By Adele Barlassina, Association of European Cancer Leagues
The European Code Against Cancer (ECAC) recommends limiting alcohol consumption to reduce the risk of developing certain types of cancers . Studies have established a causal link between alcohol intake and the development of various types of cancers . The 2012 Monograph of the International Agency for Research on Cancer (IARC) classifies alcohol as a carcinogen for humans of group 1, which means that there is enough evidence to conclude that it can cause cancer . The cancer type most strongly associated with alcohol consumption is seen for the oral cavity, throat, and oesophagus. A smaller risk has also been established for colorectal, female breast cancer, and for liver cancer in people with liver cirrhosis .
Epidemiological research supports evidence showing that ethanol causes serious damage to DNA, which can give rise to cancer . Various factors may contribute to the development of alcohol associated cancer including an individual’s genetic predisposition. This may explain why some people develop cancer at relative moderate daily alcohol consumption while only a percentage of chronic heavy drinkers develop certain types of cancer . Therefore, the WHO concluded that there is no safe level of alcohol consumption for cancer prevention . The ECAC, stresses the importance of limiting the alcohol intake to reduce the risk of developing cancer (ECAC message 6) .
The WHO European Region has the highest level of alcohol consumption in the world. Although per capita alcohol consumption has been falling over the past three decades, it remains significantly above the global average consumption . Estimates suggest that in 2018, 4.3% of all new cancer cases in Europe are attributable to alcohol consumption . Given the causal evidence, alcohol attributable cancer is a major health concern in the region . The WHO’s European Programme of Work 2020-2025, recommends countries to adopt cost-effective and easy to implement policy options to encourage the reduction of alcohol consumption. These include, increasing taxes for alcoholic beverages, enforcing bans on alcohol advertising, and limiting the physical availability of alcohol .
Although it is well established that alcohol can cause cancer, public awareness on the causal relationship between alcohol and cancer in most countries is still low . Alcohol associated cancer-risk is underestimated and believed to be relevant only for heavy drinkers . Whilst the risk of developing cancer and other non-communicable diseases increases with increased alcohol consumption , the evidence is clear that there is no safe level of consumption for cancer prevention . Most national health bodies in European countries introduced low risk drinking guidelines and the ECAC generally recommends limiting the alcohol intake . Developing an appropriate strategy for the communication of the risk remains a key challenge.
 IARC, “European Code Against Cancer”, International Agency for the Research on Cancer, c2021
 H. Seitz and P. Becker, "Alcohol Metabolism and Cancer Risk," Alcohol Research & Health, vol. 30, no. 1, pp. 38-47, 2007.
 C. Scoccianti et al., "European Code against Cancer 4th Edition: Alcohol drinking and cancer," Cancer Epidemiology, vol. 45, pp. 181-188, 2016.
 WHO, "Alcohol and Cancer in the WHO European Region - An appeal for better Prevention," WHO Regional Office for Europe, Copenhagen, 2020.
 WHO Europe & IARC, “Alcohol and Cancer in the WHO European Region, an appeal for better prevention”, WHO Regional Office for Europe, 2020
 WHO, “Q&A – How can I drink alcohol safely?”, WHO Regional Office for Europe, Copenhagen, 2020
 European Commission, “Alcoholic beverages”, EU Science Hub, 2020