Alcohol-attributable cancer risk and burden estimates for Australia's updated alcohol consumption guidelines

The Australian alcohol health guidelines were revised in 2020 to recommend a maximum of 10 drinks/week. We calculated estimates of cancer caused by alcohol use in Australia for the updated recommended limits.

Cox regression models were used to estimate hazard ratios (HR) for cancer incidence in relation to self-reported alcohol consumption (drinks/week) among 225,805 participants aged ≥45 years (2005-2009) in the New South Wales (NSW) 45 and Up Study, an Australian prospective cohort study (baseline n = 267,357). Cumulative absolute risk of cancer to age 85 years was estimated using 0 to <1 drink/week as the comparator. Population attributable fractions were calculated using Australian national alcohol consumption and cancer incidence data, compared to a theoretical minimum risk exposure of no alcohol consumption. Cancer cases and deaths were ascertained through record linkage to the NSW Cancer Registry and NSW Registry of Births Deaths & Marriages to 2019. Participants diagnosed with cancer pre-baseline were excluded.

Over a median 11.4 years, 34,860 cancer cases were recorded. When modelled as a continuous variable, alcohol-related cancer risk increased by 19% for every ten drinks/week increase in consumption (HR: 1.19; 95% confidence interval: 1.15-1.23). By age 85 years, those who consumed >10 drinks/week had an estimated 4.9% higher cumulative absolute risk of an alcohol-related cancer compared to those consuming 0 to <1 drink/week. An estimated 7804 cancer cases (4.6% of all cancer cases) were attributable to alcohol use in 2024.

The proportion of alcohol-attributable cancers in Australia is substantial and somewhat higher than previously estimated.