BMC: How many cigarettes are there in a bottle of wine?

29 April, 2019

Dear HIFA colleagues,

Interesting paper in BMC Public Health. Citation, abstract below.

CITATION: A comparison of gender-linked population cancer risks between alcohol and tobacco: how many cigarettes are there in a bottle of wine?

Theresa J. Hydes, Robyn Burton, Hazel Inskip, Mark A. Bellis and Nick Sheron

BMC Public Health 2019;19:316© The Author(s). 2019


Background: In contrast to our knowledge about the number of cancers attributed to smoking, the number of cancers attributed to alcohol is poorly understood by the public. We estimate the increase in absolute risk of cancer (number of cases per 1000) attributed to moderate levels of alcohol, and compare these to the absolute risk of cancer attributed to low levels of smoking, creating a ‘cigarette-equivalent of population cancer harm’.

Methods: Alcohol and tobacco attributable fractions were subtracted from lifetime general population risks of developing alcohol- and smoking-related cancers, to estimate the lifetime cancer risk in alcohol-abstaining non-smokers. This was multiplied by the relative risk of drinking ten units of alcohol or smoking ten cigarettes per week, and increasing levels of consumption.

Results: One bottle of wine per week is associated with an increased absolute lifetime cancer risk for non-smokers of 1.0% (men) and 1.4% (women). The overall absolute increase in cancer risk for one bottle of wine per week equals that of five (men) or ten cigarettes per week (women). Gender differences result from levels of moderate drinking leading to a 0.8% absolute risk of breast cancer in female non-smokers.

Conclusions: One bottle of wine per week is associated with an increased absolute lifetime risk of alcohol-related cancers in women, driven by breast cancer, equivalent to the increased absolute cancer risk associated with ten cigarettes per week. These findings can help communicate that moderate levels of drinking are an important public health risk for women. The risks for men, equivalent to five cigarettes per week, are also of note.

COMMENT (NPW): The full text of this paper starts: 'The health risks of smoking are indisputable and well understood by the public...' This widespread assumption does not apply worldwide. For example, a recent paper on 'Knowledge and perception about health risks of cigarette smoking among Iraqi smokers' found that 'smokers had low awareness about some risk effects of smoking such as lung cancer in nonsmokers (30.1%), impotence in male smokers (52.6%), premature ageing (64%), and stroke (66.3%)'. It would be interesting to map knowledge of risks of smoking across different countries and among groups within countries. Knowledge of such risks is an important (but not sufficient) factor in quitting smoking (and, perhaps to a lesser extent, in starting to smoke). The strength of the correlation between knowledge and quitting is also likely to vary across countries/populations (one factor being fatalism).

The paper also notes: 'For many years the tobacco industry tried to suppress information linking tobacco use and cancer, and there is evidence that the alcohol industry are currently employing similar tactics.'

Best wishes, Neil

Coordinator, HIFA Project on Information for Citizens, Parents and Children:

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: