This is not alarmism: alcoholic beverages are group 1 carcinogens. In Italy almost 20,000 deaths a year could be avoided by reducing consumption.
We’re not exaggerating. It is not medical terrorism. They are numbers, data, scientific evidence accumulated over decades of research. In Italy almost 20,000 deaths from cancer every year could be avoided by reducing the consumption of alcoholic beverages. Yet, among all the oncological risk factors, alcohol remains the most underestimated, almost removed from collective perception. We have been drinking it at the table for millennia, it accompanies our parties and our toasts, it is part of our culture. But that doesn’t make it harmless.
Not just the liver When we talk about damage from alcohol, our thoughts immediately turn to liver cirrhosis. But the list of cancers for which ethanol is a recognized risk factor is much longer. «Alcohol is strongly associated with tumors of the oral cavity, pharynx, larynx and esophagus» explains Carlo La Vecchia, epidemiologist at the University of Milan and former head of the Department of Epidemiology of the Mario Negri Institute. Added to these are tumors of the stomach, colorectal, liver, gallbladder, pancreas and, surprisingly for many, breast.
The International Agency for Research on Cancer (IARC) classifies alcohol as a group 1 carcinogen, the same as cigarette smoke and asbestos: substances for which there is sufficient scientific evidence of the ability to cause cancer in humans. According to the WHO, alcohol abuse causes 26% of oral cancers, 11% of colorectal cancers and 7% of breast cancers. In Europe, the continent with the highest alcohol consumption in the world (9.24 liters per capita per year), the incidence of alcohol-related diseases is double the world average.
Breasts: the great unknown. It is perhaps the least known fact, the one that deserves more attention. Between 5 and 11% of new breast cancer diagnoses in Italy can be attributed to the regular consumption of alcoholic beverages: approximately 2,500-5,000 cases per year. Almost all of them concern young women of childbearing age. An English study published in 2020 in the journal BMJ Open confirmed how little this association is known to the general public.
There are at least two biological reasons. The first: alcohol toxicity seems more marked in young women. The second: ethanol stimulates the action of estrogens, the hormones involved in the growth of almost 70% of breast tumors. The risk increases by 7% for each glass above the threshold of 10 grams of ethanol per day. And it can almost quadruple (+27%) if the mammary gland tissue has estrogen receptors.
According to an Italian study conducted between 2015 and 2019, approximately 2,918 of the 63,428 breast cancer deaths in Italy are attributable to alcohol consumption. Of these, 1,269 (about 2%) were caused by moderate drinking.
How alcohol damages cells. The mechanisms by which alcohol contributes to the development of tumors are multiple and now well documented. Ethanol irritates the mucous membranes, preventing damaged cells from repairing properly: this favors the development of mouth and throat cancers. In the liver, the organ responsible for making the substances that pass through it less toxic, alcohol can cause inflammation and cellular alterations which over time can evolve into neoplasms. At the colon level, alcohol acts through acetaldehyde (a substance into which it is converted, recognized as a carcinogen) and by reducing the absorption of folates, compounds that appear to protect against colon and breast cancer. Furthermore, alcohol stimulates the production of estrogens and androgens circulating in the blood.
Wine or spirits? It makes no difference. There is no one drink that is “safer” than another. Beer, wine, aperitifs, grappa: what matters is exclusively the quantity of ethanol ingested. A 125ml glass of wine, a 330ml can of beer or 40ml of spirits all contain around 12 grams of pure alcohol, i.e. one unit of alcohol. Most alcohol-associated cancers occur in those who drink more than 2 units of alcohol per day (men) or 1 (women). After the age of 65, when the ability to metabolize alcohol progressively decreases, the recommended limit drops to 1 unit per day.
The multiplier effect with smoking. Those who drink and smoke do not add the risks: they multiply them. According to a study by the Mario Negri Institute in Milan published in the journal Alcohol and Alcoholism, those who consume alcohol are 32% more likely to develop mouth and throat cancer than those who do not drink. If you add smoking, the risk almost increases tenfold. Similar results have been consolidated for two decades now also for liver cancer: those who consume more than 5 units of alcohol per day and are also heavy smokers have a more than 10 times higher risk of developing the disease.
Prevention is possible: 40% of cancers are avoidable. The good news? Approximately 40% of new cancer cases are potentially preventable through healthy lifestyles. Not smoking, doing regular physical activity, following a varied and balanced diet in line with the Mediterranean diet, limiting or eliminating alcohol, adhering to vaccinations and screening recommended for early diagnosis: these are concrete, daily choices that significantly reduce the risk.
Despite this evidence, the situation in Italy presents important critical issues, especially among the youngest. Approximately 37% of children are overweight and, of these, 17% are obese: numbers among the highest in Europe, mainly due to insufficient physical activity and a diet that has moved away from the principles of the Mediterranean diet. Young people also start drinking at an increasingly earlier age and are often subject to real alcoholic “binges”.
