Alcohol: Executive summary

Introduction

Alcohol is an established Class 1 carcinogen, with a large global study estimating that 4%, or 5,800 of all new cancer cases in Australia in 2020 were due to alcohol.¹ There is no ‘safe’ level of alcohol use, with even small amounts of alcohol increasing the risk of cancer.² Alcohol is causally linked to seven cancer types including breast, mouth, throat (pharynx), voice box (larynx), oesophagus, liver and bowel (colorectum); and has been identified as having a role in at least five others (Table 1).³ To reduce the risk of alcohol related cancers, Cancer Council recommends people avoid or limit their consumption of alcohol, and if people choose to drink, limit consumption to within the National Health and Medical Research Council (NHMRC) guidelines. The less alcohol used, the lower the risk of alcohol-related cancer.⁴

Table 1 Evidence of a link between alcohol and cancer type⁵

Robust evidence exists on measures to prevent and reduce harms from alcohol and improve long-term health outcomes. The World Health Organization (WHO) has identified effective and cost-effective measures to prevent noncommunicable diseases, known as ‘Best Buys’ and other recommended interventions.⁷ These include the following alcohol control interventions:

1. Increasing excise
2. Enacting and enforcing bans or comprehensive restrictions on alcohol advertising
3. Enacting and enforcing restrictions on the physical availability of retailed alcohol. The WHO has also released the SAFER initiative, which provides a framework of strategies and interventions for a world free from alcohol-related harm through a focus on the most cost-effective priority interventions.⁸

This policy discusses Cancer Council’s recommendations that have the greatest potential to create healthy communities and reduce the risk of alcohol-related cancer across the Australian population.

An estimated 250,000 new cancer cases will be caused by alcohol use over the lifetime of the cohort of Australian adults.⁹ Alcohol use in Australia is high by international comparison. Australian alcohol use was the sixth highest (alongside Denmark) of 18 comparable developed countries.¹⁰ In 2022, 31% of Australians, or 6.6 million people, drank alcohol at levels above the recommendations outlined in the national alcohol guidelines.¹¹ Research by the National Drug Research Institute estimates that alcohol use costs the Australian community $66.8 billion per year.¹² This figure includes costs associated with healthcare, road traffic crashes, crime, workplace absenteeism and injury, and premature death.

In Australia, Aboriginal and Torres Strait Islander communities have identified alcohol use as a significant concern.¹³ While Aboriginal and Torres Strait Islander peoples are less likely to be current drinkers than non-Indigenous peoples, those who do drink are more likely to have more than 4 standard drinks in a single day at least monthly, which can be defined as risky drinking.¹⁴ However, the prevalence of risky drinking significantly varies between and within Aboriginal and Torres Strait Islander communities with the variability being driven by various social and cultural determinants including differences in experiences of racism and trauma although individual motivations for drinking are also important to consider.^13,15,16

In 2018, alcohol use was the second largest contributor to the total burden of disease experienced by Aboriginal and Torres Strait Islander peoples, comprising of 10.5% of the total burden of disease.¹⁷ The mortality rate attributable to alcohol use was five times higher for the Indigenous population compared to the non-Indigenous population between 2013 to 2017.¹⁸ Mouth and pharyngeal cancers have been found to be the leading condition attributable to alcohol misuse resulting in deaths among Aboriginal and Torres Strait Islander peoples.¹⁹

Research indicates that the effects of alcohol on Aboriginal and Torres Strait Islander peoples are not simply a direct result of the substance itself but rather the amount and way in which it is consumed and the subsequent effect it has on individual behaviours.²⁰ These aspects are conditioned by the characteristics of alcoholic products and their availability, marketing and price, the intrapersonal factors of those who drink and their life experiences including ongoing impacts of colonialisation, emotional and social wellbeing, the broader sociocultural settings as well as the social determinants of health.²⁰