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Alcohol consumption driving cancer cases

Image ID: 95724123 (L). terovesalainen. Alcohol consumption concept
Image credit: terovesalainen / 123rf

New research published in The Lancet indicates that alcohol consumption was linked to more than 741,000 new cancer cases in 2020. 

The study, which “[presents] global, regional, and national estimates of alcohol-attributable cancer burden in 2020 to inform alcohol policy and cancer control across different settings globally”, estimated that 741,300 new cancer cases in 2020 were linked to alcohol consumption of which males accounted for 568,700. It found that cancers of the oesophagus, liver, and breast contributed the most cases, at an estimated 189,700, 154,700, and 98,300 cases respectively.

Cancer is on the rise globally and in India, where it is one of the country’s leading causes of death. As reported by Health Issues India in February, “the growing rise of cases of cancer in India translates to one in ten Indians being affected by the disease in their lifetime and one in fifteen losing their lives. Recent decades saw cancer in India emerge as the country’s second-largest killer – and the country’s cancer burden is only expected to grow.” 

According to India Against Cancer, cancer of the oesophagus is the fifth-most common cancer among men in India whilst cancer of the breast is the most common cancer among women in India. The study flagged both cancers as one of the three cancers which contributed the most cases attributable to alcohol consumption. Concerningly, the study notes, “alcohol use is on the rise in Asian countries, such as China, India, and Vietnam, and in many countries in sub-Saharan Africa.”

As India witnesses alcohol consumption grow, it is key that the findings of the study – which the authors state “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” – be taken to heart. “We urgently need to raise awareness about the link between alcohol consumption and cancer risk among policy makers and the general public,” said Harriet Rumgay of the International Agency for Research on Cancer (IARC) in France. “Public health strategies, such as reduced alcohol availability, labelling alcohol products with a health warning, and marketing bans could reduce rates of alcohol-driven cancer. 

“Tax and pricing policies that have led to decreased alcohol intake in Europe, including increased excise taxes and minimum unit pricing, could also be implemented in other world regions. Local context is essential for successful policy around alcohol consumption and will be key to reducing cancer cases linked to drinking,” 

Illicit alcohol. miragik / 123rf
Customers queue at a liquor store in Varkala, Kerala. Image credit: miragik / 123rf

As India is projected to see alcohol consumption increase, it ought to invest in common-sense policies to decrease excessive alcohol consumption although even moderate drinking is a risk factor. Just two drinks a day is estimated to have led to 103,000 cases in 2020 – accounting for nearly one in seven alcohol-associated cancer cases. 

Furthermore, the disruption of the COVID-19 pandemic is thought to have potentially increased alcohol consumption. As the study notes, “the COVID-19 pandemic could have also affected individuals’ total consumption of alcohol, as shown by a reported increase in the proportion of the UK population binge drinking or drinking four or more times a week observed during national lockdowns in the UK. However, any changes in drinking patterns among individuals are not yet evident for current cancer rates, but could be reflected in the next decades.” Furthermore, the COVID-19 pandemic also disrupted routine health services including cancer screening and diagnosis – a vicious circle and an ominous portent as the pandemic continues well into 2021. 

Ultimately, the study concludes, “alcohol use causes a substantial burden of cancer, a burden that could potentially be avoided through cost-effective policy and interventions to increase awareness of the risk of alcohol and decrease overall alcohol consumption. General population strategies, such as WHO’s best buys, include a reduction of availability, an increase in price via taxation, and a ban on marketing, and are most effective for an outcome such as alcohol-attributable cancer, where even lower levels of drinking can increase the risk of cancer. With increases in alcohol consumption predicted until at least 2030 in several world regions, action must be taken to reduce the avoidable burden of cancer attributable to alcohol.” 

In India, a study published last year argued that “various policymakers, media, professionals and society have to be educated about the consequences of chronic alcohol through sensitisation programmes and health education campaigns. There is a dire need for rational alcohol control policy with specific objectives like alcohol taxation, production and promotion policy.” There is a substantial disconnect countrywide when it comes to alcohol, with some states even prohibitionist – so-called ‘dry states’. The sale of alcohol and its consumption is partially banned in some districts of Manipur and entirely so in Bihar, Gujarat, Tripura, Lakshadweep, Mizoram, and Nagaland. 

Yet there is an issue as it pertains to bootleg alcohol. As my colleague Nicholas Parry noted in 2019, “prohibition of alcohol can also drive people into purchasing illegal — and therefore unregulated — alcohol…It is the poor that are disproportionately affected by bootleg alcohol, those who can afford legal, or imported alcohol are largely free of the potential for poisoning by contaminants. Those who cannot afford branded alcohol are often driven to buying dangerous products laced with contaminants such as methanol, a chemical used in products such as antifreeze.” 

Combating the negative public health effects of alcohol requires a difficult balancing act. Outright prohibition is a potentially hazardous policy, giving rise to a black market where consumers are endangered as much – if not, in some cases, more so – than if they were purchasing legal liquor. Nonetheless, there is a need to address the real dangers of alcohol consumption. Going forward, implementing cost-effective, common-sense approaches to reducing alcohol consumption involving the best-buy strategies experts advocate for carries the potential to effect meaningful change with benefits for public health, communities, and the individuals themselves.

“Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study” can be accessed here.

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