Europe’s best-known public cancer prevention checklist has been updated, and one recommendation has clearly toughened. In the new European Code Against Cancer, 5th edition (ECAC5), the guidance on alcohol now reads: “Avoid alcoholic drinks.” The previous edition advised people who drink to limit their intake, while noting that not drinking is better for cancer prevention.

 

ECAC is meant to be short and usable, a set of evidence-based recommendations written for the general public. ECAC5 keeps that format, presenting “14 ways you can help prevent cancer,” and it also introduces a major structural change: for the first time, the Code pairs the public advice with a corresponding set of recommendations aimed at policy-makers, reflecting the idea that prevention depends not only on individual choices but also on the environments that shape those choices.

 

The updated Code and its evidence base are described in two linked scientific publications: an overview article in The Lancet Regional Health – Europe, and a series of detailed articles in Molecular Oncology, including a paper covering tobacco, second-hand smoke, and alcohol.

 

What the new edition is trying to do

The authors describe ECAC5 as a response to a growing cancer burden and persistently low public awareness of effective cancer prevention. In the Lancet overview, they also underline why prevention matters at scale: based on current knowledge of cancer causes, they estimate that around 40 to 50 percent of cancers, and 44 percent of cancer deaths, could be prevented.

 

ECAC5 was developed through a structured review process involving around 80 experts, and the project also included work on how the recommendations are understood and remembered. The Lancet paper describes research efforts to test and refine messaging, including qualitative research in nine EU member states and an EU-wide evaluation study on communication and message recall.

 

The alcohol shift, from “limit” to “avoid”

The clearest public-facing change is the alcohol line. In the Molecular Oncology paper, the authors state directly that the recommendation on alcohol has been updated from the earlier phrasing, “If you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention,” to the new ECAC5 wording: “Avoid alcoholic drinks.”

 

In the Lancet overview table comparing recommendations, ECAC5 also frames this change in plain terms for the public: avoiding alcohol is presented as the prevention benchmark, not moderation.

 

Why the wording got stronger

The Molecular Oncology paper lays out the scientific reasoning behind the stronger message.

 

First, it describes the cancer link as broad and not limited to heavy drinking. The authors note that all types of alcoholic drinks, including beer, wine and spirits, can cause cancer, and that risk begins at low levels and increases as intake rises and as ethanol content rises. They state that there is no safe level of alcohol consumption, because there is no threshold below which there is no increased risk for at least some cancers.

 

They list several cancer sites linked to alcohol, including cancers of the oral cavity, pharynx, larynx, oesophagus, stomach, colorectum, liver (hepatocellular carcinoma), and female breast.

 

Second, they quantify the burden in the European Union. The paper cites an estimate that in 2020, alcohol consumption caused 111 300 new cancer cases in the EU, representing 4.1 percent of all new cases. It also notes that almost 70 percent of these cases were in men, which the authors partly relate to higher average consumption among men.

 

Third, the paper draws attention to “light to moderate” drinking, because that is where public perceptions often diverge from the evidence. It cites estimates that in 2017, light-to-moderate alcohol consumption contributed to around 23 000 new cancer cases in the EU, accounting for 13.3 percent of all alcohol-attributable cancers. The authors add that nearly half of these cases were female breast cancers, and that over one-third of alcohol-related cancers at these consumption levels were linked to drinking less than one standard drink per day.

 

Taken together, those points explain the shift in tone. The authors summarise the implication in simple terms: for cancer prevention, the best option is to avoid alcohol completely, and no level of consumption is considered risk free.

 

The paper also connects the updated cancer prevention message to a broader reassessment of alcohol’s overall health profile. It argues that recent findings have likely overestimated cardiovascular benefits attributed to alcohol in earlier research, and it concludes that not drinking is the healthiest choice because no safe amount can be established.

 

"Avoid" for individuals, and action for governments

ECAC5 does not treat alcohol as purely a matter of personal responsibility. Both the Lancet overview and the Molecular Oncology paper emphasise population-level policy measures that can reduce alcohol harm and support prevention.

 

The Lancet paper highlights the importance of integrated policy approaches to reduce consumption and denormalise alcohol use. In practice, the Molecular Oncology paper lists a set of policy actions alongside the public recommendation, including:

• raising prices through alcohol taxation and other pricing measures

• restricting availability and accessibility

• stronger age restrictions

• bans or restrictions on marketing, advertising, promotion and sponsorship

• health warning labels on alcoholic beverages

• improved access to screening and brief interventions, and treatment for alcohol use disorder

public information campaigns about health harms, including cancer risk.

The authors also flag why these policies matter culturally. They note that heavy drinking is often socially disapproved of, while moderate drinking can remain socially acceptable or even encouraged. In that context, they argue, policies that denormalise alcohol use are important to make the goal of reducing intake to zero more widely acceptable.
 

Why this matters for public communication

The “avoid alcohol” line is short, but the implication is big. ECAC5 is a mainstream European cancer prevention framework, and it is now explicitly aligning its public message with the position that, for cancer risk, there is no safe level of drinking.

 

That does not mean the science claims every individual risk is identical, or that all drinking leads to cancer. What it does mean, based on the evidence review described in the ECAC5 publications, is that the safest recommendation for cancer prevention is zero consumption, and that a prevention guide aimed at the whole population should say so plainly.

 

Sources

Espina C, Ritchie D, Riboli E, et al. European Code Against Cancer 5th edition: 14 ways you can help prevent cancer. The Lancet Regional Health – Europe (2026, Volume 63).

Feliu A, et al. European Code Against Cancer, 5th edition, tobacco and nicotine-containing products, second-hand smoke and alcohol. Molecular Oncology (2026).

IARC press release (23 January 2026)