Background:
Relative risks from epidemiological studies highlight the strength of an association.  However, they are not ideal for communicating public health risks because they are poorly understood by the general public and clinicians. In 2021, we published an epidemiologic analysis of alcohol and cancer risk in a large Australian cohort study: the 45 and Up Study. Relative risks for various cancer types were estimated in relation to weekly alcohol consumption among 226,162 people aged 45 years and older. Unlike many cohort studies, we reported both relative risk of cancer and estimates of alcohol-attributable absolute risk. Because of this uncommon feature, the U.S. National Cancer Institute and the Australian Cancer Institute New South Wales (NSW) engaged us for applications of these results for risk communication.

Objectives:
To adapt our epidemiologic estimates of alcohol and cancer risk to inform the 2025 U.S. Surgeon General’s Advisory on Alcohol and Cancer Risk, and to inform an online cancer risk calculator developed by Cancer Institute NSW.

Methods:
We recalculated our estimates of cumulative absolute risks of cancers of the upper aerodigestive tract, colorectum, liver, breast and all alcohol-related cancers combined to age 85 years for men and women using US standard drink sizes and life expectancy data to inform U.S. Surgeon General’s Advisory. We calculated risk estimates for Australian adults based on a range of weekly alcohol consumption levels for the Australian population to inform the Cancer Institute NSW risk calculator. For the Surgeon General’s Advisory we examined a wide range of graphical formats to communicate risk, and the online risk calculator was user tested and refined.

Results:
Our published study reported increasing relative risks of cancers of the upper aerodigestive tract, colorectum, liver and female breast in relation to increasing amounts of alcohol use. By age 85 years, men and women who consumed >14 drinks/week were estimated to have 4.4% and 5.4% higher cumulative absolute risk of an alcohol-related cancer, respectively, compared to those consuming 0 to <1 drink/week. Results for the US population were similar to Australian estimates since the age structure and alcohol consumption levels of the two countries were similar. The U.S. Surgeon General’s Advisory presentation emphasised that ~5 additional women and ~3 additional men out of 100 would develop cancer due to the consumption of ~2 drinks/day, and that ~4 additional women out of 100 would develop breast cancer. The online risk calculator allows consumers to estimate their lifetime cancer risk based on their age, sex, and number of drinks/week, and estimates how much they can reduce their risk if they adhere to the Australian alcohol guidelines. Both the Advisory and the online risk calculator received widespread media attention, and some evidence suggests the proportion of Americans aware that alcohol is a carcinogen increased in 2025.

Conclusions and implications:
These projects highlight how risk communication can be strengthened by presenting absolute risk.  Both approaches enabled key outcomes from an epidemiologic study to reach wide audiences and promote greater public awareness of the links between alcohol and cancer.