Alcohol and Cancer: Current UK developments Professor Linda Bauld Chair in Behavioural Research for Cancer Prevention Cancer Research UK
Overview Alcohol and Cancer Prevention New Alcohol Guidelines for the UK Alcohol Policy: Key recommendations for cancer prevention
Cancer Incidence and Mortality
Preventable Cancers in the UK
Key Prevention Areas
Alcohol and Cancer o Alcohol is responsible for around 12,800 cancers in the UK every year o A large proportion of head and neck cancers are caused by alcohol e.g. 30% of UK mouth cancers o But because the underlying risk is higher, alcohol is responsible for more cases of breast and bowel cancer a combined total of around 8,000 cases a year
New UK Alcohol Guidelines o Published in January 2016 after a 2 year review led by the Chief Medical Officers of the UK o First update to guidelines since 1994 o Substantial change to recommended limits due to: The acknowledgement of stronger evidence linking alcohol consumption with increased cancer risk Weaker evidence than was available previously of health protective effects from alcohol o Guidelines for pregnant women also changed, not entirely because of new evidence but to provide less ambiguous advice to women
Recent CRUK report on alcohol and cancer awareness
Methods and Findings o Study commissioned by CRUK s Policy Research Centre for Cancer Prevention and conducted by Penny Bukyx and colleagues at the University of Sheffield o 2,100 Adults in England surveyed just before the new Guidelines were released o Questions were about knowledge and use of alcohol guidelines as well as awareness of which health conditions are linked to alcohol o When our study participants were asked to name health conditions linked to drinking too much alcohol, only 13 per cent mentioned cancer. They were then shown a list of health conditions and asked to name those that could be caused by drinking too much alcohol. Almost half (47 %) selected cancer. But this is still a low level of awareness compared to 95 % who selected liver disease, and 59 per cent who selected diabetes. 84 % also recognised that alcohol can cause obesity and excess body weight.
Need for the guidelines o Overall, we found that 87 % of people in England don t associate drinking alcohol with an increased risk of cancer o Very few correctly linked specific types of cancer with alcohol consumption o This low level of public awareness implies there is a need for better information for consumers about the health risks associated with drinking alcohol o The new guidelines are clearly needed and equally importantly, how they are communicated needs to be linked to improving awareness of cancer risk.
CMO Guidelines The new Chief Medical Officer guidelines for both men and women state: o You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level. o If you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more. If you have one or two heavy drinking sessions, you increase your risks of death from long term illnesses and from accidents and injuries. o The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis. o If you wish to cut down the amount you re drinking, a good way to help achieve this is to have several drink-free days each week.
Cancer evidence underpinning the guidelines o People who drink even low levels of alcohol have a greater risk of getting some cancers than people who do not drink alcohol o Even at low levels of alcohol intake, below 1.5 units per day (10.5 units per week), there is an increased risk of the following cancer types: - mouth and throat (oral cavity and pharynx) - gullet (oesophagus) - breast in women o At alcohol intakes above approximately 1.5 units per day (10.5 units per week), there is an increased risk of the following cancer types: - voice box (larynx) - large bowel (colorectum) o At high levels of alcohol intake, above approximately 6 units per day (42 units per week), there is an increased risk of the following cancer types: - liver - pancreas
Previous work in Australia cancer awareness & policy support Pricing and taxation Availability Marketing Labelling Banning sport sponsorship Restrict internet advertising <18 Drinking guideline info Health warnings OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI Female 1.10 0.89-1.35 0.90 0.74-1.09 1.14 0.94-1.37 1.46 1.22-1.75 1.55 1.28-1.87 1.89 1.56-2.27 1.61 1.33-1.96 Age 1.01 1.00-1.01 1.03 1.02-1.03 1.01 1.01-1.02 1.01 1.00-1.02 1.01 1.01-1.02 1.01 1.01-1.02 1.01 1.00-1.01 Non metro 0.90 0.73-1.11 0.90 0.74-1.10 0.99 0.82-1.20 1.01 0.84-1.21 1.15 0.94-1.39 0.91 0.76-1.10 1.06 0.87-1.29 Education Yr 10 or less Yr 11 or 12 0.89 0.64-1.24 1.07 0.78-1.45 0.97 0.71-1.31 1.07 0.81-1.43 1.00 0.74-1.36 1.17 0.87-1.58 0.89 0.65-1.21 Diploma 0.79 0.60-1.05 1.15 0.88-1.50 1.02 0.79-1.32 1.27 0.99-1.62 1.05 0.81-1.37 1.01 0.78-1.31 0.84 0.64-1.10 University 1.44 1.04-1.99 1.91 1.40-2.61 1.34 0.99-1.81 1.80 1.34-2.41 1.15 0.84-1.56 1.32 0.97-1.79 1.25 0.90-1.73 Income <$30,000 $30k <$55k 1.32 0.97-1.81 1.20 0.89-1.60 0.79 0.59-1.05 0.97 0.74-1.27 1.20 0.89-1.62 0.81 0.61-1.08 0.77 0.56-1.04 $55k <$85k 1.11 0.80-1.55 0.97 0.71-1.32 0.79 0.59-1.06 0.80 0.60-1.06 0.95 0.70-1.28 0.79 0.58-1.06 0.67 0.49-0.91 $85,000+ 1.00 0.72-1.38 0.99 0.74-1.33 0.73 0.55-0.98 0.76 0.57-1.00 1.03 0.77-1.38 0.85 0.64-1.14 0.79 0.58-1.08 Don t know 0.84 0.48-1.47 0.73 0.43-1.24 0.68 0.41-1.14 0.83 0.51-1.34 0.84 0.51-1.39 0.83 0.50-1.38 0.68 0.40-1.16 No answer 1.00 0.69-1.43 0.72 0.51-1.00 0.77 0.56-1.07 0.93 0.68-1.28 0.99 0.71-1.39 0.66 0.47-0.92 0.64 0.45-0.90 Audit C 0.74 0.71-0.77 0.81 0.78-0.83 0.83 0.80-0.86 0.87 0.84-0.90 0.95 0.92-0.97 0.95 0.92-0.98 0.92 0.90-0.95 Non smoker 1.44 1.07-1.93 1.77 1.36-2.30 1.13 0.88-1.45 1.15 0.92-1.46 1.33 1.05-1.67 1.35 1.07-1.70 1.28 1.01-1.61 Know cancer risk 1.49 1.23-1.81 1.30 1.09-1.55 1.56 1.31-1.86 1.41 1.19-1.67 1.35 1.13-1.61 1.60 1.34-1.90 1.44 1.20-1.73 p < 0.05; p < 0.01; p < 0.001 Source: Buykx et al, 2014
Our ambition Reduce overall consumption of alcohol with an emphasis on hazardous and harmful drinking
Alcohol Our Calls Call for a comprehensive alcohol strategy for England and for devolved nations including: - Further investment in mass media campaigns on alcohol harms - Minimum Unit Pricing across devolved nations Build on the Health First strategy which was part funded by CRUK, and learning from a 4 nations report that tracked progress towards the strategy s recommendations.
Alcohol - What CRUK will do Health Information Joint Working Advocacy particularly in the devolved nations and continue to fund research that informs the best way to reduce alcohol related harm in individuals and communities
Alcohol current progress o The 4 nations report from our team and colleagues at Sheffield provides an audit of current alcohol policies o Overall, Scotland has the strongest approach to evidencebased alcohol policy and the greatest alignment with the recommendations of Health First. However, more can still be done, particularly on marketing.
Future Research Projects: Primary Care Alcohol Advice AIM: To investigate the alcohol advice given by primary care professionals: is there parity, are the new CMO guidelines being used, and what are the barriers. METHOD: National cross-sectional survey of GPs and nurses. The study will be carried out by the PRCP following the new CMO guidelines. Publication expected in early 2017 KEY MESSAGES: Highlight the current situation re. alcohol brief advice in primary care, awareness and use of the new guidelines and recommendations to overcome existing barriers POLICY GOALS: Raise awareness of alcohol and cancer. Support the new CMO guidelines
How other see us Source: Snowdon (2016) http://nannystateindex.org/
Thank you Linda.Bauld@cancer.org.uk