ALCOHOL AND SOCIETY 30% of all alcohol-attributable “If you’re too tired to take your cancer cases in Sweden are kid to the football match on caused by moderate or low Sunday, you drank too much levels of alcohol consumption. on Saturday night.” Claudia Fahlke, Professor of Psychology THEME 2016/2017: ALCOHOL AND CANCER The Swedish Society of Medicine and IOGT-NTO are voluntary organisations independent of commercial interests. The Swedish Society of Medicine is the scientific organisation of the Swedish medical pro- fession and has a broad range of interests across the entire field of medicine. The importance of lifestyle to people’s health at both individual and societal level, is a priority issue. IOGT-NTO focuses on the effects of alcohol and narcotics on individuals and society, but is also engaged in broad social and club activities. CERA is an interdisciplinary and collaborative centre for education and research into hazardous use, abuse and addiction at Gothenburg University – which works to strengthen and develop research and education in the field of addiction, and to disseminate scientific expertise to people working professionally in the field of abuse and addiction, and other interested parties. Published by IOGT-NTO, the Swedish Society of Medicine and CERA in cooperation with Forum Ansvar, 2016/2017 A Swedish language version of this report is also available from www.iogt.se or www.sls.se. © IOGT-NTO & Swedish Society of Medicine & CERA, 2016 Graphic design: ETC kommunikation Printers: Fridholm och Partners, Hindås URN: urn:nbn:se:iogt-2016-aos-en CENTRUM FÖR UTBILDNING OCH FORSKNING KRING RISKBRUK, MISSBRUK OCH BEROENDE (CERA) 3 TABLE OF CONTENTS Foreword ...................................................................................4 Executive Summary ............................................................. 7 Introduction Alcohol as a cause of cancer .....................................10 How does alcohol cause cancer? ................................. 12 Cancers accepted by IARC as caused by alcohol ............................................................................... 14 Other cancers probably caused by alcohol consumption ....................................................17 Cancer possibly caused by alcohol .............................. 18 Possible underestimation of alcohol-related cancers .................................................... 19 Methods used to estimate alcohol caused cancers in Sweden ............................................. 20 Results Awareness ............................................................................. 28 Prevention policy ................................................................30 Report Find out more about the latest research showing clear links between alcohol and cancer. References ............................................................................32 PAGE 6 Interview Addiction doesn’t discriminate .................................... 34 It’s important to talk about alcohol ...........................40 Current research Should the alcohol industry be regulated in the same way as the tobacco industry? ............. 39 Alcohol policies have long-term effect on consumption ..................................................................44 Is moderate alcohol consumption good Interview Interview for health? ............................................................................44 Jonas Sjögreen: Claudia Fahlke, Alcohol – a sensitive Professor of Health issue in health care. Psychology, on Alcohol PAGE 40 Dependence. PAGE 34 4 Foreword Clear link between alcohol and cancer Healthy living and lifestyles are a strong to intensify initiatives aimed at prevention trend in Sweden, but no other EU national- and information provision. ity knows less about or is less aware of the The Swedish Society of Medicine and link between alcohol and cancer. And given IOGT-NTO, with the financial support of that alcohol is the second most common Forum Ansvar, publishes an annual research contributory factor in terms of the global report entitled “Alcohol & Society”, with the cancer burden, according to the World aim of illustrating the harmful effects of Health Organisation, this is something we alcohol consumption at both an individual are keen to change. Which is why we hope and a societal level. This year’s report, which that this report can help boost knowledge is on the theme of alcohol and cancer, was levels and awareness, and increase interest also produced in partnership with CERA, an in the issue, both in the health care sector interdisciplinary centre for education and and in society as a whole. research into hazardous use, abuse and International research has shown that addiction at Gothenburg University. alcohol can cause cancer, even at moderate The report is produced by a group headed consumption levels. This report includes by Harold Holder and comprising some of estimates that almost 30% of the cases of the foremost researchers in the field of alcohol-induced cancer in Sweden are due international alcohol research. The group to moderate or low levels of alcohol con- collates and aggregates facts and fig- sumption, and that the more the individual ures from international studies, and then draws conclusions and proposes measures tailored for use in Sweden and the other “ It is our hope that readers will find Nordic countries. They receive no financial the report thought-provoking and remuneration for this work. Previous years’ reports have addressed that it will provide you with valuable such issues as alcohol and young people, information on the latest findings in the effects of low dose consumption, and the second-hand harm caused by alcohol. alcohol-related research! The report’s articles are aimed at a broad target group and can be read by anyone consumes, the greater the risk. It should interested in public health. An English-lan- also be noted that the cost of hospital guage version with a full bibliography is also treatment of alcohol-induced cancer ex- provided for more in-depth study, and is ceeded SEK 320 million in Sweden in 2014. available on our respective websites. This year’s report also includes estimates It is our hope that readers will find the re- of the percentage of Swedish deaths from port thought-provoking and that it will pro- cancer where alcohol was a factor, in order vide you with valuable information on the to highlight the importance of the issue and latest findings in alcohol-related research! STEFAN LINDGREN, CLAUDIA FAHLKE, DIRECTOR JOHNNY MOSTACERO, CHAIRMAN SWEDISH CERA UNIVERSITY OF CHAIRMAN IOGT-NTO SOCIETY OF MEDICINE GOTHENBURG 5 6 Report 7 EXECUTIVE SUMMARY • Alcohol causes cancer. Any among men, and breast cancer alcohol consumption increases among women. the risk of certain cancers, and Authors • More than 10% of breast higher levels of consumption cancer deaths in Sweden are further increase those risks. attributable to alcohol. Sven Andréasson • Evidence for the relationship Karolinska Institutet, Department of • Critically, the evidence between alcohol and cancer Public Health Sciences, Stockholm, summarised in this report comes from chemical toxicology Sweden. indicates that approximately studies, animal studies, and 30% of all alcohol-attributable epidemiological studies among Tanya Chikritzhs cancer cases and deaths humans. Alcohol is considered Curtin University, National Drug in Sweden are caused by a Group I carcinogen (highest Research Institute, Perth, Western moderate or low levels of level) by the International Australia. alcohol consumption. Agency for Research on Cancer of the World Health • The number of alcohol- Frida Dangardt Organization. attributable cancer deaths in Sahlgrenska Academy and Univer- Sweden has increased by 7.3 sity Hospital, The Queen Silvia Chil- • Human cancers that are percent since 2001 dren´s Hospital – Paediatric Clinical considered causally related Physiology, Goteborg, Sweden. to alcohol consumption • Hospitalizations from alcohol- include cancers of the oral attributable cancers cost at Harold Holder cavity (mouth), pharynx least 324 million SEK in 2014 Senior Scientist Emeritus och tidig- (throat), larynx (voice box), esophagus, stomach, liver, • The public and members of the are chef för Director of Prevention colon and rectum, and female medical professions are largely Research Center, Pacific institute for breast. Other cancers that unaware of the role of alcohol Research and Evaluation, Berkely, are associated with alcohol as a cause of cancer. Among CA, USA. consumption and are probably the general public in European causally related to alcohol Union nations, Swedes had Timothy Naimi include cancers of the pancreas the lowest recognition of the Boston Medical Center, Section on and prostate. There are other relationship between alcohol General Internal Medicine, Boston, cancers that are associated and cancer in a recent study. MA, USA. with alcohol consumption (e.g., • A number of steps should be Tim Stockwell lung cancer, melanoma) but taken to raise public awareness where a causal relationship is of the link between alcohol Dept of Psychology – Centre for Ad- more speculative in nature. consumption and cancer, dictions Research of BC, University of Victoria, BC, Canada • In Sweden in 2014, there were including the labeling of alcohol an estimated 996 alcohol- containers with warnings about the risk of specific cancers. We are grateful to Dr. Jinhui Zhao attributable cancer deaths and to Adam Sherk of the Centre (4.5% of all cancer