International Agency for Research on Cancer Lyon, France
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1 Global Burden of Cancer in Attributable to Alcohol Consumption International Agency for Research on Cancer Lyon, France Kevin D Shield (Shieldk@fellow.iarc.fr), Pietro Ferrari, Jacques Ferlay, Freddie Bray, Isabelle Soerjomataram
2 Alcohol consumption and cancer A causal relationship has been confirmed for oral cavity, oesophageal, colorectal, liver, laryngeal, and breast cancer sites. Biological pathways: Ethanol metabolism Inhibition of the one carbon metabolism pathway Modification of hormone levels and associated signalling pathways Aim of this study To estimate the burden of new cancer cases and cancer deaths attributable to alcohol consumption
3 Data sources All data by country, age and sex. Outcome Cancer incidence and mortality by site: GLOBOCAN Exposures Alcohol consumption data: Adult per capita consumption of ethanol for 5 - Global Information System on Alcohol and Health Drinking data: Surveys on drinking status and consumption among drinkers globally for 5 s: Recent meta-analyses Population data: United Nations population division 3
4 Population-Attributable Fraction P LA, P FD and P CD represent the prevalence of lifetime abstainers, former drinkers and current drinkers respectively. RR FD and RR CD represent the RR functions for a cancer site for former drinkers and current drinkers respectively (given a daily ethanol consumption amount of x, in grams per day). 4
5 Alcohol consumption (ethanol, litres/adult/year)
6 Alcohol-attributable cancers 6
7 Population-attributable fractions by cause Population-attributable fraction
8 Alcohol-attributable cancers by country Age-standardized incidence per, people Age-standardized mortality per, people Age-standardized rate per, people 8
9 Limitations The risk relationship between alcohol and cancer incidence may be modified by genetic variations in alcohol metabolism genes (such as ADH and ALDH [the flushing gene]). With respect to oesophageal cancers, only squamous cell carcinoma is causally related to alcohol. Misclassification of light drinkers as lifetime abstainers may have led to a downward shift in the RR. Interaction with smoking is not taken into account. Cancers of the pancreas, stomach, prostate, gallbladder, lung, thyroid and kidney, as well as lymphoma, are not included. 9
10 Conclusions Alcohol leads to a large burden of new cancer cases (4.7%) and cancer deaths (4.5%). Alcohol-attributable colorectal (%) and breast cancers (%) were the greatest contributors to new cancer cases. Alcohol-attributable oesophageal (4%) and liver cancers (3%) were the greatest contributors to cancer deaths. The burden of alcohol-attributable cancers was highest in Eastern Europe.
11 Contact information Kevin D Shield PhD Postdoctoral researcher International Agency for Research on Cancer Cancer Surveillance 5 Cours Albert Thomas, Latarjet building, Room L 6937 Lyon CEDEX 8, France Tel: +33 () ext ShieldK@fellows.IARC.fr 3 June 6
12 Relative risk functions 9 Oral cavity 5 Esophageal.5 Liver Men Women Lifetime abstainers Men Women Lifetime abstainers Men Women Lifetime abstainers Larynx Breast Colorectal Pancreatic Men Women Lifetime abstainers Women Lifetime abstainers Men Women Lifetime abstainers Men Women Lifetime abstainers 8 June 6
13 Alcohol consumption data Data from population surveys / imputation Amount of alcohol consumed during heavy drinking occasions Prevalence of people who are heavy episodic drinkers Prevalence of current drinkers, former drinkers and lifetime abstainers Amount of alcohol consumed by age and sex Country level alcohol consumption data Adult per capita consumption of alcohol Adult per capita consumption of recorded alcohol Adult per capita consumption of unrecorded alcohol Adult per capita consumption of alcohol by tourists and from cross-border shopping 3
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