Alcohol consumption is estimated to be responsible for approximately 3% of the new cancers (i.e. nearly 3,500 cases) seen in Australia each year.
Reducing alcohol consumption, in line with the National Health and Medical Research Council (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking Alcohol (Guidelines), lowers the risk of cancer and other chronic illnesses.
Alcohol and increased cancer risk
Alcohol is a Group 1 carcinogen. This is the highest classification available and means that it is an acknowledged cause of cancer.
There is convincing evidence that drinking alcohol increases the risk of at least seven types of cancer including female breast, liver, mouth, throat (pharynx and larynx), oesophagus and bowel.
There is a dose-response relationship between alcohol consumption and cancer risk, meaning that the risk increases with every drink. There is no evidence of a safe threshold in relation to cancer risk.
The precise mechanisms of how alcohol consumption causes certain cancers are not completely understood. The World Cancer Fund/American Institute for Cancer Research state:
- A large body of experimental evidence has shown that acetaldehyde, the most toxic metabolite of alcohol, disrupts DNA synthesis and repair and thus may contribute to a carcinogenic cascade.
- Higher ethanol consumption also induces oxidative stress through increased production of reactive oxygen species, which are potentially genotoxic.
- It is hypothesised that alcohol may also function as a solvent for cellular penetration of dietary or environmental (for example tobacco) carcinogens or interfere with DNA repair mechanisms.
- High consumers of alcohol may also have diets that are lacking in essential nutrients, such as folate, rendering target tissues more susceptible to the carcinogenic effects of alcohol.
- Alcohol may increase the circulating levels of oestrogen in our body which is a known risk factor for breast cancer.
The NHMRC guidelines
It is recommended that people reduce their drinking to reduce their risk of cancer.
For some people, not drinking at all may be the safest option.
People who do drink alcohol should follow the NHMRC Guidelines.
The NHMRC Guidelines recommend that healthy men and women drink no more than two ‘standard drinks’ on any day.
For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol related disease or injury.
The NHMRC is currently revising these Guidelines, however the 2009 Alcohol Guidelines remain current until the revision of the Guidelines is complete.
Embedding brief advice into routine care
Research suggests that most Australian adults are unaware that alcohol is a risk factor for cancer.
General practice is an ideal environment to screen for risky drinking and provide brief advice, with general practitioners being accepted as a well trusted, authoritative source of health advice [i]. Further, in many cases, practice nurses may also be well positioned to provide brief advice given their role providing holistic, integrated care.
Establishing routine provision of brief advice for alcohol reduction can have many positive benefits for a practice including: a decrease in the time taken for risk assessment; an increase in confidence in managing alcohol issues; and a decrease in the stigma associated with raising alcohol issues, which can result in improved communication with patients.
The RACGP recommends using the ‘5As’, an internationally accepted framework for the assessment and management of lifestyle related risk factors, to assess and manage high-risk drinking.
The RACGP recommends that all patients aged 15 years and older should be asked about the quantity and frequency of their alcohol intake, with the results logged in the patient record. The Alcohol Use Disorders Identification Test (AUDIT) or abbreviated, three-item AUDIT-C tool can be utilised for this purpose.
This tool asks three questions to find out:
- how often someone drinks alcohol
- how many standard drinks they have on a particular day
- how often they have six or more drinks on any occasion.
Each person then gets a score that can indicate whether they are at risk of harmful drinking, which can prompt a discussion about their drinking.
The RACGP also provides information on how you could use these tools, and others, with your patients.
Tools, such as the AUDIT and AUDIT-C 33 ( a five minute intervention) can reduce harmful alcohol consumption by nearly one-third and are often as effective as more extensive treatments.
- DirectLine 1800 888 236 can provide free, immediate telephone and online support, including clinical advice, referral options and support for your patients to help reduce drinking.
- RACGP 'Guidelines for preventive activities in general practice, 9th edition'
- RACGP 'Smoking, nutrition, alcohol, physical activity (SNAP) A population health guide to behavioural risk factors in general practice, 2nd edition'
Learn more about how you can talk with your patients about reducing alcohol consumption:
You can also order hard copies.
Information and groups
If your patients want to learn more about cutting down the amount of alcohol they drink or stopping for good, here are some other information sources that might interest them:
- DirectLine: 1800 888 236
- Provides free, 24/7, telephone and online support staffed by professional counsellors, including clinical advice, referral options and support for your patients to help reduce drinking.
- DrugInfo: 1300 85 85 84 / email@example.com
- DrugInfo is a free and confidential service where you can speak to a real person for real information about alcohol and other drugs, and get advice on how you can best support yourself or someone you’re concerned about.
- The Victorian Government Department of Health and Human Services has produced a helpful list of alcohol support telephone and online services available across Victoria.
- Online communities, such as Hello Sunday Morning. Their app, ‘Daybreak’, is an online program that offers people the chance to share their experiences of cutting back or giving up on alcohol with each other.
- Mental health support services such as Beyond Blue, that provide information and resources related to alcohol, drug use and mental health.