Study shows Europe's alcohol-linked cancer burden
By Kate Kelland
LONDON | Thu Apr 7, 2011 9:14pm EDT
(Reuters) - Almost 10 percent of all cancers in men and 3.0 percent in women in western Europe are caused by people drinking too much alcohol, scientists said on Friday.
German researchers analyzed data from France, Italy, Spain, Britain, The Netherlands, Greece, Germany and Denmark and found 50,400 out of a total of 79,100 cases of certain types of cancers -- in including bowel and throat tumors -- in 2008 were caused by people drinking more than recommended limits.
"Many cancer cases could have been avoided if alcohol consumption was limited to two alcoholic drinks per day in men and one alcoholic drink per day in women, ... the recommendations of many health organizations," said Madlen Schutze of the German Institute of Human Nutrition, who led the study.
"And even more cancer cases would be prevented if people reduced their alcohol intake to below recommended guidelines or stopped drinking alcohol at all."
A standard drink contains about 12 grams of alcohol and is equivalent to one 125 milliliter (ml) glass of wine or a half pint of beer.
"Many people just don't know that drinking alcohol can increase their cancer risk," said Sara Hiom, director of health information at the charity Cancer Research UK.
She noted that in Britain, mouth cancer has become much more common in the last 10 years, and "one reason for this could be because of higher levels of drinking, as this study reflects."
According to the International Agency for Research on Cancer (IARC), part of the World Health Organization, there is a causal link between alcohol consumption and liver cancer, breast cancer colon or bowel cancer, and cancers of the upper digestive tract such as mouth, throat and oesophageal cancers.
STICK TO THE LIMITS
The researchers, whose work was published in the British Medical Journal, used data from research known as the European Prospective Investigation into Cancer (EPIC) study in which 363,988 men and women, mostly aged between 35 and 70 when they joined the study, were followed for cancer from the mid-1990s.
They calculated that in 2008, alcohol consumption by men was responsible for about 57,600 cases of cancer of the types known to be linked to drinking. More than half of the cases, or 33,000, were due to having more than two drinks a day.
Alcohol intake by women in the eight countries caused about 21,500 cases of upper digestive tract, liver, colorectum, and breast cancer, of which more than 80 percent, or 17,400, were due to their having more than one standard drink a day.
Manuela Bergmann, who worked with Schutze on the study, said the findings provided solid support for recommended drinking limits and said she hoped more people would stick to them.
"It underlines that at the very least, it would be good to stay within the limits," she said in a telephone interview.
"Many people believe it's only a small group who drink more than the upper limits, but it's becoming more of a problem because alcohol is cheap and available, so people drink more."
Estimates from the American Institute for Cancer Research and the World Cancer Research Fund published in February said a third of all common cancers in the United States, China and Britain could be prevented each year if people had healthier diets, drank less alcohol and exercised more.
(Editing by Jon Hemming)
BMJ 2011; 342:d1584 doi: 10.1136/bmj.d1584 (Published 7 April 2011)
Cite this as: BMJ 2011; 342:d1584
Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study
Free via Creative Commons: OPEN ACCESS
Madlen Schu"tze, PhD student1,
Heiner Boeing, professor, department chair1,
Tobias Pischon, scientist, group head1,
Ju"rgen Rehm, professor, director23,
Tara Kehoe, statistician2,
Gerrit Gmel, data analyst2,
Anja Olsen, scientist4,
Anne M Tj?nneland, department head4,
Christina C Dahm, postdoctoral researcher5,
Kim Overvad, professor of epidemiology6,
Franc,oise Clavel-Chapelon, department head78,
Marie-Christine Boutron-Ruault, senior scientist78,
Antonia Trichopoulou, professor of nutrition9,
Vasiliki Benetou, scientist10,
Dimosthenis Zylis, scientist10,
Rudolf Kaaks, professor, division head11,
Sabine Rohrmann, senior scientist11,
Domenico Palli, unit chief12,
Franco Berrino, department chief13,
Rosario Tumino, director14,
Paolo Vineis, chair of environmental epidemiology, unit chief1528,
Laudina Rodri'guez, section chief16,
Antonio Agudo, scientist17,
Mari'a-Jose' Sa'nchez, lecture director18,
Miren Dorronsoro, unit chief19,
Maria-Dolores Chirlaque, scientist2021,
Aurelio Barricarte, department head21,
Petra H Peeters, professor of epidemiology22,
Carla H van Gils, associate professor of epidemiology22,
Kay-Tee Khaw, professor of clinical gerontology23,
Nick Wareham, director24,
Naomi E Allen, scientist25,
Timothy J Key, deputy director25,
Paolo Boffetta, professor, deputy director2627,
Nadia Slimani, scientist, group head26,
Mazda Jenab, scientist26,
Dora Romaguera, research associate28,
Petra A Wark, research fellow28,
Elio Riboli, director28,
Manuela M Bergmann, scientist1
+ Author Affiliations
1Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
2Centre for Addiction and Mental Health (CAMH), Toronto, Canada
3Institute for Clinical Psychology and Psychotherapy, TU Dresden, Germany
4Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen
5Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark
6Department of Epidemiology, School of Public Health, Aarhus University, Aarhus
7Centre for Research in Epidemiology and Population Health, U1018, Institut Gustave Roussy, F-94805, Villejuif, France
8Paris South University, UMRS 1018, F-94805, Villejuif
9WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School and Hellenic Health Foundation, Greece
10WHO Collaborating Centre for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School
11Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
12Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy
13Department of Preventive and Predictive Medicine, Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
14Cancer Registry and Histopathology Unit “Civile M.P.Arezzo” Hospital, ASP 7 Ragusa, Italy
15Institute for Scientific Interchange Foundation, Turin, Italy
16Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain
17Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (IDIBELL), Barcelona, Spain
18Andalusian School of Public Health, Granada (Spain) and CIBER de Epidemiologi'a y Salud Pu'blica (CIBERESP), Spain
19Public Health Department of Gipuzkoa and CIBERESP, San Sebastian, Spain
20Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
21CIBER Epidemiologi'a y Salud Pu'blica (CIBERESP), Spain
22Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
23Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
24MRC Epidemiology Unit, Cambridge
25Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford
26International Agency for Research on Cancer, IARC, Lyon, France
27Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY, USA
28Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London
Correspondence to: M Schu"tze email@example.com
Accepted 4 January 2011
Objective To compute the burden of cancer attributable to current and former alcohol consumption in eight European countries based on direct relative risk estimates from a cohort study.
Design Combination of prospective cohort study with representative population based data on alcohol exposure.
Setting Eight countries (France, Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Denmark) participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.
Participants 109 118 men and 254 870 women, mainly aged 37-70.
Main outcome measures Hazard rate ratios expressing the relative risk of cancer incidence for former and current alcohol consumption among EPIC participants. Hazard rate ratios combined with representative information on alcohol consumption to calculate alcohol attributable fractions of causally related cancers by country and sex. Partial alcohol attributable fractions for consumption higher than the recommended upper limit (two drinks a day for men with about 24 g alcohol, one for women with about 12 g alcohol) and the estimated total annual number of cases of alcohol attributable cancer.
Results If we assume causality, among men and women, 10% (95% confidence interval 7 to 13%) and 3% (1 to 5%) of the incidence of total cancer was attributable to former and current alcohol consumption in the selected European countries. For selected cancers the figures were 44% (31 to 56%) and 25% (5 to 46%) for upper aerodigestive tract, 33% (11 to 54%) and 18% (−3 to 38%) for liver, 17% (10 to 25%) and 4% (−1 to 10%) for colorectal cancer for men and women, respectively, and 5.0% (2 to 8%) for female breast cancer. A substantial part of the alcohol attributable fraction in 2008 was associated with alcohol consumption higher than the recommended upper limit: 33 037 of 178 578 alcohol related cancer cases in men and 17 470 of 397 043 alcohol related cases in women.
Conclusions In western Europe, an important proportion of cases of cancer can be attributable to alcohol consumption, especially consumption higher than the recommended upper limits. These data support current political efforts to reduce or to abstain from alcohol consumption to reduce the incidence of cancer.
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