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There is strong evidence that alcohol causes cancer at seven sites, and probably others.
The measured associations exhibit gradients of effect that are biologically plausible, and there is some evidence of reversibility of risk in laryngeal, pharyngeal and liver cancers when consumption ceases.
The limitations of cohort studies mean that the true effects may be somewhat weaker or stronger than estimated currently, but unlikely to be qualitatively different (e.g. to not exist or to be J-shaped).
Ongoing research will elucidate mechanisms more clearly and increase confidence in the epidemiology.
At the same time there will be orchestrated attempts to discredit the science and the researchers, and to confuse the public. The stakes are high for alcohol industries when there is no argument, on current evidence, for a safe level of drinking with respect to cancer.
Promotion of health benefits from drinking at moderate levels is seen increasingly as disingenuous or irrelevant in comparison to the increase in risk of a range of cancers.
Breast cancer poses a particular challenge for the industries’ marketing efforts, being a leading cause of cancer death in women with an identified causal factor that is amenable to change.
It has also had a high profile with the public as a tragic, mutilating, blameless condition, a reputation which is due largely to large-scale emotive fund-raising campaigns.
Recent active discussion of cancer risk, along with increasing attention to fetal alcohol spectrum disorder, provides more support for population-level control of alcohol consumption, weakening the industry arguments that making better individual choices is the answer.
However, the large multi-national alcohol corporations have virtually unlimited resources available to tackle commercials threats, and cannot be expected to step back from this challenge.
Some individualized approaches to prevention and treatment may depend upon more detailed understanding of the mechanisms by which alcohol causes cancer, but population approaches to reducing incidence and mortality from cancer caused by alcohol are clear enough and are consistent with strategies to reduce other forms of alcohol-related harm [43].
From a public health perspective, alcohol is estimated to have caused approximately half a million deaths from cancer in 2012; 5.8% of cancer deaths world-wide [21].
The highest risks are associated with the heaviest drinking, but a considerable burden is experienced by drinkers with low to moderate consumption, due to the distribution of drinking in the population [44].
Thus, population-wide reduction in alcohol consumption will have an important effect on the incidence of these conditions, while targeting the heaviest drinkers alone has limited potential.
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http://onlinelibrary.wiley.com/doi/10.1111/add.13477/abstracthttp://onlinelibrary.wiley.com/doi/10.1111/add.13477/full
