# Alcohol in France: room for improvement

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Based on an analysis of the French National Hospital Discharge database, Michaël Schwarzinger and colleagues¹ show in their study in *The Lancet Public Health* that, in a population of more than 865 000 individuals with alcohol dependence, alcohol rehabilitation treatment or a history of abstinence was associated with lower risks of alcohol-associated cancers than no rehabilitation treatment nor abstinence.

This is an important result from a country with a notoriously high level of alcohol consumption. In 2022, an average of 165 g of pure alcohol per week per inhabitant aged 15 years and older was sold in France, with wine representing 52% of these sales, beer 25%, spirits 21%, and other alcoholic beverages (ciders, port, etc) less than 2%.² This average is much larger than the upper limit of reasonable consumption recommended by the health authorities (ie, 100 g of pure alcohol per week).³ The fraction of cancers attributable to alcohol drinking in France is one of the highest in western Europe, both in the male and in the female population.⁴

Schwarzinger and colleagues conclude that to prevent future cancers, alcohol rehabilitation should be offered more widely. But the offer of rehabilitation is only part of the solution.

Indeed, most individuals are not aware of their risk. The French population, in particular, needs better information than "alcohol abuse is dangerous for your health", which features by law on advertising material. Moreover, the information "drink in moderation" (which is added on an initiative of the alcohol industry) leaves open the definition of moderation. Specifying the number of grams of pure alcohol and the number of calories on each container of alcoholic drink, together with the upper limit of reasonable consumption, would deliver the information directly to the population. The available evidence indicates that these facts are not widely known.⁵

However, such a change is, at the present time, unlikely. French authorities are rather complacent with the alcohol industry.⁶,⁷ This was recently illustrated with the reluctance from the government to support the Dry January initiative.⁸

In this context, the fact that alcohol abstinence or rehabilitation treatment correlates with a reduced risk

of alcohol-associated cancer is valuable information. Among the 865 043 hospitalised individuals identified with alcohol dependence, only 333 273 (38.5%) were identified as having received alcohol rehabilitation treatment or having a history of abstinence. This leaves a very large population of patients who could be offered an intervention to address their alcohol problem during or after their stay in hospital. According to the results from Schwarzinger and colleagues' study, such an intervention might prevent substantial numbers of hepatocellular carcinomas and oral, pharyngeal, laryngeal, oesophageal, and colorectal cancers. It might also reduce the risk of female breast cancers, although the evidence is less clear. Lastly, implementation of such an intervention would show that the French health-care system, which historically prioritised curative care over prevention,⁹ is beginning to give more importance to prevention. The French health-care system is good but there is room for improvement; the results of the study by Schwarzinger and colleagues provide a valuable contribution to improving the health of the population.

I declare no competing interests.

Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.

Catherine Hill

catherine.hill@gustaveroussy.fr

Biostatistics and Epidemiology Unit, Gustave Roussy, 94805 Villejuif, France

1 Schwarzinger M, Ferreira-Borges C, Neufeld M, Alla F, Rehm J. Alcohol rehabilitation and cancer risk: a nationwide hospital cohort study in France. *Lancet Public Health* 2024; 9: e461-69.

2 Observatoire Français des drogues et des tendances addictives. La consommation d'alcool et ses conséquences en France en 2022. November, 2023. https://www.ofdt.fr/publications/collections/bilans-la-consommation-dalcool-et-ses-consequences-en-france-en-2022/ (accessed May 31, 2024).

3 Santé publique France, Institut national du cancer. Avis d'experts relatif à l'évolution du discours public en matière de consommation d'alcool en France. Saint-Maurice: Santé publique France, 2017. https://www.santepublique.fr/fr/les-actualites/2017/avis-d-experts-relatif-a-l-evolution-du-discours-public-en-matiere-de-consommation-d-alcool-en-france-organise-par-sante-publique-france-et-l-insti (accessed May 31, 2024).

4 International Agency for Research on Cancer. Estimated PAF in 2020 attributable to alcohol drinking, Europe, females. https://gco.iarc.fr/causes/alcohol/tools-map?mode=1&sex=2&population=1&continent=5&cancer=4&0&key=paf&age_group (accessed May 31, 2024).

5 Quatremère G, Guignard R, Cogordan C, Andler R, Gallopel-Morvan K, Nguyen-Thanh V. Effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms and low-risk drinking guidelines, and in lowering alcohol consumption. *Addiction* 2022; 118: 658-68.

6 Saverot D. Emmanuel Macron: Un président qui aime le vin, qui en boit, qui en est fier! La Revue du vin de France. https://www.larvf.com/emmanuel-macron-un-president-qui-aime-le-vin-qui-en-boit-qui-en-est-fier,4778341.asp (accessed May 31, 2024).

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7 Horel S. Une lobbyiste du vin au cœur du quinquennat et de la campagne électorale d'Emmanuel Macron. Le Monde. March 21, 2022. https://www.lemonde.fr/les-decodeurs/article/2022/03/21/une-lobbyiste-du-vin-au-cur-du-quinquennat-et-de-la-campagne-electorale-d-emmanuel-macron_6118392_4355770.html (accessed May 31, 2024).

8 Le Parisien. Dry January: «Je ne vais pas le faire», avance Marc Fesneau qui préfère la «modération». Dec 16, 2023. https://www.leparisien.fr/societe/dry-january-je-ne-vais-pas-le-faire-avance-marc-fesneau-qui-prefere-la-moderation-16-12-2023-GMGLZ5MTPFDN3BL4GZDWSNO6KI.php (accessed May 31, 2024).

9 Francis-Oliviero F, Constantinou P, Haneef R, et al. The health state of France before COVID-19 pandemic between 1990 and 2019: an analysis of the Global Burden of Disease study 2019. *Lancet Reg Health Eur 2024; 39: 100848.*