45 and Up Study data behind US Surgeon General’s Advisory on cancer and alcohol

Research using data from the Sax Institute’s 45 and Up Study has played a key role in informing the US Surgeon General’s Advisory on alcohol and cancer risk, published earlier this month.

The Advisory, which highlights alcohol as the third leading preventable cause of cancer in America, draws on work by researchers from the Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney, focused on cancer control and policy. In their 2020 paper, the Daffodil Centre researchers tracked alcohol consumption and cancer diagnoses in more than 220,000 participants of the 45 and Up Study over five years, making this one of the largest studies of its kind ever conducted. 

The researchers found that alcohol consumption was associated with an increased risk of at least seven types of cancer, including breast, colorectum, oesophagus, liver, mouth, throat and larynx. Consumption of more than 14 standard drinks a week raised the lifetime absolute risk of these cancers by 4.4% in men and 5.4% in women, compared with drinking less than one drink per week. Liver cancer and oesophageal cancer were found to be most strongly associated with alcohol consumption, with the relative risk rising by 22% for both cancer types with every additional 7 drinks per week, while the highest absolute risks over a lifetime were found for breast cancer in women and colorectal cancer in men.

“Late last year the US National Cancer Institute contacted us about using the alcohol and cancer lifetime risk data from our work, in an upcoming US Surgeon General’s Advisory about alcohol and cancer risk,” explained lead author Dr Peter Sarich.

“Our study was selected because it is one of the few studies ever to have published absolute risk data for alcohol and cancer. We were happy to provide our US colleagues with the data converted into US standard drink sizes and we reviewed the figures. Our 45 and Up Study findings are featured prominently in the Advisory’s figures for risk communication to the public.”

Published on January 3, the Advisory received widespread coverage both in the US and in Australia. The Surgeon General has issued several calls to action, in particular that health warning labels on alcoholic drinks should include a warning about cancer risk, as awareness levels that alcohol is a risk factor for cancer are currently very low. Other recommendations are to reassess recommended limits for alcohol consumption; to highlight alcohol consumption as a leading modifiable cancer risk factor and incorporate proven alcohol prevention strategies into cancer prevention initiatives; and to inform patients in clinical settings about the link between alcohol consumption and cancer and provide alcohol screening and treatment as needed.

Sax Institute CEO Dr Martin McNamara said he was delighted that data from the 45 and Up Study had informed new recommendations that would likely influence public health policy and awareness campaigns in the US and worldwide.

“This work is a fantastic example of the real-world impact of research using the data collected through the 45 and Up Study,” Dr McNamara said.

“We’re increasingly seeing that the depth and breadth of study data collected over almost two decades offers unique insights into the relationship between behaviours, environments and health outcomes.”

Access the full US Surgeon General’s Advisory here.

Access the Daffodil Centre’s 45 and Up Study alcohol and cancer paper here.

Learn more about the 45 and Up Study here.