Cancer risks associatedwith alcohol remain difficult to assess

WHILE NEW research is painting a clearer picture of the links between alcohol and cancer, in Ireland statistical information is still difficult to assess.

Given the high rates of both binge and daily drinking here, it would make sense that we have higher instances of certain cancers associated with alcohol. These include mouth, larynx, oesophagus, liver, colorectum and breast cancers, with international research now showing a higher likelihood of such cases if a person consumes alcohol.

But the picture is complicated somewhat by the fact that persons who consume alcohol may also be smokers. Also, data collection in Ireland in relation to alcohol consumption and other illnesses is not definitive or thorough.

There is also a problem of public perception. When one usually thinks of illnesses associated with alcohol consumption, often the link is made with liver disease, mental health issues, or general malnutrition.

While the links between cancer and smoking have been well articulated, perhaps our public health lobby has been less successful in communicating the danger alcohol consumption poses in relation to cancer.

Dr Eleanor O’Sullivan is a clinical lecturer in University College Cork who points out that Ireland has seen increases in inter-oral cancers in the past decade, as well as cancers of the palate. “We have a high tolerance of alcohol and think nothing of consuming alcohol on a daily basis and often to excess,” she says.

“There haven’t been many campaigns linking alcohol with other diseases. The media campaign has been better with tobacco, where everyone knows that if you smoke, it is harmful. People don’t realise that alcohol increases major risk for many cancers.”

One of the complications when linking alcohol with certain cancers is that it is difficult to separate excessive alcohol consumption from other negative lifestyle choices that go with it.

“We know alcohol on its own increases the risk of cancer, but it tends to vary by the way it is measured,” Dr O’Sullivan says. “It is complicated by the fact that most head and neck cancer patients who I have seen in 30 years’ experience who do consume alcohol will be smokers as well.

“In the south of Ireland in a study we carried out, 90 per cent of those who smoked also consumed alcohol. But, from US studies of groups who don’t consume alcohol, we know they have a lower instance of head and neck cancers.

Another study in the US found that 3 per cent of all cancer deaths are attributed to alcohol. Among alcoholics, there are higher instances of cancer and an increased number of lesions.”

The National Cancer Registry in Ireland doesn’t capture specific data linking alcohol to cancer. Even if it did, it is unlikely that Ireland’s current drinking habits and their impact on cancer patterns would present for at least another decade, as the incubation period for many alcohol-linked cancers is about of 15 years.

Norma Cronin, health promotion manager with the Irish Cancer Society, says that in an effort to reduce the risks of cancer, alcohol consumption should be limited to two drinks per day for men and one for women. The recommendation for cancer prevention, as put forward by the World Health Organisation, is to not consume alcohol at all. This seems highly aspirational.

“The key thing is the data doesn’t suggest any significant difference depending on the type of drink you consume. The more you drink, the bigger the risk,” says Cronin. “We have increasing scientific evidence on links between alcohol and the risk of a number of cancers including mouth, pharynx, larynx, the oesophagus, breast and bowel cancer in men. The convincing evidence is there, people just need to be made more aware of it.”

Alcohol Action Ireland is currently calling for the Government to introduce a minimum pricing for alcohol as a means of reducing consumption in Ireland. The organisation argues that reducing per capita consumption will have a knock-on effect on many diseases, including cancer.

“The introduction of minimum pricing, a floor price below which alcohol cannot be sold, will go some way to reducing the overall amount we drink,” says director Fiona Ryan. “If we’re serious about tackling alcohol-related cancer, then we need to get serious about tackling our drinking.”

Deadly mix: Alcohol and cancer

- One in 10 cancers in men and one in 33 in women is caused by drinking alcohol

- Many cancers, including cancer of the mouth, larynx, oesophagus, liver, colorectal and breast, can be caused by alcohol

- Cancer of the liver has had the highest rate of increase of all cancer types in Ireland

- Drinking one standard alcoholic drink a day increases the risk of a women developing breast cancer by 9 per cent, while drinking between three and six standard drinks a day increases the risk by 41 per cent

- Almost one in five people in Ireland are unaware of the link between alcohol and cancer risk