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In January, England’s Chief Medical Officer, Professor Dame Sally Davies, unveiled the Government’s new alcohol guidelines.

And it’s fair to say that they received mixed reviews. Some welcomed being better informed about the health risks – including increased cancer risk – associated with drinking alcohol. Others have expressed the opinion that guidelines put the UK on the path towards becoming a ‘nanny state’.

As an organisation dedicated to beating cancer, we were in the former camp. Guidelines like these don’t tell people what to do. Instead, they offer information on how people can reduce their risk of cancer by informing them about the risks of drinking. When they were launched, we blogged about the updated guidelines, the weekly guideline of 14 units for both men and women, and how this could be useful in helping people cut their cancer risk.

But how easy is it for people to do this? And do we, as a nation, truly understand the links between alcohol and different types of cancer?

The public consultation on how the Government should communicate these guidelines closes today. And our Policy Research Centre for Cancer Prevention, an in-house research team at Cancer Research UK, working with Dr Penny Buykx’s team at the University of Sheffield’s Alcohol Research Group, have attempted to find out more about people’s awareness of the risks of alcohol.

Their latest study – carried out before the new guidelines were in place – reveals some worrying gaps in public awareness of alcohol’s harms and people’s knowledge of guidelines.

The headline figure shows that almost nine in 10 people don’t link alcohol to an increased risk of cancer. And if we dig a bit deeper, an even more worrying gap emerges.

Alcohol and cancer

We’ve written a lot about the link between alcohol and cancer – from discussing the evidence that it causes cancer, to talking about how drinking less reduces your risk of developing the disease.

When it comes to the science of how and why alcohol causes cancer, the picture isn’t too clear. But there are a few leading theories, which we blogged about recently.

Regardless of the underlying mechanism, we know that 12,800 cases of cancer are linked to alcohol each year in the UK.

To find out how much the public knows about the link, we worked with Dr Buykx’s team to survey 2,100 people in England, asking questions about their knowledge and use of alcohol guidelines – as well as their awareness of which health conditions are linked to alcohol.

Public misconceptions of alcohol and cancer

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 per cent) selected cancer. But this is still a low level of awareness compared to 95 per cent who selected liver disease, and 59 per cent who selected diabetes. A large proportion (84 per cent) also recognised that alcohol can cause obesity and excess body weight.

But people were even more unsure when asked which types of cancer are linked to alcohol, and at what level drinking alcohol increases the risk of these cancers.

In the study, people were asked which of seven different types of cancer they thought were linked to alcohol. Of these seven cancers, four are linked to drinking (bowel, breast, mouth and throat, and liver) and three are not (brain, bladder and ovarian). The graphic below shows that awareness of the risk – or lack of risk – varied a fair bit. For example, only 18 per cent of people questioned correctly answered that breast cancer was linked to alcohol.

Each year in the UK, alcohol causes 3,200 cases of breast cancer, the second largest amount after bowel cancer, with 4,800 cases down to alcohol each year. Yet only around four in 10 people (40 per cent) linked alcohol with bowel cancer, and just under half with mouth and throat cancers.

Conversely, over half believed that bladder cancer was linked to alcohol, when research hasn’t actually found a link.

Next, the participants were asked at what level of drinking they thought a person’s risk of developing cancer starts to increase for each type. While eight in 10 people (80 per cent) had correctly said that liver cancer was linked to drinking alcohol, the majority thought this was linked to lower levels of drinking than appears to be the case.

In the UK, around 400 cases of liver cancer are linked to alcohol each year (for context, there are nearly 5,500 cases each year overall). High levels of drinking are thought to trigger liver cancer because this causes conditions – such as cirrhosis – that damage the liver’s ability to repair itself.

Public knowledge of alcohol guidelines

Taken together, these results suggest that the public may not be too well informed about the health risks associated with drinking alcohol. If this is the case, simply offering new guidelines on drinking isn’t going to be enough to help people to understand the health risks.

But they are a good place to start. It’s the duty of the government to inform the public of health risks, and provide these guidelines to help people make decisions about their own health.

The new guidelines are clear that there is no safe level of drinking when it comes to cancer risk. But our study suggests that awareness of the risks needs to improve if the guidelines are going to have the desired effect.

Until the recent announcement, the government’s alcohol guidelines had not been reviewed since 1995.

Our survey reveals that even  though the guidelines haven’t changed in 20 years, only one in 10 men and one in seven women could correctly identify the guidelines for their own gender, and reported using this sometimes to keep track of their own drinking.

Now that the guidelines have changed to 14 units per week for both men and women, can we expect the public to know what they are? Our survey suggests that, without further work, this is unlikely.

So it’s important we – and others – continue to raise awareness of the health risks of drinking alcohol, and especially the links to cancer.

By helping people understand the guidelines, we hope that people will feel they have the information they need to make decisions about when they choose to drink, and how much. And that ultimately this will lead to a healthier nation.

Lucie Hooper is a researcher in the Policy Research Centre for Cancer Prevention at Cancer Research UK

Comments

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Lucie Hooper April 15, 2016

Thanks for all your comments,
Cancer is a very complex disease, and it isn’t possible to know exactly what caused any individual person’s cancer.
The 3,200 figure for breast cancer used in this article was calculated by researchers who looked at how much alcohol UK women drink and at the evidence on how breast cancer risk increases with the amount of alcohol consumed. From this information they estimated that 6 per cent of female breast cancers in the UK are linked to alcohol – which is about 3,200 cases each year. You can find more information on our website.
Research is helping us understand more and more about lifestyle factors that can raise the risk of breast cancer, such as drinking alcohol, being overweight or obese, or not keeping active. But other factors, such as the genes we are born with, our family history, and whether or not a woman has children, also play a role.
Best wishes,
Lucie, Cancer Research UK

Bev McDonald April 9, 2016

We know being overweight can raise risk of breast cancer as oestrogen is stored in fat cells. I know so many ladies, myself included, who’ve had oestrogen positive breast cancer who are very slim, eat healthily and exercise. Why?

Bev McDonald April 9, 2016

As a breast cancer survivor (so far!) a very interesting article. I always thought it was scaremongering! I need to understand why alcohol causes SOME breast cancer cases and not others i.e. 3200 cases out of the many more cases that there are. I have a lot of friends aged 50+, slim friends who don’t drink much and got breast cancer, and fat friends who drink a lot who haven’t! This is why i don’t put too much importance on how alcohol is relevant to breast cancer. I, and i’m certain, my friends, and the ladies i know from my breast cancer support group, would welcome your feedback. Many thanks.

Nane April 8, 2016

Hi cancer research …I am sure you are absolutely correct .. Your evidents points to these results …. However my nephew has gone through hell with leukaemia for the last 4 years …. Since 16yrs old. He eat healthy -blueberries / gobie berries !!! never drank or smoked or took drugs and life has had hit him so very hard ..and if he survives a bit longer he will have this for life!!!
I don’t drink but fell 75ft and survived and now in recovery I drink and so I think I have nothing to lose. Enjoy life whilst you can …cos cancer or other stuff happened.. Good bye to gobi berries and healthy greens I would rather have a gin & tonic ( tonic sounds a good word) …
If you can explain why a healthy / positive / vibrant person suffers with cancer and a pot head & drunk does not I may take your advise jx

Tony April 8, 2016

Good informative information ?

Lucie Hooper April 7, 2016

Hi Jon,
Thanks for your comment. We’ve amended the first paragraph you’ve mentioned to clarify.
On your second point, you’re correct that the risk of liver cancer only seems to increase for people who drink more heavily. In the survey, the participants were shown four different levels of drinking based on weekly units, and asked at which level they thought a person’s risk of each type of cancer might start to increase. The survey questions were phrased in terms of alcohol units rather than ‘heavy’ ‘moderate’ or ‘light’ drinking as these can be interpreted in different ways by people – what one person sees as ‘moderate’ might be perceived as ‘heavy’ for another. The categories in the survey weren’t chosen with specific reference to either the previous or the new alcohol guidelines.
Best wishes,
Lucie, Cancer Research UK

Jan April 7, 2016

“Each year in the UK, alcohol causes 3,200 cases of breast cancer”. If I am diagnosed with breast cancer, how do I know what caused it, be it alcohol or anything else?

Vadim Shapoval April 4, 2016

Cancer Research UK and Father of Oncology; Alcohol and Cancer. Alison Cox, Cancer Research UK’s Director of Cancer Prevention, said: The link between alcohol and cancer is now well established, and it’s not just heavy drinkers who are at risk. Vadim Shapoval, the Father of Oncology, said: Alcoholics love alcohol; Directors, scientists and researchers love money; Cancer, ALS and HIV love iron. Is alcoholism a sin or a disease? Despite his penchant for food, liquor and cigars, Winston Churchill reached the ripe old age of 90. Want to live to 100? Stalin’s hospitality was renowned for involving large quantities of alcohol and he preferred negotiating with heavy drinkers. Was Joseph Stalin (Man of Steel) an alcoholic? Scientists at Stalin’s sharashkas were prisoners. Chairman Mao’s Cultural Revolution moved swiftly to establish control of Chinese scientists. Why some heavy smokers get cancers – and others (Churchill, Stalin, Mao) are spared? Smoking distorts iron metabolism. Alcohol of any type, including beer, enhances iron absorption. Heavy drinkers can develop iron overload. African iron overload is associated with consumption of a traditional African beer that contains dissolved iron from the metal drums in which it is brewed. Cancer occurs when cellular iron overload chaotically affects cellular molecules and organelles. Primary tumors always develop at body sites of excessive iron deposits. Such deposits can be inherited or acquired. If you have Churchill’s iron-deficiency genes and diseases, if you are asymptomatic alcoholic patient with iron-deficiency anemia (IDA), you can successfully neutralize precancerous and cancerous cells, ALS (a form of cancer), HIV and antibiotic-resistant bacteria. Iron is present in all cells in the human body. Viruses and bacteria need iron to reproduce. Iron deficiency is the enemy of viruses and bacteria, but severe iron deficiency can lead to a wide array of signs and symptoms. Iron is important for regulating body temperature. In very severe IDA, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing cardiac output. Anticancer/antiviral IDA goes undetected in many people, and symptoms can be minor or vague. Iron-refractory iron-deficiency anemia (IRIDA) is an anemia which does not respond to treatment (treatment for anemia focuses on increasing iron stores). IDA may also be refractory as a clinical manifestation of gastrointestinal problems which disrupt iron absorption or cause occult bleeding. The future world of medicine is really exciting. Textbooks on cells should be rewritten. Vanga’s prediction is becoming real: humanity will stop the cancer epidemic and the AIDS epidemic, but a new disease will be worse than cancer and AIDS.

Byron Sharp April 2, 2016

Telling people about estimated risks of drinking for individual cancers is likely to confuse people. For them to then calculate their own risk they need to also know and consider their risk of being afflicted with that individual cancer.

It would be better to instead tell people how much they might increase their risk being diagnosed with any cancer (eg Jin et al 2013), yet this would also be misleading because many cancer diagnoses (eg breast) are false, or for benign/indolent cancers. So it would be more correct to tell them how much drinking might increase their chance of dying from cancer (eg Gou et al 2013 no risk for breast cancer death or reoccurrence). But this would also be misleading because cancer is only one cause of death (and not so such a risk for younger people).

So it would be more responsible to tell the public about the evidence on drinking and life expectancy, and on their chances of ageing successfully without the impairment of chronic diseases like diabetes and dementia. The evidence here is that regular drinking of alcohol has a positive effect on mortality risk (eg Doll et al 2005, Di Castelnuovo 2006) and disease-free ageing (eg Sun et al 2011), up to levels of consumption far higher than the current UK guidelines. And, as one part of a small suite of healthy behaviours that in combination have a dramatic effect on disease-free survival (Ford et al 2011).

To confuse the general public with far less important statistics about individual cancers, while well meaning, is not responsible. And it will erode public trust.

Jon April 1, 2016

Thanks for posting this.

I’m confused by this paragraph:

“Next, the participants were asked at what level of drinking they thought a person’s risk of developing cancer starts to increase for each type. While eight in 10 people (80 per cent) had correctly said that liver cancer was linked to drinking alcohol, in this next section, the majority thought this was linked to lower levels of drinking than appears to be the case.”

As I read that paragraph I’m confused by the sub-clause “this next section” – what next section? The next section of the survey or the next section of the paragraph?

Then, going on “The majority thought this was linked to lower levels of drinking than appears to be the case.” So, does that mean that live cancer is caused by higher levels of drinking? If that’s what you’re saying, how does the survey distinguish (for the sake of the person being surveyed) between higher level and lower level? Is that lower than the new government guidelines?

Sorry if this seems picky. Not intending it to be read that way. Just seeking clarification.