Background:
Alcohol consumption is a major preventable cause of cancer, with a well-established causal link to at least seven cancer sites. The IARC Handbooks of Cancer Prevention have concluded that reducing alcohol consumption lowers cancer risk (Volume 20A) and that several population-based alcohol policies effectively reduce alcohol consumption (Volume 20B). Yet, translating these findings into estimates of cancer prevention at the population-level remains an important evidence gap.
 
Objectives:
To estimate the potential reduction in alcohol-attributable cancer incidence in the European Union (EU) under four evidence-based alcohol control policy scenarios, based on well-controlled real-world evaluations identified in IARC Handbook Volume 20B: increased alcohol excise taxation, alcohol Sunday sales ban, a national alcohol marketing ban, and an integrated policy approach combining all three.
 
Methods:
We conducted a multi-country modelling analysis for the 27 EU countries. Counterfactual policy scenarios were applied to 2012 alcohol consumption levels, with impacts on cancer incidence of seven cancer-sites linked to alcohol, estimated for 2022 assuming a 10-year latency. Consumption data, tax structures, and prices were obtained from WHO; cancer incidence from IARC; and population data from the United Nations. Under the four policy scenarios defined, we estimated changes in consumption and then changes in cancer incidence using a comparative risk-assessment framework, estimating alcohol population-attributable fractions by sex, age group, cancer site, and country. Outcomes included alcohol-attributable cancer cases averted and changes in age-standardized incidence rates. Uncertainty was quantified using Monte Carlo simulation.
 
Results:
In 2022, an estimated 908,027 new cancer cases occurred in the EU across the seven alcohol-related cancer sites, of which 142,878 cases (15·7%) were attributable to alcohol. The integrated policy scenario produced the largest effects, averting 9,163 (95%UI 7,097–11,125) cases, or 6·4% of alcohol-attributable cases. Increased taxation would avert 8 589 (95%UI: 7,428–9,748) cases, Sunday sales ban 5,685 (95%UI: 5,354–6,111) cases, and marketing ban 6,406 (95%UI: 4,543–8,310) cases. The largest absolute reductions were observed for female breast cancer and oesophageal cancer with 3,300 (95%UI: 2,930–3,599) and 2,170 (95%UI: 1,955–2,415) cases averted, respectively, under the integrated policy scenario. Oesophageal cancer showed the largest relative reductions, with up to one in every 14 oesophageal cancer cases in the EU being averted. Effects varied across countries, reflecting population size, baseline cancer incidence, differences in alcohol consumption, taxation structures, and share of recorded alcohol consumption. Relative reductions in alcohol-attributable cancer cases ranged between 3·2% in Romania (247·0, 95%UI: 196·1–296·5 cases) and 9·6% in Estonia (39·7, 95%UI: 31·3–47·3 cases), under the integrated policy scenario, and reaching 14·6% in Finland (246·2, 95%UI: 212·6–277·3 cases) under the taxation scenario.
 
Conclusions/Implications for practice or policy:
Population-level alcohol control policies endorsed as WHO “best buys” could prevent thousands of cancer cases annually in the EU, representing underused tools for cancer prevention and other diseases. Framing alcohol taxation, availability restrictions, and marketing bans explicitly as cancer prevention measures may strengthen policy uptake and support integration of alcohol control into European cancer control strategies.