Impact: Alcohol and cancer

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Impact: Alcohol and cancer


Alcohol was estimated to be responsible for 3.1% of Australia's cancer disease burden in 2003[1]. In 2005, 2,997 new cancer cases and 1,376 cancer deaths were attributed to excessive alcohol consumption[2]. In 2015, an Australian study estimated 3,208 cancers (2.8% of all cancers) diagnosed in 2010 could be attributed to alcohol consumption[3] (see Table 1 below). The population attributable fraction was highest for cancers of the mouth and pharynx (31%) and oesophagus (25%)[3]. The largest number of cancers attributable to alcohol consumption were for bowel cancer and breast cancer in women[3].

The following section of this chapter summarises the available evidence of the links between alcohol consumption and cancer.


Table 1. Population attributable fraction (PAF) for males and females and estimated number of cancers diagnosed in Australia in 2010 attributable to alcohol consumption

Site Males Females Total number of cancers
Mouth, pharynx 38.0 13.1 613
Larynx 22.0 8.0 126
Liver 15.7 4.7 175
Oesophagus 36.1 10.9 126
Bowel 11.7 (colon)

15.5 (rectum)

3.8 (colon)

5.2 (rectum)

1,338

Breast in women 5.8 830
All cancers 3.0 2.5 3,208

Source: Pandeya 2015[3]

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Overall health and community impact

Alcohol consumption is estimated to have caused more than 32,696 deaths in the 10 years between 1996 and 2005, with cancer one of the top five causes of alcohol-attributable deaths in 2005[4]. It is also estimated that 813,072 Australians aged 15 years and older were hospitalised for alcohol-attributable injury and disease between 1995-96 to 2004-05[4]. In 2004-05, the total costs of alcohol to Australia, including loss of life, lost productivity, healthcare costs, road accident-related costs and crime-related costs, were estimated at $15.3 billion[5]. The overall economic impact on the community may be greater. A study published in 2010 estimated that in 2008, heavy drinkers cost those around them more than $14 billion in out-of-pocket expenses, losses in wages and productivity, and more than $6 billion in intangible costs[6].


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Alcohol consumption in Australia

Australia's relatively high burden of alcohol-related cancer reflects high levels of alcohol consumption in Australia by world standards; Australia ranks within the top 30 highest alcohol consuming nations out of 180 countries on a per capita basis[7].

The 2011-2012 National Nutrition and Physical Activity Survey reported that alcohol was consumed by almost one in three people (32%) aged 19 years and over on the day before interview[8]. The most commonly consumed alcoholic drinks were wines (13%) and beers (11%), followed by spirits (2.1%)[8]. Among these people, alcoholic beverages contributed 16% of daily energy intake[8].

According to the National Drug Strategy Household Survey, the percentage of people reporting that they drink daily was 6.5% in 2013, declining from 7.2% in 2010[9]. Over the same period there was a significant increase in the proportion of people who had never consumed a full serve of alcohol (12.1% in 2010 to 13.8% in 2013)[9]. In 2013, daily drinking rates were at the lowest level seen since 1991[9].

In 2012-13, there was 9.9 L of pure alcohol available for consumption per person aged 15 and over[10]. This was 1.6% less than the amount in 2011-12 and 8.2% less than 2007-08[10]. However, increases in wine consumption, and mistaken assumptions about the alcohol content in wine, resulted in an underestimate of overall alcohol consumption levels between 1990-91 and 2008-09[11]. A revised analysis published in the Medical Journal of Australia in 2010 shows consumption levels since the early 1990s have increased significantly over that time[11].

In 2013, 18.2% of people aged 14 or older exceeded the lifetime risk guidelines, down from 20% in 2010[9]. Males were more than twice as likely as females to exceed the lifetime risk guidelines (26% compared with 10%)[9]. See Defining 'risk' in relation to alcohol consumption for more information.

Data on personal alcohol consumption is likely to be understated, as it is based on self-report and falls significantly short of consumption data based on sales, taxation and customs statistics[12][13]. Alcohol policy should be informed by data on alcohol use and harms, including credible consumption estimates based on sales data and well-targeted surveys[11].

Children and youth

Alcohol consumption among children and youth is significant in a cancer context because the more alcohol consumed over time the higher the risk of cancer[14]; moreover, young people who drink at high-risk levels are more likely to become long-term high-risk drinkers[15] and, therefore, at significantly higher risk of alcohol-related cancer.

Analyses of national survey data show that the proportion of 12-15 year olds consuming alcohol at risky levels for short-term harm approximately doubled from 1990 (circa 2.5%) to 2005 (circa 5%) and rose from 15% to around 20% for 16-17 year olds[16]. By 18 years of age, approximately 50% of both males and females consume alcohol at high-risk levels; of all age groups, Australians aged 18-24 report the highest prevalence of high-risk drinking[16].

However, the age at which 14–24 year olds first tried alcohol has increased from 14.4 since 1998 to 15.7 years in 2013[9]. Between 2010 and 2013, there was a significant increase in the proportion of people who had never consumed a full serve of alcohol (from 12.1% to 13.8%) and the proportion abstaining from alcohol increased significantly (from 64% to 72%[9].

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Indigenous Australians

Indigenous Australians are twice as likely as non-Indigenous Australians to drink at short-term risky or high-risk levels[17]; rates of alcohol-related deaths are two and a half times higher in the Indigenous population[18].

The 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey reported that around one in six (18%) Aboriginal and Torres Strait Islander people aged 15 years and over consumed more than two standard drinks per day on average, exceeding guidelines for lifetime risk[19]. Indigenous men were significantly more likely than women to drink at this level (26% compared with 10%)[19]. The proportion of Indigenous Australians drinking at this level has not changed significantly between 2001 and 2013[19].

Although Indigenous Australians are more likely to abstain from alcohol than other groups, those who drink do so at higher-risk levels. In 2004-05, 29% of Indigenous Australians had not consumed alcohol in the previous 12 months, compared to 15% of non-Indigenous Australians. But of those who had drunk over the period, 34% of Indigenous Australians had done so at long-term risky or high-risk levels compared with 22% of non-Indigenous Australians[20].

More recently, data from the 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey has suggested that the proportion of Aboriginal and Torres Strait Islander people aged 15 years drinking at levels exceeding guidelines for lifetime risk was similar to that of non-Indigenous Australians (after adjusting for differences in age structure between the two populations)[19]. It is important to note the different definitions of risk used in reference to alcohol consumption. See below for more.

Liver cancer and cancers of the lip, mouth and pharynx occur at more than twice the rate in Indigenous Australians compared with non-Indigenous Australians[21]. The higher rates of liver cancer are likely to be attributable to elevated hepatitis B infection rates, combined with excessive alcohol consumption in some Indigenous males[21]. Alcohol and tobacco are both risk factors for cancers of the lip, mouth and pharynx, with the risk increasing significantly when the two substances are combined (see Smoking and alcohol: synergies for high risk). Both high-risk alcohol consumption and smoking are more prevalent among Indigenous people than in the non-Indigenous population[17].

Defining 'risk' in relation to alcohol consumption

Definitions of 'risk' cited above were derived from the 2007 National Drug Strategy Household Survey, which provides the most recent available survey data on alcohol consumption levels in Australia nationally. The use of the terms 'risky' and 'high risk', above (and used occasionally elsewhere in this chapter) relate specifically to data from the 2007 National Drug Strategy household survey[22]. The 2007 National Drug Strategy household survey defines up to 28 standard drinks per week as ‘Low risk’ for adult males, 29 to 42 per week ‘Risky’, and 43 or more per week ‘High risk’. For adult females up to 14 standard drinks per week is considered ‘Low risk’, 15 to 28 per week ‘Risky’, and 29 or more per week ‘High risk’[22].

However, the 2009 National Health and Medical Research Council (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking Alcohol introduced the concept of progressively increasing the risk of harm with the amount of alcohol consumed, rather than specifying ‘risky’ and ‘high risk’ levels of drinking above the guideline levels. These guidelines advise men and women to consume no more than two standard drinks on any day to reduce the lifetime risk of harm from alcohol-related disease or injury[23]. See Policy context for more information.

Alcohol consumption at all levels may be relevant in a cancer prevention context. There is a relationship between short- and long-term harmful drinking (young people who binge-drink are at higher risk of consuming harmful levels of alcohol over the long term)[15]. The risk of developing an alcohol-related cancer increases cumulatively as alcohol is consumed over time[24][25][26][27].


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References

  1. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD. The burden of disease and injury in Australia 2003. Canberra: AIHW; 2007. Report No.: Cat. no. PHE 82. Available from: http://www.aihw.gov.au/publication-detail/?id=6442467990.
  2. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2008. Canberra: AIHW; 2008. Report No.: Cancer series no. 46. Cat. no. CAN 42..
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