) found that only 37% of participants fully recognised that alcohol use elevates cancer risk.

Comparing various surveys and studies that address awareness of the link between alcohol and cancer can be challenging due to differences in methodology and question phrasing. For instance, a study by the Danish Cancer Society in 2020 found that without prompting, only 22.2% were aware of the alcohol-cancer link. However, when prompted, this figure rose to 44.8%.

A 2023 Novus survey in Sweden showed findings similar to those of the European study mentioned earlier. Eighty-five per cent of people said they did not know about the link between alcohol and breast cancer. Also, three out of four people did not know that drinking a little bit of alcohol still increases the risk of breast cancer. However, the survey found that people are willing to change how much alcohol they consume if they learn about its connection to breast cancer. One in five women mentioned that knowing this would make them think about drinking less.

Why focus on awareness?

This boils down to the question: Why is awareness important? There are two main reasons for this.

Firstly, for individuals to make informed choices, they need to be aware of the risks. When it is evident that average awareness regarding the alcohol and cancer link is alarmingly low, with most people unaware of it, it’s clear that action is needed. Educational efforts must be improved and targeted to various age and social groups. Doctors’ recommendations should be always evidence-based and consistent, and national guidelines for low-risk drinking should consider the risk of alcohol and cancer. In other words, the Nordic countries should adhere to the 2023 Nordic Nutrition Recommendations. And in addition, policy-level actions should be taken, such as introducing health warning labels that include the link between alcohol and cancer, as has already been decided in Ireland, for example.

The second reason stands out even if this awareness does not change people’s behaviour. And for many, it probably won’t. However, people still have the right to know. This is the consumer protection argument. While people ultimately decide how to act upon this information, ensuring they are informed is essential.

The article is written by

Lauri Beekmann

Executive director, Nordic Alcohol and Drug Policy Network (NordAN)

Editor of alcoholandcancer.eu

on the request of PopNAD