Background: Alcohol is a major preventable risk factor for cancer, causally linked to seven types of cancer. Yet the potential cancer-preventive impact of population-level alcohol control policies remains unquantified; this study provides the first such estimates for the European Union (EU).

Methods: We conducted a modelling analysis for 27 EU countries to estimate changes in alcohol consumption and alcohol-attributable cancer incidence. Four policy scenarios were examined, based on real-world studies from high-income economies reviewed in the International Agency for Research on Cancer Handbooks of Cancer Prevention Volume 20B: increased alcohol excise taxation, a Sunday alcohol sales ban, a national alcohol marketing ban, and an integrated alcohol policy implemented in Lithuania Relative changes in recorded alcohol consumption were applied to 2012 exposure data to estimate cancer incidence in 2022, assuming a 10-year latency period. Alcohol-attributable fractions were calculated for seven causally related cancers by country, sex, and age, with uncertainty quantified using Monte Carlo-like simulation.

Findings: In 2022, an estimated 146,194 cancer cases (16.1% across seven causally related sites) in the EU were attributable to alcohol. All policy scenarios would have reduced cancer incidence across the EU. The integrated policy scenario would avert 9220 cases (95% UI: 8568–9833; 6.5% of alcohol-attributable cases). Increased taxation would avert 8387 cases (95% UI: 7954–8 862, 5.9%), a Sunday sales ban 5491 cases (95% UI: 5365–5 618, 3.8%), and a marketing ban 6434 cases (95% UI: 5899–6 973, 4.5%). The largest absolute reductions were for female breast, and oesophageal cancers.

Interpretation: Implementation of major alcohol policies could prevent thousands of cancer cases in the EU. Population-level alcohol policies represent an underused tool for cancer prevention and should be integrated within EU and national cancer control frameworks.