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Multicenter Study
. 2011 Apr 7:342:d1584.
doi: 10.1136/bmj.d1584.

Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study

Madlen Schütze  1 , Heiner Boeing, Tobias Pischon, Jürgen Rehm, Tara Kehoe, Gerrit Gmel, Anja Olsen, Anne M Tjønneland, Christina C Dahm, Kim Overvad, Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, Antonia Trichopoulou, Vasiliki Benetou, Dimosthenis Zylis, Rudolf Kaaks, Sabine Rohrmann, Domenico Palli, Franco Berrino, Rosario Tumino, Paolo Vineis, Laudina Rodríguez, Antonio Agudo, María-José Sánchez, Miren Dorronsoro, Maria-Dolores Chirlaque, Aurelio Barricarte, Petra H Peeters, Carla H van Gils, Kay-Tee Khaw, Nick Wareham, Naomi E Allen, Timothy J Key, Paolo Boffetta, Nadia Slimani, Mazda Jenab, Dora Romaguera, Petra A Wark, Elio Riboli, Manuela M Bergmann
Affiliations
Multicenter Study

Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study

Madlen Schütze et al. BMJ. .

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.

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Conflict of interest statement

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.

Figures

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Fig 1 Equations for computation of alcohol attributable fractions
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Fig 2 Total and partial alcohol attributable fractions with 95% confidence intervals and corresponding number of cases of cancer with 95% confidence intervals in men in selected EPIC countries (Italy, Spain, UK, Greece, Germany, Denmark) in 2008. UADT=upper aerodigestive tract
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Fig 3 Total and partial alcohol attributable fractions with 95% confidence intervals and corresponding number of cases of cancer with 95% confidence intervals in women in selected EPIC countries (France, Italy, Spain, UK, Netherlands, Greece, Germany, Denmark) in 2008. UADT=upper aerodigestive tract
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