Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study -- Schütze et al. 342 -- bmj.com

BMJ 2011; 342:d1584 doi: 10.1136/bmj.d1584 (Published 7 April 2011)
Cite this as: BMJ 2011; 342:d1584
Research
Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study

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Madlen Schütze, PhD student1, Heiner Boeing, professor, department chair1, Tobias Pischon, scientist, group head1, Jürgen Rehm, professor, director23, Tara Kehoe, statistician2, Gerrit Gmel, data analyst2, Anja Olsen, scientist4, Anne M Tjønneland, department head4, Christina C Dahm, postdoctoral researcher5, Kim Overvad, professor of epidemiology6, Françoise Clavel-Chapelon, department head78, Marie-Christine Boutron-Ruault, senior scientist78, Antonia Trichopoulou, professor of nutrition9, Vasiliki Benetou, scientist10, Dimosthenis Zylis, scientist10, Rudolf Kaaks, professor, division head11, Sabine Rohrmann, senior scientist11, Domenico Palli, unit chief12, Franco Berrino, department chief13, Rosario Tumino, director14, Paolo Vineis, chair of environmental epidemiology, unit chief1528, Laudina Rodríguez, section chief16, Antonio Agudo, scientist17, María-José Sánchez, lecture director18, Miren Dorronsoro, unit chief19, Maria-Dolores Chirlaque, scientist2021, Aurelio Barricarte, department head21, Petra H Peeters, professor of epidemiology22, Carla H van Gils, associate professor of epidemiology22, Kay-Tee Khaw, professor of clinical gerontology23, Nick Wareham, director24, Naomi E Allen, scientist25, Timothy J Key, deputy director25, Paolo Boffetta, professor, deputy director2627, Nadia Slimani, scientist, group head26, Mazda Jenab, scientist26, Dora Romaguera, research associate28, Petra A Wark, research fellow28, Elio Riboli, director28, Manuela M Bergmann, scientist1

+ Author Affiliations

1Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
2Centre for Addiction and Mental Health (CAMH), Toronto, Canada
3Institute for Clinical Psychology and Psychotherapy, TU Dresden, Germany
4Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen
5Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark
6Department of Epidemiology, School of Public Health, Aarhus University, Aarhus
7Centre for Research in Epidemiology and Population Health, U1018, Institut Gustave Roussy, F-94805, Villejuif, France
8Paris South University, UMRS 1018, F-94805, Villejuif
9WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School and Hellenic Health Foundation, Greece
10WHO Collaborating Centre for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School
11Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
12Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy
13Department of Preventive and Predictive Medicine, Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
14Cancer Registry and Histopathology Unit “Civile M.P.Arezzo” Hospital, ASP 7 Ragusa, Italy
15Institute for Scientific Interchange Foundation, Turin, Italy
16Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain
17Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (IDIBELL), Barcelona, Spain
18Andalusian School of Public Health, Granada (Spain) and CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
19Public Health Department of Gipuzkoa and CIBERESP, San Sebastian, Spain
20Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
21CIBER Epidemiología y Salud Pública (CIBERESP), Spain
22Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
23Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
24MRC Epidemiology Unit, Cambridge
25Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford
26International Agency for Research on Cancer, IARC, Lyon, France
27Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY, USA
28Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London


Correspondence to: M Schütze m.schuetze@dife.de
Accepted 4 January 2011


Abstract
Objective
To compute the burden of cancer attributable to current and former alcohol consumption in eight European countries based on direct relative risk estimates from a cohort study.

Design Combination of prospective cohort study with representative population based data on alcohol exposure.

Setting Eight countries (France, Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Denmark) participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Participants
109 118 men and 254 870 women, mainly aged 37-70.


Main outcome measures
Hazard rate ratios expressing the relative risk of cancer incidence for former and current alcohol consumption among EPIC participants. Hazard rate ratios combined with representative information on alcohol consumption to calculate alcohol attributable fractions of causally related cancers by country and sex. Partial alcohol attributable fractions for consumption higher than the recommended upper limit (two drinks a day for men with about 24 g alcohol, one for women with about 12 g alcohol) and the estimated total annual number of cases of alcohol attributable cancer.


Results
If we assume causality, among men and women, 10% (95% confidence interval 7 to 13%) and 3% (1 to 5%) of the incidence of total cancer was attributable to former and current alcohol consumption in the selected European countries. For selected cancers the figures were 44% (31 to 56%) and 25% (5 to 46%) for upper aerodigestive tract, 33% (11 to 54%) and 18% (−3 to 38%) for liver, 17% (10 to 25%) and 4% (−1 to 10%) for colorectal cancer for men and women, respectively, and 5.0% (2 to 8%) for female breast cancer. A substantial part of the alcohol attributable fraction in 2008 was associated with alcohol consumption higher than the recommended upper limit: 33 037 of 178 578 alcohol related cancer cases in men and 17 470 of 397 043 alcohol related cases in women.


Conclusions
In western Europe, an important proportion of cases of cancer can be attributable to alcohol consumption, especially consumption higher than the recommended upper limits. These data support current political efforts to reduce or to abstain from alcohol consumption to reduce the incidence of cancer.


Footnotes
Contributors: All authors had full access to all of the data (including statistical reports and tables) and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors MS, MMB, TP, HB, JR, TK, and ER were responsible for study concept and design. HB, TJK, K-TK, PP, AB, MD, M-DC, MJS, LR, AA, PV, RT, FB, DP, AT, RK, FC-C, KO, AMT, AO, CD, M-CB-R, VB, DZ, SR, CvG, NW, MJ, NS, DR, PAW, and ER acquired the data. MS, MMB, HB, TP, JR, TK, GG, PB, NEA, and PP analysed and interpreted the data. MS, MB, TP, HB, JR, TK, NEA, KO, PP, and PB drafted the manuscript, which was critically revised for important intellectual content by all the authors. MS, JR, TK, GG, TP, and MMB were responsible for the statistical analysis. MMB, JR, and HB supervised the study. MS is guarantor.


Funding: The work was performed (partly) within the coordinated action EPIC (SP23-CT-2005-006438), which has received research funding from the Community’s Sixth Framework Programme, as well as by the “Europe Against Cancer” Programme of the European Commission (SANCO); Deutsche Krebshilfe; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health (grant No: Network RCESP C03/09); Spanish Regional Governments of Andalucia, Asturias, Basque Country, Murcia and Navarra; ISCIII, Red de Centros RETIC(RD06/0020) (grant No: C03/09); Cancer Research UK; Medical Research Council, UK; Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; Wellcome Trust, UK; Italian Association for Research on Cancer (AIRC); Compagnia di San Paolo; Progetto Integrato Oncologia-PIO, Regione Toscana; Dutch Ministry of Public Health, Welfare and Sports; National Cancer Registry of the Netherlands; Greek Ministry of Health and Social Solidarity; Hellenic Health Foundation and Stavros Niarchos Foundation. The funders were independent of the research of the presented study.


Role of sponsors: The sponsors had no input in the design, the conduct, the analysis, or the interpretation of the study, and did not influence the manuscript preparation.
Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.


Ethical approval: The EPIC study was approved by the IARC ethical committee and by the local ethics committees relevant for each study centre. All participants gave informed consent.
Data sharing: No additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study -- Schütze et al. 342 -- bmj.com





Casi el 10% de los cánceres en hombres en Europa se debe al consumo excesivo de alcohol, según un estudio
El análisis, realizado en ocho países europeos, entre ellos España, señala que el 3% de los casos de la enfermedad en mujeres está causado por la ingesta de alcohol por encima de los límites recomendados
REUTERS - Londres - 08/04/2011

El 9,6% de los cánceres que padecen los hombres y el 3% de los que sufren las mujeres en Europa Occidental son causados por un consumo excesivo de alcohol, según un estudio del Instituto Alemán de Nutrición Humana (DIFE) que publica la revista British Medical Journal.


Los autores del informe analizaron los datos de la Investigación Prospectiva Europea en Cáncer (EPIC), el estudio, desde mediados de los 90, de 363.988 hombres y mujeres de Francia, Italia, España, Reino Unido, Holanda, Grecia, Alemania y Dinamarca, la mayoría de los cuales tenía entre 35 y 70 años cuando se iniciaron los trabajos. Del análisis de la información recabada, los investigadores concluyeron que 50.400 de un total de 79.100 casos de determinados tipos de cáncer -como de esófago o intestino- registrados en 2008 correspondieron a personas que consumieron alcohol por encima de la cantidad diaria recomendada (dos vasos de vino o dos cervezas en el caso de los varones y la mitad para las mujeres).

En los hombres, 57.600 cánceres estaban asociados a la ingesta de alcohol y más de la mitad, 33.000, al consumo por encima de lo aconsejado. Respecto a las mujeres, 21.500 casos fueron de cáncer de esófago, hígado, colon y cáncer de mama, asociados al alcohol, de los que más del 80%, 17.400, estaban vinculados al haber bebido más de un vaso de vino o una cerveza al día.

"Muchos de estos cánceres podrían haberse evitado si la ingesta de alcohol se hubiera limitado a la cantidad aconsejada por las organizaciones sanitarias de referencia", ha señalado Madlen Schutze, del Instituto Alemán de Nutrición Humana. "También se prevendrían más casos si los ciudadanos consumieran alcohol por debajo de lo recomendado, o si dejaran de tomarlo por completo", ha añadido. "Mucha gente no sabe que beber alcohol puede aumentar el riesgo de padecer cáncer", ha declarado Sara Hiom, de la organización británica Investigación del Cáncer.

Manuela Bergmann, investigadora del estudio, ha afirmado que el mismo aporta evidencias de la conveniencia de respetar los límites de consumo de alcohol establecidos, y ha deseado que, gracias al informe, mucha más gente tome conciencia de este riesgo y modere la ingesta de alcohol. "Muchas personas piensan que solo un pequeño grupo de población bebe por encima de lo normal, pero eso no es así: el alcohol es barato y está disposible casi en cualquier sitio, por lo que cada vez se bebe más".

Según la Agencia Internacional de Investigación del Cáncer (IARC), parte de la Organización Mundial de la Salud (OMS), existe una relación causal entre el consumo de alcohol y el desarrollo de determinados tipos de cáncer, como el de hígado, de mama, de colon o de intestino, así como de los del tracto digestivo superior, esto es, de boca, garganta o esófago.

El Instituto Americano para la Investigación del Cáncer (AICR) y el Fondo Internacional de Investigación del Cáncer señalaron en febrero pasado que una tercera parte de los cánceres más comunes en Estados Unidos, China y Reino Unido podrían prevenirse si la población adoptara una dieta equilibrada, redujera el consumo de alcohol y realizara ejercicio moderado y periódico.

Casi el 10% de los cánceres en hombres en Europa se debe al consumo excesivo de alcohol, según un estudio · ELPAÍS.com


► DIFE -- German Institute of Human Nutrition Potsdam-Rehbrücke
DIFE -- German Institute of Human Nutrition Potsdam-Rehbrücke


► Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study -- Schütze et al. 342 -- bmj.com
Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study -- Schütze et al. 342 -- bmj.com
► bmj.com


► EPIC - European Prospective Investigation into Cancer and Nutrition
EPIC - European Prospective Investigation into Cancer and Nutrition


► IARC - INTERNATIONAL AGENCY FOR RESEARCH ON CANCER
IARC - INTERNATIONAL AGENCY FOR RESEARCH ON CANCER


► American Institute for Cancer Research (AICR): Homepage
American Institute for Cancer Research (AICR): Homepage


► World Cancer Research Fund International | Cancer Prevention Charity
World Cancer Research Fund International | Cancer Prevention Charity