Impact: Alcohol and cancer

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Impact: Alcohol and cancer


Alcohol was estimated to be responsible for 4.5% of Australia's cancer disease burden in 2015[1]. An Australian study estimated 3,208 cancers (2.8% of all cancers) diagnosed in 2010 could be attributed to alcohol use[2] (see Table 1 below).The population attributable fraction was highest for cancers of the mouth and pharynx (31%) and oesophagus (25%)[2]. The largest number of cancers attributable to alcohol use were for bowel cancer and breast cancer in women[2]. A follow-up study found that up to 2% of alcohol-related cancers (~29,600 cancers) could be avoided between 2013-2037, if all Australian adults consumed no more than two standard drinks a day[3]. Bowel cancer in men and breast cancer in women were the cancer sites with the highest numbers of potentially avoidable cases with 9,900 and 4,100 respectively[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[2]

Overall health and community impact

Alcohol use is estimated to have caused 5785 deaths in Australian aged 15 years and older in 2015[4]. Cancers were responsible for the largest proportion (36%) of these deaths[4]. It is also estimated that 144,192 Australians aged 15 years and older were hospitalised for alcohol-attributable injury and disease between in 2012/13[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 use in Australia

The 2019 National Drug Strategy Household Survey reported that alcohol was used daily by 5.4% of people aged 14 years and over, a significant decline from 6% in 2016[7]. The most commonly used alcoholic drinks among recent drinkers were bottled wine (33.8%%) and regular strength beer (18.8%), followed by bottled spirits and liqueurs (15.3%)[7].

Between 2016 and 2019 the proportion of Australians aged 14 years and over who had never drunk a full serve of alcohol remained stable(14.7% in 2016 to 14.4% in 2019)[7]. In 2019, daily drinking rates were at the lowest level seen since 1991.

In 2019, 16.8% of people aged 14 or older exceeded the lifetime risk guidelines, down from 18.2% in 2013[7]. Males were more than twice as likely as females to exceed the lifetime risk guidelines (27% compared with 9.2%)[7]. See Defining 'risk' in relation to alcohol consumption for more information.

Data on personal alcohol use is likely to be understated, as it is based on self-report and falls significantly short of alcohol use data based on sales, taxation and customs statistics[8][9]. Alcohol policy should be informed by data on alcohol use and harms, including credible alcohol use estimates based on sales data and well-targeted surveys[10].

Children and youth

Alcohol use among children and youth is significant in a cancer context because the more alcohol used over time the higher the risk of cancer[11]; moreover, young people who drink at high-risk levels are more likely to become long-term high-risk drinkers[12] and, therefore, at significantly higher risk of alcohol-related cancer.

Analyses of national survey data show that by 18 years of age, approximately 50% of both males and females drink alcohol at high-risk levels; of all age groups, Australians aged 18-24 report the highest prevalence of high-risk drinking[13]. However, the age at which 14–24 year olds first tried alcohol has increased from 14.4 since 1998 to 16.2 years in 2019 [7]and rates of abstention for teenagers are increasing. There are fewer secondary students drinking alcohol with rates having decreased from 74% in 2011 to 66% in 2016[14].

Older Australians

While prevalence of risky drinking in people under 30 is considerably lower than previous generations over the long term, for people over 40, drinking 5 or more standard drinks at least once a month has been trending upwards since 2001[7]. In particular for people in their 50s, this rate has risen from 22% to 27% from 2001 to 2019[7]. Furthermore, in 2019 a greater proportion of 18-24 year olds drink 11 or more standard drinks on a single occasion at least once in the past surveyed year than in 2016 (30.5% in 2019 compared to 29.1% in 2016)[7].

Aboriginal and Torres Strait Islander Australians

Aboriginal and Torres Strait Islander people are 1.2 times as likely as non-Indigenous people to drink at levels exceeding guidelines for lifetime risk [7]; rates of alcohol-related deaths are two and a half times higher in the Aboriginal and Torres Strait Islander people[15].

The 2019 National Drug Strategy Household Survey reported that more than 27% of Aboriginal and Torres Strait Islander people aged 14 years and over have more than two standard drinks per day on average, exceeding guidelines for lifetime risk[7]. The proportion of Aboriginal and Torres Strait Islander people drinking at this level has significantly decreased between 2016 and 2019, from 29.4% to 27.4%[7].

Although Aboriginal and Torres Strait Islander people are also more likely to abstain from alcohol than other groups (29.3% of Aboriginal and Torres Strait Islander people vs 23.4% for non-Indigenous), those who drink do so at higher-risk levels[7].

Data has suggested that the gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians exceeding the lifetime risk guidelines has narrowed, from 1.5 times more likely in 2010 to 1.2 in 2019. [7] It is important to note the different definitions of risk used in reference to alcohol use. See below for more.

Liver cancer and cancers of the lip, mouth and pharynx occur at more than twice the rate in Aboriginal and Torres Strait Islander people compared with non-Indigenous Australians[16]. The higher rates of liver cancer are likely to be attributable to elevated hepatitis B infection rates, combined with long-term, high-risk alcohol use in some Aboriginal and Torres Strait Islander males[16]. 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 use and smoking are more prevalent among Aboriginal and Torres Strait Islander people than in the non-Indigenous population[17].

Defining 'risk' in relation to alcohol consumption

The 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 used[18]. These guidelines advise men and women to consume no more than ten standard drinks a week to reduce the lifetime risk of harm from alcohol-related disease or injury[18].

See Policy context for more information.

Alcohol use 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)[12]. The risk of developing an alcohol-related cancer increases cumulatively as alcohol is used over time[19][20][21][22].


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References

  1. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Canberra: AIHW; 2019. Report No.: Series no. 19. Cat. no. BOD 22. Available from: https://www.aihw.gov.au/reports/burden-of-disease/burden-disease-study-illness-death-2015/contents/table-of-contents.
  2. 2.0 2.1 2.2 2.3 Pandeya N, Wilson LF, Webb PM, Neale RE, Bain CJ, Whiteman DC. Cancers in Australia in 2010 attributable to the consumption of alcohol. Aust N Z J Public Health 2015 Oct;39(5):408-13 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26437723.
  3. 3.0 3.1 Wilson LF, Baade PD, Green AC, Jordan SJ, Kendall BJ, Neale RE, et al. The impact of reducing alcohol consumption in Australia: An estimate of the proportion of potentially avoidable cancers 2013-2037. Int J Cancer 2019 Feb 12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/30748013.
  4. 4.0 4.1 4.2 Lensvelt, E., Gilmore, W., Liang, W., Sherk, A. and Chikritzhs, T.. Estimated alcohol-attributable deaths and hospitalisations in Australia 2004 to 2015. Perth: National Drug Research Institute, Curtin University; 2018 [cited 2019 Jul 24]. Report No.: Bulletin 16. Available from: https://ndri.curtin.edu.au/ndri/media/documents/naip/naip016.pdf.
  5. Collins DJ, Lapsley HM. The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. Canberra: Commonwealth of Australia; 2008 Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono64/$File/mono64.pdf.
  6. Laslett A, Catalano P, Chikritzhs T, Dale C, Doran C, Ferris J, et al. The range and magnitude of alcohol’s harm to others. Fitzroy, Victoria: AER Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Eastern Health; 2010 Available from: http://www.fare.org.au/wp-content/uploads/2011/10/The-Range-and-Magnitude-of-Alcohols-Harm-to-Others.pdf.
  7. 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13 Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2019. Canberra: AIHW; 2020 [cited 2020 Jul 29]. Report No.: Drug statistics series no.32. PHE 270. Available from: https://www.aihw.gov.au/getmedia/3564474e-f7ad-461c-b918-7f8de03d1294/aihw-phe-270-NDSHS-2019.pdf.aspx?inline=true.
  8. Stockwell T, Donath S, Cooper-Stanbury M, Chikritzhs T, Catalano P, Mateo C. Under-reporting of alcohol consumption in household surveys: a comparison of quantity-frequency, graduated-frequency and recent recall. Addiction 2004 Aug;99(8):1024-33 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15265099.
  9. Stockwell T, Zhao J, Chikritzhs T, Greenfield TK. What did you drink yesterday? Public health relevance of a recent recall method used in the 2004 Australian National Drug Strategy Household Survey. Addiction 2008 Jun;103(6):919-28 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18482414.
  10. Chikritzhs TN, Allsop SJ, Moodie AR, Hall WD. Per capita alcohol consumption in Australia: will the real trend please step forward? Med J Aust 2010 Nov 15;193(10):594-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21077816.
  11. Ridolfo B, Stevenson C. The quantification of drug-caused morbidity and mortality in Australia. Canberra: AIHW; 2001 Feb 23. Report No.: Cat. no. PHE 29.. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459309.
  12. 12.0 12.1 Australian Institute of Health and Welfare. Young Australians: their health and wellbeing 2011. Canberra: AIHW; 2011 Jun 10. Report No.: Cat. no. PHE 140. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737419259.
  13. Roche AM, Bywood PT, Borlagdan J, Lunnay B, Freeman T, Lawton L, et al. Young people and alcohol: the role of cultural influences. Adelaide: National Centre for Education and Training on Addiction, DrinkWise Australia Ltd; 2007 Available from: http://nceta.flinders.edu.au/files/8512/5548/2802/EN360.pdf.
  14. Guerin, N. & White, V.. ASSAD 2017 Statistics and Trends: Australian Secondary School Students’ Use of Tobacco, Alcohol, Over the-counter Drugs, and Illicit Substances. Melbourne: Cancer Council Victoria; 2019 [cited 2019 Jul 25] Available from: https://www.cancervic.org.au/downloads/cbrc/R18_NG_ASSAD_2017_National_Report.pdf.
  15. Chikritzhs T, Brady M. Fact or fiction? A critique of the National Aboriginal and Torres Strait Islander Social Survey 2002. Drug Alcohol Rev 2006 May;25(3):277-87 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16753652.
  16. 16.0 16.1 Threlfall TJ, Thompson JR. Cancer incidence and mortality in Western Australia, 2007. Perth: Department of Health; 2009. Report No.: Statistical Series Number 86. Available from: http://www.health.wa.gov.au/docreg/Reports/Diseases/Cancer/WACR_Cancer_incidence_mortality_main_2007.pdf.
  17. Australian Institute of Health and Welfare. Australia's health 2010. Canberra: AIHW; 2010. Report No.: Australia’s health series no. 12. Cat. no. AUS 122. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442452962.
  18. 18.0 18.1 National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. [homepage on the internet] Canberra ACt: Australian Government; [cited 2021 Mar 3]. Available from: https://www.nhmrc.gov.au/health-advice/alcohol.
  19. World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007.
  20. Million Women Study Collaborators, Allen NE, Beral V, Casabonne D, Kan SW, Reeves GK, et al. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst 2009 Mar 4;101(5):296-305 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19244173.
  21. Collaborative Group on Hormonal Factors in Breast Cancer, Hamajima N, Hirose K, Tajima K, Rohan T, Calle EE, et al. Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer 2002 Nov 18;87(11):1234-45 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12439712.
  22. Corrao G, Bagnardi V, Zambon A, La Vecchia C. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med 2004 May;38(5):613-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15066364.

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