EXPERT REACTION: Alcohol industry misleads public on cancer link

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A UK study has found that alcohol industry groups misrepresent the alcohol-related risk of cancer in public information. By surveying websites and documents from 27 alcohol industry organisations, including Australia's Drinkwise, the researchers found denial and misrepresentation of the cancer risk from consuming alcohol, and distraction from the effects of alcohol on common cancers such as breast and bowel. They concluded that the alcohol industry was using similar tactics as the tobacco industry, to the detriment of public health.

Journal/conference: Drug and Alcohol Review

DOI: 10.1111/dar.12596

Organisation/s: London School of Hygiene and Tropical Medicine, UK

Funder: No specific funding.

Media Release

From: London School of Hygiene and Tropical Medicine, UK

Alcohol industry misleading the public about alcohol-related cancer risk

Study identifies “denying, distortion and distraction” as main strategies

The alcohol industry (AI) is misrepresenting evidence about the alcohol-related risk of cancer with activities that have parallels with those of the tobacco industry, according to new research published in the journal Drug and Alcohol Review.

Led by the London School of Hygiene & Tropical Medicine with the Karolinska Institutet, Sweden, the team analysed the information relating to cancer which appears on the websites and documents of nearly 30 alcohol industry organisations around the world between September 2016 and December 2016. Most of the organisational websites (24/26) showed some sort of distortion or misrepresentation of the evidence about alcohol-related cancer risk, with breast and colorectal cancers being the most common focus of misrepresentation.

The most common approach involves presenting the relationship between alcohol and cancer as highly complex, with the implication or statement that there is no evidence of a consistent or independent link. Others include denying that any relationship exists or claiming inaccurately that there is no risk for light or ‘moderate’ drinking, as well discussing a wide range of real and potential risk factors, thus presenting alcohol as just one risk among many.

According to the study, the researchers say policymakers and public health bodies should reconsider their relationships to these alcohol industry bodies, as the industry is involved in developing alcohol policy in many countries, and disseminates health information to the public.

Alcohol consumption is a well-established risk factor for a range of cancers, including oral cavity, liver, breast and colorectal cancers, and accounts for about 4% of new cancer cases annually in the UK1. There is limited evidence that alcohol consumption protects against some cancers, such as renal and ovary cancers, but in 2016 the UK’s Committee on Carcinogenicity concluded that the evidence is inconsistent, and the increased risk of other cancers as a result of drinking alcohol far outweighs any possible decreased risk².

This new study analysed the information which is disseminated by 27 AI-funded organisations, most commonly ‘social aspects and public relations organisations’ (SAPROs), and similar bodies. The researchers aimed to determine the extent to which the alcohol industry fully and accurately communicates the scientific evidence on alcohol and cancer to consumers. They analysed information on cancer and alcohol consumption disseminated by alcohol industry bodies and related organisations from English speaking countries, or where the information was available in English.

Through qualitative analysis of this information they identified three main industry strategies. Denying, or disputing any link with cancer, or selective omission of the relationship, Distortion: mentioning some risk of cancer, but misrepresenting or obfuscating the nature or size of that risk and Distraction: focussing discussion away from the independent effects of alcohol on common cancers.

Mark Petticrew, Professor of Public Health at the London School of Hygiene & Tropical Medicine and lead author of the study, said: “The weight of scientific evidence is clear - drinking alcohol increases the risk of some of the most common forms of cancer, including several common cancers. Public awareness of this risk is low, and it has been argued that greater public awareness, particularly of the risk of breast cancer, poses a significant threat to the alcohol industry. Our analysis suggests that the major global alcohol producers may attempt to mitigate this by disseminating misleading information about cancer through their ‘responsible drinking’ bodies.”

A common strategy was ‘selective omission’ - avoiding mention of cancer while discussing other health risks or appearing to selectively omit specific cancers. The researchers say that one of the most important findings is that AI materials appear to specifically omit or misrepresent the evidence on breast and colorectal cancer. One possible reason is that these are among the most common cancers, and therefore may be more well-known than oral and oesophageal cancers.

When breast cancer is mentioned the researchers found that 21 of the organisations give no, or misleading, information on breast cancer, such as presenting many alternative possible risk factors for breast cancer, without acknowledging the independent risk of alcohol consumption.

Professor Petticrew said: “Existing evidence of strategies employed by the alcohol industry suggests that this may not be a matter of simple error. This has obvious parallels with the global tobacco industry’s decades-long campaign to mislead the public about the risk of cancer, which also used front organisations and corporate social activities.”

The researchers say the results are important because the alcohol industry is involved in conveying  health information to people around the world. The findings also suggest that major international alcohol companies may be misleading their shareholders about the risks of their products, potentially leaving the industry open to litigation in some countries.

Professor Petticrew said: “Some public health bodies liaise with the industry organisations that we analysed. Despite their undoubtedly good intentions, it is unethical for them to lend their expertise and legitimacy to industry campaigns which mislead the public about alcohol-related harms. Our findings are also a clear reminder of the risks of giving the AI the responsibility of informing the public about alcohol and health.

“It has often been assumed that, by and large, the AI, unlike the tobacco industry, has tended not to deny the harms of alcohol. However, through its provision of misleading information it can maintain what has been called ‘the illusion of righteousness’ in the eyes of policymakers, while negating any significant impact on alcohol consumption and profits.

“It’s important to highlight that if people drink within the recommended guidelines they shouldn’t be too concerned when it comes to cancer. For accurate and accessible information on the risks, the public can visit the NHS website.”

The authors acknowledge limitations of their study including that there are many other mechanisms and organisations through which industry disseminates health-related information which they did not examine, although it is unlikely that the messages would be different.

The researchers also say there is an urgent need to examine other industry websites, documents, social media and other materials in order to assess the nature and extent of the distortion of evidence, and whether it extends to other health information, for example, in relation to cardiovascular disease.


Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Professor Sandra Jones is Pro Vice-Chancellor for Engagement and Director of the Centre for Health and Social Research (CHaSR) at Australian Catholic University

This study was the first to analyse the information that alcohol industry SAPROs (social aspects and public relations organisations) provide to consumers about the links between alcohol and cancer.  A strength of the study was its inclusion of 27 organisations from a range of English-speaking countries, including Australia.

A particularly disturbing finding from the study was the exclusion of information on breast cancer, given the clear scientific evidence of a link between breast cancer and alcohol consumption. More than 17,000 Australian women will be diagnosed with breast cancer this year. Alcohol consumption is one of the known modifiable causes of breast cancer, but many women are not aware of this association. 

The industry tactics identified in this study that are used to obscure information about the link between alcohol and cancer– denial/omission, distortion and distraction – resonate with those they use to reframe conversations about alcohol-related violence.  

In Australia, Drinkwise places a particular focus on the 'drinking culture' as the primary cause of alcohol-related harm and changes in individual behavior as the solution.

Last updated: 07 Sep 2017 11:06am
Dr Emma Miller is a public health researcher at Flinders University

This study underscores the perceptions that many public health professionals already have about alcohol industry funded/affiliated public information services. While the stated aim of these organisations is to promote ‘responsible’ drinking, the misinformation and obfuscation common in their messages (‘denial’, ‘distortion’ and ‘distraction’) is more about promoting the sale of alcohol.

Alcohol has been identified as a class one carcinogen and it is strongly associated with many cancers – particularly breast cancer in women and bowel cancer in men – yet many people are unaware of this.

Let’s put this in the Australian context where rates of breast cancer have been increasing at the same time as women in the most risky age group have been drinking more alcohol. As the study points out, groups such as Drinkwise in Australia are particularly likely to provide misleading information about breast cancer. This may be because the alcohol industry is attempting to counter evidence about the link because women are more aware of breast cancer or, even more cynically, they are attempting to address any threat to the market of women drinkers they desire to grow.

Whatever the reason, it is likely to be part of the business model to lessen the impact of authentic public health voices. In all the confusion, however, breast cancer rates will continue to climb in Australian women.

Last updated: 07 Sep 2017 11:03am
Prof Ross Gordon is an Associate Professor in Marketing at Macquarie University and President of the Australian Association of Social Marketing

The alcohol industry has a history of contesting research that identifies alcohol's harms. I learned this while researching the links between exposure to alcohol marketing and adolescent drinking.

It’s not surprising that the Petticrew study finds that the alcohol industry disseminates misrepresentative information about alcohol and cancer. Contesting the research evidence base is often part of the stakeholder marketing strategy of the alcohol industry. This has parallels with the tobacco industry who contested the links between smoking and cancer for years.

The Petticrew study uses qualitative analysis of alcohol industry websites and reports, to identify denial or omission, distortion, or distraction regarding the effects of alcohol on common cancers. This is an appropriate research design. However, a noted limitation of the study is that that the alcohol industry disseminates information through several other organisations and communication channels (e.g. Twitter or advertising campaigns). These were not included in the study. So, further research that examines other industry sources and channels of information on alcohol and cancer would be helpful.

Given the significant human cost of cancer in Australia, it is important that information on risk factors is accurate. The alcohol industry has a social responsibility to provide accurate information to Australians. If not, then Australian policymakers may need to intervene to ensure this is done to protect consumers and to enable them to make informed choices.

Last updated: 07 Sep 2017 10:36am
Julia Stafford is Executive Officer of the McCusker Centre for Action on Alcohol and Youth at Curtin University

The research by Petticrew and colleagues shows that alcohol industry groups in various countries, including Australia, misrepresent the evidence about the link between alcohol and cancer.
For the alcohol industry, it is an inconvenient truth that alcohol use is a cause of cancer. There is now convincing evidence that alcohol causes a range of cancers, and the risk of cancer increases as alcohol use increases. Cancer is a significant fear for many people so the alcohol-cancer link presents a threat to alcohol industry profits.
Public awareness of the alcohol-cancer link is low. It doesn’t help that the alcohol industry appears to be muddying the waters about the link between alcohol and cancer.
Health information about alcohol should come from governments and health authorities, not alcohol industry groups. Consumers have a right to reliable information about the risks associated with alcohol and how they can reduce their risk of harms. The new research is a reminder that the public should not rely on the alcohol industry for up-to-date, reliable health information.  
In Australia, the alcohol industry often still has a seat at the table where alcohol policy is developed, unlike the tobacco industry. Given the conflicts of interest and the growing evidence about industry strategies to mislead the public about alcohol’s health risks, the role of the industry in alcohol policy development needs an urgent rethink.

Last updated: 07 Sep 2017 10:30am
Terry Slevin is Chair of Cancer Council Australia's Occupational and Environmental Cancer Risk Committee, and is President of the Public Health Association Australia

There is no doubt the alcohol industry understands and is concerned about community response to the established and growing evidence linking alcohol consumption to cancer risk.

An education campaign linking alcohol with breast cancer risk - run in Western Australia in 2010/11 - resulted in a large increase in women reporting the intention to reduce their drinking. That means fewer sales, and the industry will always resist action that causes downward pressure on consumption.
Cancer remains the health issue that generates the greatest fear and emotional response in the community. That is particularly so in middle-aged and older people who see their own peers increasingly getting cancer diagnoses. People in that baby boomer generation are also in senior decision-making roles. So the industry that sells the product is keen to muddy the waters about what is a clear link.

For too many people the alcohol and cancer story is new news. The more we drink the more we increase the risk of cancer. This is another inconvenient truth to add to the list.
I congratulate the authors on an important and insightful paper.

Last updated: 07 Sep 2017 10:28am

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  • EXPERT REACTION Alcohol industry misleads public on cancer link

    Terry Slevin, Julia Stafford, Sandra Jones and Ross Gordon give their reaction to the research regarding misleading information on alcohol consumption

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    Unedited interviews of Julia Stafford, Terry Slevin and Sandra Jones

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