Many people across the WHO European Region will celebrate 8 March, International Women’s Day, by raising a glass of an alcoholic beverage – oblivious to the fact that drinking alcohol is a major risk factor for the most common cancer among women, breast cancer. Low awareness of this link represents a significant barrier to cancer prevention and a challenge to women’s health across Europe.

According to a recent study, only 21% of women across 14 European countries were aware of the connection between alcohol consumption and the risk of developing breast cancer. Awareness was even lower among men – just 10% of the men surveyed knew of this link.

This fact is even more worrying given that the biological mechanisms linking alcohol to cancer are well-established and substantiated by decades of evidence from across the world.

How does alcohol cause breast cancer?
The biological mechanisms through which alcohol causes cancer are complex and varied. The most important one involves the metabolism of ethanol into acetaldehyde, a metabolite that causes DNA damage and mutations that potentially result in cancer. In the case of breast cancer, alcohol consumption also affects estrogen levels. Estrogen plays a significant role in the development and progression of many breast cancers, and alcohol’s impact on these hormone levels could partly explain the heightened risk.

Additionally, substances often affect men and women differently due to differences in metabolism and body composition between the sexes. These distinctions underscore the need for gender-specific approaches in public health strategies related to alcohol consumption and reducing cancer risk.

Breast cancer cases in Europe higher than ever
Breast cancer represents a major health concern for women across the WHO European Region, with more than 600 000 cases in 2022. The role of alcohol as a preventable risk factor for breast cancer is critical. For women in Europe, breast cancer is the primary cancer caused by alcohol, making up 66% of all cases of alcohol-attributable cancers.

Research indicates that even relatively low levels of alcohol consumption can contribute to the risk of developing breast cancer. More than half of all breast cancer cases attributable to alcohol in Europe are not due to heavy drinking, and about one third of new cases every year are due to drinking the equivalent of up to 2 small glasses of wine per day.

Countries of the WHO European Region must protect their populations from alcohol-attributable cancers as the deadline to achieve the global targets for noncommunicable diseases (NCDs) is closing fast.

Investing in breast cancer prevention means investing in women’s health and future well-being
Countries have committed to reducing premature mortality from cancer and other NCDs by 25% by 2025 from the 2010 levels through measures to strengthen health system response and to address NCD risk factors, including alcohol consumption. There have been no changes in alcohol consumption per capita in the European Union since 2010, and countries are not on track to reach their NCD targets. Therefore, there is an increasing urgency for governments to act immediately to implement evidence-based public health alcohol policy and legislation to reduce the burden of preventable cancers such as alcohol-attributable breast cancer.

Investing in cancer prevention, as outlined in Europe’s Beating Cancer Plan, includes raising awareness of the health risks associated with alcohol consumption, for example, through better labelling regulations for alcoholic beverages. Health warning labels that inform consumers about cancer risks are a standard practice for tobacco products. Considering that both alcohol and tobacco, have been classified as Group 1 carcinogens by the International Agency for Research on Cancer since the 1980s, it appears that there are several lessons to be learned from tobacco control. Women across Europe have the right to know about the link between alcohol and cancer, especially breast cancer, so that they can make informed and healthier decisions.

Healthier behaviours could prevent up to 4 in 10 new cancer cases. However, collective action and commitment to public health beyond the individual level are needed to change the course of cancer incidence and ensure that future generations are better informed, healthier, and less exposed to the risks posed by alcohol consumption.