Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study

Abstract

Summary Background Alcohol use is causally linked to multiple cancers. We present global, regional, and national estimates of alcohol-attributable cancer burden in 2020 to inform alcohol policy and cancer control across different settings globally. Methods In this population-based study, population attributable fractions (PAFs) calculated using a theoretical minimum-risk exposure of lifetime abstention and 2010 alcohol consumption estimates from the Global Information System on Alcohol and Health (assuming a 10-year latency period between alcohol consumption and cancer diagnosis), combined with corresponding relative risk estimates from systematic literature reviews as part of the WCRF Continuous Update Project, were applied to cancer incidence data from GLOBOCAN 2020 to estimate new cancer cases attributable to alcohol. We also calculated the contribution of moderate (<20 g per day), risky (20–60 g per day), and heavy (>60 g per day) drinking to the total alcohol-attributable cancer burden, as well as the contribution by 10 g per day increment (up to a maximum of 150 g). 95% uncertainty intervals (UIs) were estimated using a Monte Carlo-like approach. Findings Globally, an estimated 741 300 (95% UI 558 500–951 200), or 4·1% (3·1–5·3), of all new cases of cancer in 2020 were attributable to alcohol consumption. Males accounted for 568 700 (76·7%; 95% UI 422 500–731 100) of total alcohol-attributable cancer cases, and cancers of the oesophagus (189 700 cases [110 900–274 600]), liver (154 700 cases [43 700–281 500]), and breast (98 300 cases [68 200–130 500]) contributed the most cases. PAFs were lowest in northern Africa (0·3% [95% UI 0·1–3·3]) and western Asia (0·7% [0·5–1·2]), and highest in eastern Asia (5·7% [3·6–7·9]) and central and eastern Europe (5·6% [4·6–6·6]). The largest burden of alcohol-attributable cancers was represented by heavy drinking (346 400 [46·7%; 95% UI 227 900–489 400] cases) and risky drinking (291 800 [39·4%; 227 700–333 100] cases), whereas moderate drinking contributed 103 100 (13·9%; 82 600–207 200) cases, and drinking up to 10 g per day contributed 41 300 (35 400–145 800) cases. Interpretation Our findings highlight the need for effective policy and interventions to increase awareness of cancer risks associated with alcohol use and decrease overall alcohol consumption to prevent the burden of alcohol-attributable cancers. Funding None.

Alcohol and Cancer: Epidemiology and Biological Mechanisms

“…Drinking alcohol increases the risk of squamous cell carcinoma of the oesophagus which is the most common histological subtype of oesophageal cancer globally, and contributed the most cases of cancer in 2020 attributable to alcohol (189,700 cases) [ 1 , 9 ]. An excess risk of oesophageal squamous cell carcinoma was found in the WCRF Continuous Update Project (RR 1.25 [95% CI 1.12–1.41] per 10 g alcohol per day) [ 7 ], and in Bagnardi and colleagues’ meta-analysis, the pooled RR estimates for light and heavy drinking were 1.26 (95% CI 1.06–1.50) and 4.95 (95% CI 3.86–6.34), respectively [ 8 ].…”

“…Approximately 4% of cancers worldwide are caused by alcohol consumption, equating to more than 740,000 cases of cancer globally in 2020 [ 1 ]. The impact of alcohol consumption on cancer burden differs by cancer type, and cancers of the oesophagus, liver, and breast represent the most alcohol-attributable cases of cancer globally ( Figure 1 ).…”

“…The impact of alcohol consumption on cancer burden differs by cancer type, and cancers of the oesophagus, liver, and breast represent the most alcohol-attributable cases of cancer globally ( Figure 1 ). Drinking alcohol even at lower levels of intake can increase the risk of cancer and we previously estimated that over 100,000 cases of cancer in 2020 were caused by light and moderate drinking of the equivalent of around one or two alcoholic drinks per day [ 1 ]. Despite this, there is low public awareness of the causal link between alcohol and cancer and alcohol use is growing in several regions of the world [ 2 , 3 ].…”

Ethanol-Induced Cell Damage Can Result in the Development of Oral Tumors

“…This estimate was recently updated in the population-based study published by Rumgay et al in The Lancet Oncology. In 2020, 741,300 or 4.1% of all new cancer cases were estimated to be attributable to alcohol consumption [12]. In 2012, the International Agency for Research on Cancer (IARC) formally classified alcoholic beverages and acetaldehyde, the first metabolite of ethanol, as type I carcinogens to humans [13].…”

Molecular Mechanisms of Alcohol-Induced Colorectal Carcinogenesis

“…Chronic alcohol consumption has also been associated with a higher risk of developing CRC [5][6][7][8]; however, while it is clear that higher levels of consumption increase risk for many types of cancer, no safe threshold (i.e., the amount of alcohol that increases the cancer risk) has been established. In 2020, the global incidence of alcohol-induced colon, rectal, and liver cancers were 1.0, 0.7 and 1.7 per 100,000 people, respectively [9]. For context, the global incidence of other alcoholic liver diseases, such as hepatitis and cirrhosis were much higher, at 8.3 and 9.9 per 100,000 people, respectively [10].…”