Charities and health campaigners have warned that hard-hitting TV campaigns about the dangers of unhealthy eating and labels on alcohol are needed to curb the huge rise in avoidable cancers. Doctors and public health campaigners are demanding that all cans and bottles of alcohol carry labels highlighting that drinking raises the risk of fatal illnesses, including cancer. Ireland recently became the first country in the world to legislate to do that. In future, labels on alcohol products will warn drinkers that “drinking alcohol causes liver disease” and “there is a direct link between alcohol and fatal cancers”.
Governments have previously used public health adverts that deployed “scare tactics”, such as fat oozing out of an artery to illustrate the dangers of smoking. About 40% of all cancers are preventable because they are caused by known risk factors, mainly smoking, alcohol, obesity and sunburn, the WCRF and Cancer Research UK (CRUK) believe.
A report last week by Frontier Economics estimated that 184,000 cases of avoidable cancer would be diagnosed in the UK this year, which would cost the country £78bn. Alcohol has been shown to cause seven forms of cancer while strong evidence has found that overweight and obese adults – two-thirds of Britons weigh more than their healthy weight – are at heightened risk of 14 different forms of the disease, according to WCRF, which tracks global changes in the evidence base for what causes cancer.
World Cancer Research Fund
The World Cancer Research Fund (WCRF) said mass media campaigns, using tough messages mirroring the graphic photographs and wording on cigarette packets, were now needed to tackle the widespread lack of awareness that alcohol and being overweight are both major causes of cancer.
“There is a dire need for impactful campaigns to highlight important health messages and to reduce the risk of preventable cancers,” said Dr Panagiota Mitrou, the WCRF’s director of research. “History shows that sometimes very graphic, hard-hitting tactics in campaigns – even images that risk upsetting some people – are necessary to alert the public to the dangers of unhealthy behaviour,” she added.
For some people, the recommendation on limiting how much alcohol to drink can be the hardest one to swallow. From sipping merlot in Bordeaux to clinking steins of beer in Munich, to warming up with vodka in Russia, drinking alcohol is an ingrained part of many cultures worldwide. Globally the amount of alcohol consumed in 2010, was equal to 620 measures of whiskey, or 310 glasses of red wine per person over the age of 15, and Eastern Europeans drank more alcohol than any other part of the world. These habits could be putting huge numbers of us at risk.
World Cancer Research Fund International’s global analysis of research shows that drinking alcohol is linked to an increased risk of several cancers: bowel, breast, mouth and throat, oesophageal, and liver. But how does alcohol actually interact with us to cause such a drastic effect? Nobody is completely sure exactly how alcohol interacts with our bodies to increase the likelihood of cancer forming, but there are some strong theories for how this could work.
Alcohol that we drink contains ethanol, which has been found to be carcinogenic. When we drink ethanol, it is converted by an enzyme in our cells into a toxic substance, acetaldehyde. Usually acetaldehyde is converted by other enzymes (known as aldehyde dehydrogenase) into acetate, which is useful for the cells to make energy.
However, when there is a large amount of alcohol entering the body, there is more acetaldehyde than the enzymes can process, causing a build up of acetaldehyde. This can be dangerous because acetaldehyde can directly damage DNA, affecting how the DNA functions and its ability to repair itself, which can lead to the cells becoming cancerous. So the more we drink, the more toxic acetaldehyde builds up, the more DNA damage occurs and the cancer risk increases.
But it’s not just heavy drinkers who are at risk. Bacteria found in the mouth are particularly good at converting ethanol into the toxic acetaldehyde, which can give you a build up of acetaldehyde even if you’ve only been drinking smaller amounts.
Folate is a vitamin found in a variety of different foods such as dark green vegetables and legumes. It affects the way DNA works, in most cases acting as an ‘off’ switch for particular genes. Drinking too much alcohol can reduce how much folate we absorb in the liver. Absorbing less folate can remove this ‘off’ switch mechanism, which can result in big changes in the cell, potentially in ways that can make a cell more likely to become cancerous. Another theory is that alcohol could physically help carry other cancer-causing substances into cells. This means that alcohol can act as a solution that carcinogens can mix with to help them sneak into cells.
There are also some explanations of how drinking alcohol can lead to specific cancer types. One example of this is that drinking excess alcohol can cause liver cirrhosis, which can make liver cancer much more likely. For breast cancer there is an idea that alcohol can affect hormone levels in women, causing oestrogen levels to rise, which could help cancer cells to grow. However, many factors can affect oestrogen levels, so this explanation isn’t that straightforward.
Alcohol consumption has been linked to more than 200 diseases and injury conditions, including cirrhosis, infectious diseases, cardiovascular disease, early dementia and cancer. Worldwide consumption of alcoholic drinks in 2016 was equal to 6.4 litres of pure alcohol (ethanol) per person aged 15 years or older, which is equivalent to about one alcoholic drink per day. However, consumption varies widely.
In many countries, alcohol consumption is a public health problem. Alcohol consumption is expected to continue to rise in half of the World Health Organization (WHO) regions unless effective policy reverses the trend. The Panel judges that alcoholic drinks are a cause of various cancers, irrespective of the type of alcoholic drink consumed. This is because all alcohol contains ethanol and ethanol is the cancer causing compound. The extent to which alcoholic drinks are a cause of various cancers depends on the amount and frequency of alcohol consumed.
Cancer Research UK
Michelle Mitchell, the chief executive of CRUK, called for a revival of the use of arresting public health adverts to help the UK’s 6 million smokers, most of whom want to give up. But she voiced concern that government funding for such initiatives has fallen sharply.
“Mass media campaigns can be highly impactful and cost-effective in motivating people to stop smoking and discouraging uptake, but they must be of sufficient intensity and be sustained to see continued benefit. Yet national spending in England on public education campaigns has significantly dropped since 2008. We’re calling on the UK government to better fund stop smoking services and public health campaigns to help people quit for good,” she said. Mitchell said that most people knew that smoking caused cancer, but awareness of other risk factors – notably obesity – remained “worryingly low”.
Hazel Cheeseman, the deputy chief executive of the campaign group Action on Smoking and Health (Ash), said that while campaigns such as Stoptober were proven to help smokers quit, “the evidence says that hard-hitting health messages are what change behaviour”. She voiced alarm that Ash’s latest annual Smokefree GB survey, of 12,000 adults who were weighted to reflect the UK population as a whole, had found barely half (55%) of 18- to 24-year-olds who smoke knew that doing so caused cancer, while even fewer were aware that it also caused strokes (46%), heart disease (50%) and lung problems (55%). That was far fewer than the very large majorities of those aged 25 or over who were aware of those links.
“Lack of health messages on TV, online, radio and billboards will be contributing to lower levels of understanding among all young smokers, but particularly young smokers who won’t recall the hard-hitting campaigns of the past,” said Cheeseman. More young adults began smoking when the Covid-19 pandemic hit in 2020 and have maintained their habit since, figures suggest.
Ash’s research also found that while 86% of people knew smoking caused cancer, only 54% were aware that obesity was a key risk factor and 53% knew that alcohol was one. While the number of people who smoke has been falling steadily for years, other measures as well as advertising campaigns – such as raising the legal age of buying cigarettes from 18 to 21 – were needed to get it down further, said Cheeseman.
The Alcohol Health Alliance, a grouping of medical organisations and health charities, wants the UK to follow Ireland’s example on warning labels. Dr Sadie Boniface, head of research at the Institute of Alcohol Studies thinktank, said the move would improve the “very low” levels of awareness that alcohol caused cancer. “The fox has been left in charge of the hen house, with the alcohol industry self-regulating its own product labelling. A couple of years ago the government promised a consultation on wine labelling but it is yet to materialise,” she said.
Health charities urged ministers to learn from the success of public health education campaigns run in the north-east by Fresh and Balance, which are funded by local NHS trusts and local councils. The groups, which target smoking and harmful drinking, specialise in hard-hitting mass media ads. In Fresh’s “smoking survivors” campaign, two women who got cancer after smoking spoke of their regret at ever taking up cigarettes. Fresh believes that this and other campaigns it has run have helped to cut smoking in the north-east from 29% in 2005 to 13% – the biggest fall in any English region.
Ailsa Rutter, the director of both groups, said the use of striking and emotionally charged messages would be vital if the government was to achieve its stated ambition of making England “smoke-free” – defined as 5% or fewer of the population smoking – by 2030. A Department of Health and Social Care spokesperson said: “We are committed to tackling the causes of preventable cancers to help people live longer, healthier lives and reduce pressure on the NHS.
“The government has introduced calorie labelling, a £40m pilot to give eligible patients living with obesity access to effective obesity drugs, a million free vaping starter kits to help smokers quit and reforms to tax products directly in proportion to their alcohol content. “The government also runs regular national campaigns to highlight the risks of smoking and obesity – like the annual Stoptober campaign.”
It is clear more work needs to be done to pin down the exact mechanisms, but what is evident is there are many ways by which alcohol can really do some damage. To help fill the gaps in our knowledge about how alcohol and other lifestyle factors affect cancer risk, they are developing and testing a groundbreaking new method to work this out. This method will allow them to systematically review mechanistic studies related to diet, nutrition, physical activity and cancers in a robust, standardised way. So, it may be a difficult choice to leave the drinks on the shelf, but our bodies really will thank us in the long term.
Mandatory nutritional wine labels in EU
Digital nutritional wine labels, accessible via QR Codes, became mandatory in the EU on 8 December. The EU’s newest modification to labelling laws is the largest of its kind in over a century and will usher in a new era of digital communication in terms of the way consumers access product information. It’s a major change and one that has a lot to do with highly politicised debates around cancer prevention, health and reducing alcohol related harms, which have intensified rapidly within the EU over the past 18 months. In February 2022, the EU Parliament almost voted to enforce stronger regulations within the alcohol sector, including the introduction of compulsory health warnings. In the end, this measure was downgraded and producers were instead only compelled to include information regarding ‘moderate and responsible consumption’.
From 8 December, all wine being sold within the EU’s 27 member states, including wine made in the UK, must include full ingredient and nutritional information in the same way as any processed food product (spirits and beer for now, remain exempt).
