Most people are aware of the cancer risks associated with smoking. We see warnings on tobacco products and packaging, hear regularly about quit smoking campaigns, and are constantly reminded about how bad cigarettes are for our health. However, much less is spoken about the dangers of alcohol and how it is a risk factor for cancer.
One in two people living in Ireland will be diagnosed with invasive cancer in their lifetime. This equates to 24,000 invasive cancers and 9,000 cancer deaths every year. Prostate, breast, colorectal, lung, and melanoma skin cancer are the most common cancers diagnosed in this country.
Your risk of developing cancer is influenced by a wide range of factors, including ones we cannot control such as our age and genetics. However, there are things we can change, such as diet, lifestyle, choosing not to smoke, and reducing our alcohol consumption. The fact that 50 per cent of all cancers are preventable is a good reason to look at ways of reducing our risks.
In 1988, the World Health Organisation’s international cancer research agency classified alcohol as a group one carcinogen – a substance that may increase your risk of cancer. This put alcohol in the highest risk category alongside asbestos, radiation, and tobacco. In 2023, the global public health agency went one step further and said there was no safe level of alcohol consumption, any amount increases your cancer risk.
Each year in Ireland, 1,000 people are diagnosed with alcohol-related cancers. Alcohol causes seven types of cancer, including mouth, upper throat, larynx, oesophagus (foodpipe ), liver, breast, and bowel, according to a recent public health webinar on reducing cancer risks which was organised by the HSE’s National Cancer Control Programme (NCCP ).
Speaking at the event, Dr Clíona Ní Bhuachalla, a specialist registrar in public health medicine, said people who both smoke and drink have a five fold increased risk of developing cancers of the mouth, throat, voice box, and food pipe compared with people who only drink or smoke. The risk is up to 30 times higher for heavy drinkers and heavy smokers.
Drinking alcohol raises your cancer risk in many ways. It increases your oestrogen levels which can be associated with breast cancer, reduces your folate levels which may be linked to colorectal cancer, and can increase your weight which is an independent risk factor for cancer. In addition, alcohol aids the transportation of cancer-causing substances from tobacco to the cells of the upper aerodigestive tract.
Any type of alcoholic drink can increase your risk of cancer. “It’s important to remember it’s ethanol [alcohol] that drives the cancer risk, not the beverage type, and it’s any amount of ethanol,” she said. “It doesn’t matter if it’s beer or spirits or wine.”
How much do people drink in Ireland? Data from the Healthy Ireland Survey 2024, which was published recently, revealed that 73 per cent of people who took part in the study had a drink in the last year with 38 per cent consuming alcohol at least once a week.
The average alcohol intake per person in this country in 2023 was 9.9 litres, according to the Organisation for Economic Co-operation and Development, an intergovernmental global policy forum. Dr Ní Bhuachalla said this is a high figure compared with other OECD countries.
Increased awareness is one of the keys to reducing alcohol related cancers, she stated. “This is the first step on a complex pathway towards behaviour change of alcohol reduction or alcohol elimination. When we look at the evidence internationally, we can see there are low levels [of awareness] of less than 50 per cent reported. Increasing awareness can drive behaviour change.”
Substantial emerging evidence from Australia supports this. “We see in the international literature that increasing awareness of the alcohol cancer link increases support for wider alcohol harm reduction policies. These are in alignment with the World Health Organisation’s ‘best buys’ [cost-effective interventions] and include reducing availability of alcohol, restricting advertising, and increasing price. All of this works together to increase and result in a less alcogenic environment overall.”
She conducted a study in association with the National Cancer Control Programme recently which looked at how aware people are that alcohol is a risk factor for cancer. “This was a nationally representative survey of 2,874 adults in the Republic of Ireland which was conducted by phone between January and May 2022. What we found was a very stark finding, that overall 43.7 per cent of respondents had unprompted awareness of alcohol as a risk factor for cancer. This didn’t seem too bad until you consider that 81.6 per cent of the same group had unprompted awareness of smoking as a risk factor for cancer so we can see certainly there is a lot of work to be done.”
Certain groups were more likely to be aware of the alcohol-cancer link, according to Dr Ní Bhuachalla’s research. These included females, middle-aged and older people, those with cancer experience, higher medical literacy, higher alcohol consumption, and higher levels of physical activity.
“However, even within those who were aware, some confusion and misconceptions existed. For example, almost half of those who were aware of the alcohol-cancer link, incorrectly believed that alcohol only causes cancer if you drink a lot of it over a long period of time. So, certainly, the low level of awareness at population level, coupled with the clear misconceptions, shows there is a need for work to be done in this space.”
The study highlighted a need for greater awareness about alcohol-cancer risks, particularly that any amount of alcohol increases your risk. “To do this, we’re working at a population level, sharing study findings and raising awareness. We are also working with Alcohol Action Ireland and are working to spread the message among higher risk groups, such as younger males with lower levels of medical literacy. We are also looking at spreading the message in different settings, for example, healthcare settings. We are also raising awareness among health care professions.
“In addition, we are sharing these [study] findings with the Department of Health to help support the ongoing implementation of the Public Health [Alcohol] Act 2018. This is legislation that was introduced in Ireland to help reduce alcohol harm. As part of that, there is a plan to add cancer warning labels to alcohol containers in 2026. We need to push for this, in addition to the other measures, such as restricting advertising and increasing the price [of alcohol].”
Facts about alcohol and cancer
When alcohol is broken down in your body, it can damage your body’s cells
Alcohol increases the risk of at least seven types of cancer including mouth, throat, larynx, oesophagus, breast, stomach, and bowel
You can reduce your risk of cancer if you do not drink alcohol. The less you drink, the lower your risk of alcohol
Visit www.askaboutalcohol for more information, tips, advice, and to access an alcohol assessment tool.
How to reduce your risk of developing cancer:
Do not start smoking.
If you smoke, quitting reduces your cancer risk. It is never too late to quit. See Quit.ie for support and information.
Limit alcohol intake. Even small amounts of alcohol increase your cancer risk. The less you drink, the lower your risk.
Eat a healthy, balanced diet. Include plenty of fruit, vegetables, and wholegrains. Limit red meat and avoid processed meat such as chorizo, bacon, or salami.
Be physically active. Any amount of activity is better than none.
Maintain a healthy body weight. Eating a healthy balanced diet, being physically active, getting enough sleep, and taking care of your mental health can all help to maintain a healthy body weight.
Vaccines, such as the HPV and Hepatitis B vaccines, offer protection against some cancers.
Be SunSmart. Protect your skin from the sun and never use a sunbed.
Take part in cancer screening programmes for bowel, cervical, and breast cancer.
Consider breastfeeding. It reduces the mother’s risk of breast cancer. VisitMyChild.ie for support.
Check radon gas levels in your home or workplace and take action to reduce them, if necessary. Radon is a naturally occurring radioactive gas that results from the decay of uranium in rocks and soils. It causes about 350 cases of lung cancer in Ireland each year. Contact the Office of Radiological Protection at (01 ) 2680100, log on to www.epa.ie or email info@epa.ie for further information.
