Alcohol intake highest in Europe, increasing digestive cancer risks

The United European Gastroenterology organization released a report stating that the average daily alcohol intake was between one and four drinks per person in all 28 European Union states, representing a 21% increased risk for developing digestive cancers.

“Despite attempts in Europe to tackle the impact of alcohol on health, the amount of alcohol consumed by EU countries is higher than the rest of the world and the incidence of many alcohol related digestive cancers is on the increase,” Michael Manns, MD, president of the United European Gastroenterology for 2015 to 2017, said in the report. “We urgently require a focused multi-dimensional approach from policy and decision makers at both European and national levels to dramatically increase public and healthcare professional awareness of the dangers of alcohol, as well as to implement further strategies across the region to reduce alcohol intake and the resulting incidence of digestive cancers.”

According to the report, a recent study revealed that alcohol was responsible for cancer of the upper digestive, colon or liver in 57,000 cases among men and in 21,000 cases among women. However, additional studies showed that one in five Europeans did not believe there was a connection between alcohol and cancer and nine in 10 Europeans were unaware that alcohol increases the risk for cancer.

The report provided evidence linking alcohol specifically to liver, esophageal, pancreatic, colorectal and gastric cancer.

Liver cancer

In Europe, alcohol abuse accounts for 40% to 50% of all liver cancers and a recent meta-analysis showed that the risk for liver cancer increases by 16% with consumption of three or more drinks per day up to 22% with consumption of six or more drinks per day.

“With viral hepatitis in sharp decline in Europe, alcohol will take the number one position as cause of liver cancer with increasing incidence in eastern Europe and Great Britain,” Markus Peck-Radosavljevic, MD, chair-elect of United European Gastroenterology public affairs committee, said in the report.

Esophageal cancer

Alcohol abuse has been linked to an esophageal squamous-cell carcinoma. The highest rates of esophageal squamous-cell carcinoma in Europe are within the northeastern countries, while the lowest rates are in Scandinavia. Rates have been declining recently in France and the U.K., which may be related to stricter advertising and drinking at work regulations in France.

As prognosis is greatly improved with early initiation of treatment in cases of esophageal squamous-cell carcinoma, the researchers advise that primary care identification is vital in high risk patients and should be a focus for physicians.

Pancreatic cancer

Accumulating evidence associates alcohol consumption with pancreatic cancer equally among men and women, though further research is required.

“There is a small incremental increase in the risk of developing pancreatic cancer if you only drink alcohol, but a huge increased risk if you smoke as well,” Matthias Löhr, PhD, said in the report, on the topic of correlated lifestyle factors. “Heavy drinkers often smoke too and both risk factors go hand in hand to exacerbate damage to cancer-associated pancreas cells, triggering carcinogens which may then proliferate abnormally to form cancer.”

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Colorectal cancer

Recent studies have revealed that the risk for developing colorectal cancer increases to 21% with consumption of one to four drinks per day and up to 52% with consumption of more than four drinks per day.

Currently, data are varied on whether alcohol consumption presents a greater risk for cancer in the colon or rectum, while some studies report a similar association.

“Exactly how alcohol increases the risk of [colorectal cancer] is not well understood and needs more research,” Evelien Dekker, PhD, from the University of Amsterdam, said in the report. “As the incidence of colorectal cancer is increasing in younger people, and this does not seem to be explained by clear genetic cancer syndromes, it follows that lifestyle factors, including alcohol misuse, might add to the risk of colorectal cancer in these young patients.”

Gastric cancer

The risk for gastric cancer is increased among those who are chronic heavy drinkers, especially if accompanied by the abuse of tobacco. Men who drink four or more drinks per day were twice as likely to develop gastric cancer in the next decade compared with men who drank about half a drink or less per day, according to results of a study.

Unlike many other studies that were unable to confirm a difference in cancer risk by type of alcohol consumed, reports have shown that beer increases the risk for gastric cancer compared with other types of alcohol.

What needs to change

The researchers of the report advocate for better education among the public, increased efforts to create awareness campaigns, improved primary care and initial screening for at-risk patients, and further policies designed to decrease alcohol consumption.

“Many countries have started to implement at a national level some of the policy options from the WHO’s global strategy to reduce the harmful use of alcohol, addressing the availability and marketing of alcohol as well as introducing new higher pricing of alcohol products to reduce its accessibility,” the researchers wrote in the report. “Other policy options include reducing the public health impact of illicit alcohol and informally produced alcohol, a particular priority for eastern European countries. A recent report revealed the impact of introducing a minimum unit price for alcohol in England.”

Specific examples highlighted in the report included the lower accessibility to purchase alcohol in Scandinavian countries, tightened marketing regulations in France, and recent reductions in the consumption of cheap table wine — potentially more carcinogenic than other alcoholic products — in Mediterranean countries.

“It is time for Europe to change its approach and attitude towards alcohol consumption,” Paul Fockens, MD, PhD, United European Gastroenterology president 2017 to 2019, said in the report. “[United European Gastroenterology] calls upon EU policy makers and citizens to recognize the evidence of the digestive cancer risks associated with alcohol consumption. The societal costs and health care implications of increased alcohol consumption are huge. Now is the time to take positive and pro-active action for the benefit of current and future generations.” – by Talitha Bennett

Reference:

United European Gastroenterology: EU Affairs. Alcohol and digestive cancers across Europe: Time for change. Published June 27, 2017. https://spink.sharefile.com/share?#/view/s9b8ba75e47644849. Accessed July 3, 2017.