Dying for a drink: Experts call for cancer warnings on alcohol

Last year Scotland recorded its highest number of alcohol-specific deaths in 15 years. According to official statistics, 1,277 people died from conditions related to their drinking, an increase in one death from the previous year. And yet those figures only tell part of the story. That’s because they exclude those deaths where alcohol is merely a contributory factor, albeit a significant one. 

In reality, hundreds if not thousands of additional deaths caused by cardiovascular disease and cancer often have alcohol to blame, at least in part. Analysis carried out by Public Health Scotland (PHS) in 2020 found that on top of the number of alcohol-specific deaths, there were an extra 1,635 deaths from other conditions caused by alcohol. Indeed, it is estimated that one in eight deaths from breast cancer in women aged 36-64 and nearly half of all deaths from mouth and throat cancer in men aged 35-64 are caused by alcohol.

Last month the World Health Organisation (WHO) called for mandatory labelling on alcoholic drinks containers after its own research found public awareness of the link between alcohol and cancer was “alarmingly low”. Surveying people across 14 countries, it found only 15 per cent of people were aware that alcohol causes breast cancer and just 39 per cent were aware of the link with bowel cancer, the two cancers which account for the highest proportion of alcohol-related cancers among women and men respectively in the European Union. 

“Clear and prominent health warning labels on alcohol which include a specific cancer warning are a cornerstone of the right to health, because they empower individuals with vital information to make informed choices about the harm alcoholic products can cause,” says Dr Hans Henri P Kluge, WHO regional director for Europe. 

The science linking alcohol with cancer isn’t new – alcoholic drinks were declared “carcinogenic to humans” as far back as 1988. Ethanol, the type of alcohol found in alcoholic drinks, is classed as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC) alongside tobacco smoke, asbestos exposure and ionising radiation. And yet despite good public understanding of the cancer risks associated with smoking, for example, the same cannot be said for alcohol consumption.

“In Scotland, from Cancer Research UK polling, we know that one in two people don’t know that alcohol causes cancer,” says Nicola Merrin, policy and research manager for Alcohol Focus. “That’s really concerning especially because people are often worried about developing cancer, so I’m sure that is something they would want to know. 

“The alcohol industry has been keeping people in the dark about the health risks of their products by choosing not to provide us with the clear information we need to make choices about our health.” 

While health experts now agree that there is no safe amount of alcohol, many people are still labouring under the misapprehension that, on the contrary, small amounts of alcohol can actually be good for the health. After a series of studies linked moderate alcohol consumption, particularly red wine consumption, with better heart health, sales increased in the 1990s. But researchers began pointing out flaws in the data and the fact that moderate drinkers were more likely to be well-educated, wealthy and physically active while many of those classed as “non-drinkers” were actually people who had stopped drinking due to health reasons. A huge 2018 study published by The Lancet was unequivocal: “The level of alcohol consumption that minimised harm across health outcomes was zero standard drinks per week.”

At present in the UK, the guidelines are to drink no more than 14 units a week – the equivalent of six pints of average strength beer or six medium glasses of wine – spread over at least three days. The weekly allowance for men was cut from 21 units in 2016 amid growing evidence linking drinking with cancer. 

But while Scotland has taken public health interventions in relation to alcohol consumption – notably the introduction of Minimum Unit Pricing (MUP) – health experts argue these  measures do not go far enough. The WHO says countries should mandate health warning labels and not rely on self-regulation by the drinks industry. It is calling for clear and unambiguous labelling warning of the cancer risk and cautions against the use of QR codes after research showed less than one per cent of consumers scan them to find out health information.

Despite alcohol causing around 800,000 deaths annually in the WHO European region, health warning labels are currently implemented in only three out of 27 EU countries and only 13 out of the 53 WHO European region member states. Next year, Ireland will become the first country in the world to mandate a warning linking any level of alcohol consumption with cancer. Under the country’s Public Health Alcohol Act (2018), there will also be warnings over alcohol’s role in liver disease, and risks associated with alcohol consumption during pregnancy.

Additionally, the labels must include nutritional information and a link to a health service website. Among other EU countries, only Sweden mentions cancer in its health warnings, although these are on advertisements, not labels.

There is now strong support in favour of the Scottish Government following suit, with charities including Cancer Research UK in favour. The charity says that in 2019, nearly one in 15 of all deaths in Scotland was attributable to alcohol, with 45 per cent of those due to cancer. 
“We know that alcohol causes seven types of cancer, including two of the most common – breast and bowel,” says the charity’s Dr Sorcha Hume. “Including warning labels would help raise awareness and encourage people to think about how much they drink.

“Whatever people’s drinking habits, cutting down helps decrease cancer risk. But the world around us can make it difficult to make healthier changes, and government support is key, which is why a measure like this is so important.”

Any attempt to bring in further health messaging on alcohol products is likely to be met with at least some resistance from the industry. Minimum unit pricing was only finally introduced in Scotland in 2018 after a legal challenge brought by the Scotch Whisky Association led to a decision at the Supreme Court. 

But while MUP has been largely welcomed by public health experts, its introduction was overshadowed by the start of the Covid pandemic which has been blamed for increasing alcohol consumption worldwide. A study published by PHS in 2023 found the policy had had a positive impact on health outcomes, reducing deaths directly caused by alcohol consumption by an estimated 13.4 per cent and hospital admissions by 4.1 per cent. The largest reductions were in men living in Scotland’s most deprived communities. 

However, the study also found that while MUP had led to a three per cent reduction in alcohol consumption at a population level, there was limited evidence of any reduction in consumption for those people with an alcohol dependency – with some evidence they were prioritising spending on alcohol over food. 

And while MSPs recently voted to increase the minimum unit price from 50p to 65p, the rising number of people dying alcohol-specific deaths continues to give cause for concern.

“We’re still consuming alcohol at a level which is having a massive impact on our health and on wider society,” says Merrin. “We’re at a 15-year high in relation to the number of alcohol deaths which are double what we saw in the 1990s. There’s definitely no room for complacency. 

“The pandemic has had a drastic impact. It’s polarised our drinking habits – for those who were drinking at low or moderate levels, that’s reduced but on the other hand, those who were drinking at higher levels before the pandemic have increased the level of alcohol being consumed. The modelling suggests we’re going to have levels of harm well into the future.” 

Scotland’s relationship with alcohol remains not only problematic but complex, and everywhere you look there are mixed signals. While the government proposed measures to clamp down on the marketing of alcohol, including at sporting events, it simultaneously considered a series of pilots that would allow drink to be sold at Scotland football matches. A ban on alcohol at football has been in place since 1981, although alcohol is sold at other sporting fixtures, such as golf and rugby. First Minister John Swinney, who was pictured drinking a pint with members of the Tartan Army at Euro 2024 in Germany, later said he was “not sympathetic” to the proposal, effectively putting an end to it for now at least.

Around 35,000 Scots are told each year they have cancer. For many of us, lifestyle changes – improvements to our diet, increasing exercise levels, reducing our alcohol consumption – are likely to lower our risk. Amid worrying levels of ignorance over the link between drinking and cancer, putting more information into the public domain can only be a good thing.