History of alcohol consumption and cancer burden in Italy

Introduction
Alcohol consumption was traditionally high in Mediterranean countries, particularly in France and Italy, but substantial declines have been observed over the last four decades.

Material and methods
We obtained official resident population and death certification data from the World Health Organization (WHO) database for 5 major alcohol-related cancer sites in Italy for the 1970–2017 period. We computed age-standardised (world population) mortality rates and applied a joinpoint model to identify changes in trends. Yearly pure alcohol per capita consumption data (total, beer, spirits and wine) for Italy over the 1961–2018 period were obtained from the WHO European Health for All database.

Results
Since the late 1970’s, alcohol consumption has been declining substantially in Italy, from about 20 to 7 litres of ethanol per adult per day. In men upper-respiratory tract cancer mortality fell consistently over the last decade, oral cavity and pharyngeal cancer by 14% to 3.1/100,000 men and 2,103 deaths; oesophageal cancer by 13% to 2.0/100,000 and 1,409 deaths, and laryngeal cancer by 27% to 1.8/100,000 men and 1,428 deaths in 2017. Liver cancer had a rate of 4.9/100,000 men (3,667 deaths) in 2017.

Conclusions
This decline in alcohol consumption led to substantial declines in cirrhosis and other chronic liver diseases including liver cancer, and in all major alcohol related cancers (oral cavity and pharynx, oesophagus, larynx, liver, and also breast) in the last few decades in Italy. However, the favourable trends in alcohol-related mortality in Italy and other Mediterranean countries are not reflected in Central-Northern Europe and the USA. Thus, alcohol remains a major cause of cancer and other diseases in Europe.