Alcohol and cancer: abstinence or moderation?

Organizations that deal with cancer often issue guidelines that are different from those developed for the general population. For example, they advise women to have no more than one drink a day, rather than two, and they recommend that men have no more than two drinks a day, as opposed to three. They also say that abstinence is the best choice.

The data showing that just one drink a day increases the risk for a number of cancers – at least when such drinking behavior continues over several years – are well known. And they were fully taken into account by the expert scientists who developed the low-risk drinking guidelines that Éduc’alcool promotes.

Some people may believe that alcohol is now in the same situation as tobacco was 60 years ago, when the first connections between smoking and lung cancer were established. But we all know that drinking is a far more complex issue.

Le National Alcohol Strategy Advisory Council, of which Éduc’alcool is a member, bases its position on meta-analyses reviewing the link between the risk of death from all causes combined and regular daily alcohol consumption, in order to determine the point at which the risks and benefits balance each other out for the average person, compared to those who abstain from drinking. The distinct advantage of his methodology is that it can determine a limit for regular, daily drinking, i.e. the point at which the risk of premature death from all causes combined is no greater than that for a person who has never had a drop of alcohol.

On that basis, the most reliable data suggest a limit of 2 standard drinks a day or 10 a week for women, and 3 standard drinks a day or 15 a week for men, with no drinking at all one, and ideally two, days a week.

The way we choose to word things is important. First of all, we say “all causes combined” because no one has thought it wise to separate cancer from other impacts of drinking. Next, we always talk about “low-risk” drinking, not “risk-free” drinking. Finally, and this is by no means insignificant, the subtitle of Canada’s national alcohol strategy is “Toward a Culture of Moderation,” not “Toward a Culture of Abstinence.”

Moreover, in France, the Haut-Conseil de la Santé publique (High Council on Public Health) agrees with us: It is clear that nutrition recommendations with a public health purpose cannot be based on specific morbidity-mortality, i.e. cancer, but must take into account overall effects and potential impacts. To date, there have been no convincing arguments that warrant changing current recommendations on drinking benchmarks in favour of total abstinence.

This is the backdrop for the Éduc’alcool campaign, which has been recognized as the best of its kind in Canada and has become a model for best practices in this field.

Éduc’alcool advises people at risk for cancer to drink less than the generally recommended limits, but we are careful not to extend that warning to the general population, for whom the publicized limits are properly standardized. Moderation is always in good taste.

Hubert Sacy
Director General Éduc’alcool

May 2014