Twenty-one years ago, Ireland was the first country in the world to introduce a workplace smoking ban. Our newly installed Taoiseach, Micheál Martin, was the minister for health who, in 2004, pulled the trigger to launch what was an unprecedented public health initiative.
Might he now lead a Government that will tackle the alcohol industry in the way the tobacco lobby was tamed almost 21 years ago?
The key to the smoking ban was the finding that tobacco was carcinogenic. Published in a 1976 landmark research paper by Richard Doll, Austin Hill and Richard Peto, which proved that the risk of lung cancer was 25 times higher in those who smoked more than 25 cigarettes a day compared with non-smokers, it took another 28 years before workplace smoking was banned.
With that significant time lag in mind, what evidence is there at present with which to label alcohol as a cancer-causing substance?
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A report last September from the American Association for Cancer Research found that six types of cancer are linked to alcohol consumption:
- Head and neck cancers
- Esophageal cancer
- Liver cancer
- Breast cancer
- Colorectal cancer
- Stomach cancer
And, this month, the US Surgeon General, Dr Vivek Murthy, issued an advisory that outlined links between alcohol and cancer risk and offered recommendations to reduce alcohol-related cancers. The surgeon general called for updated warning labels on alcoholic beverages that make cancer risks clear, in the same way that cigarettes carry explicit warnings about health risks.
But is the link clear enough to justify strongly-worded labels?
Numerous studies make it clear that there’s a solid link between alcohol and certain types of cancer. Some experts feel the evidence is robust enough to justify cancer warning labels on alcoholic drinks. However, it should be noted that there hasn’t been a study where some people have been randomly assigned to drink one alcoholic beverage a day and other people have been assigned to drink no alcohol at all, with both groups followed over time.
In other words, there hasn’t been the equivalent of a robust longitudinal study of the type undertaken by Doll, Hill and Peto for tobacco. Ultimately, a randomised control study with humans is what we need to conclusively prove a causal link between alcohol consumption and cancer.
But, in the meantime, we have some evidence that could be used to craft warning labels for use on bottles of liquor. In 2019, more than one in 20 cancer diagnoses in the West were attributed to alcohol consumption, and this is increasing with time. Alcohol has also been implicated in a recent trend: rising rates of certain cancers among younger adults.
Of particular concern is the rising incidence of early onset colorectal (bowel) cancer among those under 50, with alcohol consumption emerging as a potential front-runner in the list of possible causes. The relationship between alcohol and cancer risk generally follows a dose-response pattern, meaning that higher levels of consumption are associated with greater risk.
While the latest research challenges the widespread perception of alcohol as a harmless social lubricant, it’s important to remember that while alcohol increases cancer risk, it doesn’t mean everyone who drinks will develop cancer. There are many factors that contribute to cancer development. Our genes have a role to play. And alcohol breakdown products have been shown to damage and rewrite our DNA – in other words these changes are mutagenic and are a recognised precursor of cancer development.
The take-home message is not that we should never enjoy a glass of wine or a beer with friends. Rather, the message must be about moderation, mindfulness and informed decision making.
Jennifer Carroll MacNeill will have a busy inbox as our newly minted Minister for Health. But she could once again place Ireland to the international public health forefront by implementing a labelling regime that makes people aware of the potential cancer risks of alcohol.
