Peter Anderson - Alcohol and Cancer

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Prof Peter Anderson: Substance Use, Policy and Practice, Institute of Health and Society at Newcastle University and Professor, Alcohol and Health, Faculty of Health, Medicine and Life Sciences at Maastricht University, Netherlands.

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Peter Anderson - Alcohol and Cancer

  1. 1. Alcohol and cancerPeter Anderson MD, MPH, PhDProfessor, Substance Use, Policy and Practice, Institute ofHealth and Society, Newcastle University, EnglandProfessor, Alcohol and Health, Faculty of Health, Medicineand Life Sciences, Maastricht University, NetherlandsDublin 29 May 2013
  2. 2. Overall evaluation Alcoholic beverages cause cancer inhumans (Group 1) Ethanol in alcoholic beverages causescancer in humans (Group 1) Acetaldehyde associated with alcoholicbeverages causes cancer in humans(Group 1) (Vol 100E)
  3. 3. In this presentation, we will:1.Look in more detail at what IARC said2.Consider the importance of alcohol-relatedcancers3.Consider toxicological thresholds4.Mention alcohol and heart disease, and thusconsider alcohol’s overall contribution to harm5.Discuss actions to reduce the harm done byalcohol, including alcohol-caused cancers
  4. 4. In this presentation, we will:1.Look in more detail at what IARC said2.Consider the importance of alcohol-relatedcancers3.Consider toxicological thresholds4.Mention alcohol and heart disease, and thusconsider alcohol’s overall contribution to harm5.Discuss actions to reduce the harm done byalcohol, including alcohol-caused cancers
  5. 5. International Agency for Research on Cancer:Alcohol is a causal agent for cancers of: Oral cavity, pharynx, and larynx Oesophagus Liver Colon Rectum Breast
  6. 6. 12345670 10 20 30 40 50 60 70 80 90 100RelativeriskGrams alcohol consumption per day (10 grams = 1 drink)Oral cavity & Pharynx (86%)Larynx (43%)Oesophagus (39%)Breast (25%)Liver (19%)Rectum (9%)Colon (5%)Source: Corrao et al 2009In brackets, increased risk at 20g/day compared with not drinking
  7. 7. Decline in risk of oesophageal cancer after drinking cessationSource: Jarl & Gerdtham 2012
  8. 8. Relative risk of breast cancer by alcohol consumptionSource: Allen et al 2009
  9. 9. 0.80.911.11.21.31.41.51.61.71.8HazardratioNone<6.0≥6.0Risk of death (HR) from breast cancer recurrence by alcoholconsumption (none, <6g/day, ≥6g/day)Source: Kwan et al 2010
  10. 10. 6.1 Carcinogenicity in humans1. There is sufficient evidence in humans for the carcinogenicityof alcoholic beverages.2. The occurrence of malignant tumours of the oralcavity, pharynx, larynx, oesophagus, liver, colorectum andfemale breast is causally related to the consumption ofalcoholic beverages.3. There is substantial mechanistic evidence in humans who aredeficient in aldehyde dehydrogenase that acetaldehydederived from the metabolism of ethanol in alcoholic beveragescontributes to the causation of malignant oesophagealtumours.
  11. 11. In this presentation, we will:1.Look in more detail at what IARC said2.Consider the importance of alcohol-relatedcancers3.Consider toxicological thresholds4.Mention alcohol and heart disease, and thusconsider alcohol’s overall contribution to harm5.Discuss actions to reduce the harm done byalcohol, including alcohol-caused cancers
  12. 12. Alcohol-attributable deaths by disease groups for people aged15-64 years living in EU in 2004. Total deaths: 138,000Source: Rehm et al 2012Cancer19%CVD8%MentalDisorders10%Livercirrhosis28%Injuries32%Other3%26,000 deaths
  13. 13. Amongst people aged 15-64 yearsliving in the EU in 2004, 8% of all maleand 6% of all female cancer deathswere due to alcohol.Source: Rehm et al 2012
  14. 14. Number of alcohol-attributable cancers (95% CI) in women and men inFrance, Italy, Spain, UK, Netherlands, Greece, Germany, Denmark in 2008.Source: Schutze et al 201101020304050607080Women MenNumber(000s) >12/24g per dayTotal
  15. 15. In this presentation, we will:1.Look in more detail at what IARC said2.Consider the importance of alcohol-relatedcancers3.Consider toxicological thresholds4.Mention alcohol and heart disease, and thusconsider alcohol’s overall contribution to harm5.Discuss actions to reduce the harm done byalcohol, including alcohol-caused cancers
  16. 16.  The Margin of Exposure (MOE) compares a toxicthreshold of a substance with the exposure of thesubstance. The European Food Safety Authority judges MOEsfor carcinogens above 1,000 as low priority forpublic health when based on human data. This means that provided that the doseconsumed is 1,000 times less than the toxicthreshold, this is acceptable for public healthexposure (it does not mean that the consumptionis completely safe).
  17. 17. The toxic threshold of alcohol for human cancer isabout 50g alcohol (5 drinks a day). [This is basedon animal studies in which 10% develop cancerfrom the equivalent dose].
  18. 18. Using European Food Safety Authority guidelineson exposure to carcinogens in food anddrinks, exposure should be no more than onethousandth the toxic dose, which works out at50mg ethanol a day, about 20g alcohol (2 drinks)a year.
  19. 19. EU adults who drink alcohol on average consumeabout 30g (3 drinks) a day, 600 times more thanthe exposure level set by the European FoodSafety Authority guidelines.
  20. 20. Based on one tenth the toxic dose, theequivalent exposure for a non-carcinogenicoutcome, e.g. liver cirrhosis, should be nomore than about 3g (one third of a drink) aday.EU adults who drink consume 10 times thisamount.Source: Lachenmeir et al 2011
  21. 21. In this presentation, we will:1.Look in more detail at what IARC said2.Consider the importance of alcohol-relatedcancers3.Consider toxicological thresholds4.Mention alcohol and heart disease, and thusconsider alcohol’s overall contribution to harm5.Discuss actions to reduce the harm done byalcohol, including alcohol-caused cancers
  22. 22. Alcohol in small regular doses can reduce the riskof ischaemic events, in particular ischaemic heartdisease.This effect can be achieved at doses of 5g a day, ismoderated in overweight individuals, anddisappears with just one episode of binge drinking(60g, six drinks, on one occasion) a month.Source: Anderson 2013
  23. 23. Deaths prevented or caused by daily alcohol consumption for adults living in Englandin 2006 compared to actual median alcohol consumption of 13g/day.Source: Nichols et al 2012-8000-40000400080001200016000200002400028000320001 2 3 4 5 6 7 8 12 16 20 24 32 40 48Liver diseaseCancerCVDDeaths due todecreasingconsumptionDeaths due toincreasingconsumptionMedian consumption →
  24. 24. In this presentation, we will:1.Look in more detail at what IARC said2.Consider the importance of alcohol-relatedcancers3.Consider toxicological thresholds4.Mention alcohol and heart disease, and thusconsider alcohol’s overall contribution to harm5.Discuss actions to reduce the harm done byalcohol, including alcohol-caused cancers
  25. 25. 05001000150020002500Eur-A Eur-B Eur-CDALYs/millionpeopleavertedIncrease tax by 20% Reduced accessAdvertising ban Brief advice to 30% at riskSource: World Health Organization 2009
  26. 26. In addition, consumers should be informed thatalcohol causes cancer through highly visible andsimple warning labels on all beverage containers.
  27. 27. And, we should encourage our friends andcolleagues to drink less.
  28. 28. Framingham Heart Study: Impact of fraction offriends/family who abstained or drank heavily at oneexamination on drinks/day at next examination.Source: Rosenquist et al 2010
  29. 29. Conclusions:1.Alcohol is a carcinogen, causing cancers of theoralcavity, pharynx, larynx, oesophagus, liver, colorectum and female breast.
  30. 30. 2. Adopting the standards of the EuropeanFood Safety Authority for genotoxiccarcinogens, human exposure should beno more than 50 milligrams of ethanol aday. This is the same as about 20 grams(2 drinks) a year.
  31. 31. 3. Alcohol should be strictly regulated withprice increases, reduced availability andbans on all forms of commercialcommunications.
  32. 32. 4. Brief advice (and treatment) should beoffered to all people with heavy drinking(and alcohol use disorders).
  33. 33. 5. All alcohol beverage containers shouldcarry warning labels informingconsumers that alcohol causes cancer.
  34. 34. 6. We could all encourage each other todrink less.

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