In the realm of public health, one of the most overlooked but significant factors contributing to cancer is alcohol consumption. Despite robust evidence linking alcohol to various cancers, public awareness and policy interventions have been sporadic and insufficient in many regions. In United status, 6.6 million all cause deaths were observed between 2015 to 2019 among 20 to 60 years of age group. Of these 12.7% were estimated as alcohol attributable mortality (AAM) 1. And among 20 to 49 years, estimated to be 20.3% of total AAM 1. I am writing this letter to discuss the implications of current research on alcohol-attributable cancers( cancer caused by alcohol) and urgent policy reinforcements to mitigate this growing health concern.
Recent studies emphasize the substantial impact of alcohol policy on cancer incidence. For instance, a research models shown the effect of raised alcohol taxation on cancer rates in the WHO European Region, demonstrating that such fiscal policies can significantly decrease the incidence of alcohol-attributable cancers 2.
Furthermore, the global study highlights that a 4·1% of new cancer cases in 2020 were attributable to the consumption of alcohol.3 This is providing a clear call to action for countries worldwide to reconsider their alcohol control strategies.
There is increasing evidence supporting the effectiveness of comprehensive alcohol policies. It was found that stringent availability, marketing and pricing alcohol policies are associated with reduced alcohol use among adolescents, potentially decreasing the long-term risk of cancer 4. Additionally, awareness campaigns about alcohol as a risk factor for cancer, have shown to increase public support for strong alcohol policies, suggesting that education can play an important role in policy acceptance and effectiveness 5.
However, despite the clear evidence and potential benefits of strict alcohol control policies, implementation remains inconsistent. The study pointed out the varied impact of public health policies on alcohol across different countries, suggesting a need for tailored approaches that consider local cultural and social norms 6. Moreover, the Australia’s experience with alcohol and tobacco policies indicates that while such interventions can reduce cancer rates, consistent enforcement and public engagement are crucial for long-term success 7.
The reluctance to enforce stringent alcohol policies can be attributed to several factors. Economic interests, particularly those related to the alcohol industry, often pose significant barriers. Additionally, cultural norms and social acceptance of drinking require targeted educational efforts to shift public perceptions. Addressing these challenges necessitates a multi-faceted approach involving government leadership, public health advocacy, and community engagement.
It is imperative that countries adopt and enforce comprehensive alcohol control strategies that include higher taxes, restricted availability, age limits, and strong advertising regulations. Furthermore, enhancing mass awareness about the association between alcohol and cancer through continuous education and media campaigns is essential. Such efforts should be supported by evidence-based research and international collaboration to tailor policies that are culturally acceptable and effective. Researches are highlighting the key areas for policy implementation and its effectiveness (Table 1)
As the worldwide cancer burden continues to rise, addressing modifiable risk factors such as alcohol consumption must become a higher public health priority. The evidence is clear, and the time for action is now. It is hoped that this correspondence serves as a call to action for policymakers, researchers, and public health professionals to intensify their efforts in implementing effective alcohol control policies that could substantially reduce the incidence of alcohol-attributable cancers worldwide.
Table 1: Overview of Key Studies on Alcohol policy.
| Study | Characteristics | Key Findings |
| Room et al., 20228 | This paper outlines collaborative research that identifies key areas for study in low and middle-income countries (LMICs). Topics include various alcohol market structures, the influence of alcohol industry on public health, global alcohol governance, control of unrecorded alcohol, and reducing familial harm from men’s drinking. | Identified seven research priority areas for alcohol policymakingEmphasized focus on LMICs |
| Casswell et al., 20239 | This article examines how drinking behaviours vary among different demographic groups in various nations and their relationship with alcohol control policy, as measured by the International Alcohol Control (IAC) Policy Index. | Effective alcohol policies linked to decreased consumption in heavy drinkers.IAC Policy Index linked to lower drinking frequency and volume. |
| McCambridge et al., 201810 | Actors in the alcohol industry are very strategic, rhetorically adept, and well-coordinated in their efforts to influence national policy. This indicates that they employ two main strategies to shape policymaking. | Alcohol industry actors influence policymaking through framing and relationship-building.20 reports from 15 studies highlight industry’s strategic influence. |
| Jankhotkaew et al 202211 | In this study, the researchers carried out a scoping review to identify methods and tools for evaluating the enforcement of alcohol control policies. | 39 studies were included in the review.There are no standardized methods for assessing the implementation of alcohol control policies. |
References
1 Esser, M. B. et al. Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019. JAMA Network Open 5 (2022). https://doi.org:10.1001/jamanetworkopen.2022.39485
2 Carolin, K. et al. Modelling the impact of increased alcohol taxation on alcohol-attributable cancers in the WHO European Region. 11, 100225 (2021). https://doi.org:10.1016/J.LANEPE.2021.100225
3 Harriet, R. et al. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. Lancet Oncology 22, 1071-1080 (2021). https://doi.org:10.1016/S1470-2045(21)00279-5
4 Jonathan, K. N. Associations Between Alcohol Policies and Adolescent Alcohol Use: A Pooled Analysis of GSHS and ESPAD Data. Alcohol and Alcoholism 54, 639-646 (2019). https://doi.org:10.1093/ALCALC/AGZ068
5 Sarah, B. et al. Awareness of alcohol as a risk factor for cancer is associated with public support for alcohol policies. BMC Public Health 18, 688-688 (2018). https://doi.org:10.1186/S12889-018-5581-8
6 Díaz, L. A. et al. Association between public health policies on alcohol and worldwide cancer, liver disease and cardiovascular disease outcomes. Journal of Hepatology 80, 409-418 (2024). https://doi.org:https://doi.org/10.1016/j.jhep.2023.11.006
7 Heng, J. et al. Can public health policies on alcohol and tobacco reduce a cancer epidemic? Australia’s experience. BMC Medicine 17, 1-14 (2019). https://doi.org:10.1186/S12916-019-1453-Z
8 Room, R. et al. Research agendas for alcohol policymaking in the wider world. International Journal of Alcohol and Drug Research (2022). https://doi.org:10.7895/ijadr.353
9 Casswell, S. et al. Effective alcohol policies are associated with reduced consumption among demographic groups who drink heavily. Alcohol: Clinical and Experimental Research 47, 786-795 (2023). https://doi.org:10.1111/acer.15030
10 McCambridge, J., Mialon, M. & Hawkins, B. Alcohol industry involvement in policymaking: a systematic review. Addiction 113, 1571-1584 (2018). https://doi.org:10.1111/add.14216
11 Jankhotkaew, J., Casswell, S., Huckle, T., Chaiyasong, S. & Phonsuk, P. Quantitative tools and measurements for assessing the implementation of regulatory policies in reducing alcohol consumption and alcohol‐related harms: A scoping review. Drug and Alcohol Review 42, 157-168 (2022). https://doi.org:10.1111/dar.13543