Germany lacks an up-to-date assessment of the cancer burden attributable to alcohol. Therefore, cancer incidence attributable to this exposure was estimated for colorectal, liver, breast, and upper aerodigestive tract (UADT) cancer. Additionally, the impact of alcohol on UADT cancer was analyzed by smoking status, to account for synergistic interactions between these two risk factors.
Alcohol consumption and smoking prevalence from a nationwide survey in Germany 2008–2011 were combined with relative risks of incident cancer from meta-analyses to obtain population attributable risks (PARs), indicating the proportion of cancers that could be avoided by eliminating a risk factor. Each PAR was multiplied with the respective cancer incidence for 2010 to calculate the absolute number of attributable cases.
In Germany, for the year 2010, approximately 13,000 incident cancer cases could be attributed to alcohol consumption (3 % of total cases). PAR was highest for esophageal cancer (men: 47.6 % and women: 35.8 %) and lowest for colorectal cancer in men (9.7 %) and breast cancer in women (6.6 %). Among women, moderate consumption levels account for the greatest PAR overall, whereas heavy drinking contributes considerably to overall PAR among men. Additionally, moderate-to-heavy drinking among smokers substantially contributes to the overall PAR of UADT cancers compared to drinking among non-smokers.
In Germany, a substantial proportion of cases of common cancers can be attributed to alcohol consumption, even when consumed at moderate levels. Alcohol consumption with concurrent tobacco smoking is especially important for cancers of the UADT. These findings strengthen the rationale for prevention measures that address exposure at all levels.
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Assessment of multiple systematic reviews
German Health Interview and Examination Survey for Adults (2008–2011)
Food frequency questionnaire
International Agency for Research on Cancer
Population attributable risk
Robert Koch Institute
Upper aerodigestive tract
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The authors thank all the German cancer registries as well as the teams of the German health survey at the Robert Koch Institute for providing the comprehensive data sets.
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The authors declare that they have no conflicts of interest.
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Wienecke, A., Barnes, B., Neuhauser, H. et al. Incident cancers attributable to alcohol consumption in Germany, 2010. Cancer Causes Control 26, 903–911 (2015). https://doi.org/10.1007/s10552-015-0566-8
- Alcohol drinking
- Alcohol-related cancers
- Tobacco smoking
- Population attributable risks