The Strategies of Alcohol Industry SAPROs: Inaccurate Information, Misleading Language and the Use of Confounders to Downplay and Misrepresent the Risk of Cancer
SAPROs strategies in downplaying alcohol cancer risk
The alcohol industry social aspects/ public relations organisations (SAPROs) dispute in different ways the risk of cancer from alcohol consumption, particularly breast cancer, and to some extent colorectal cancer. When some risk is acknowledged, that risk is often presented in conjunction with a range of other potential confounders, thus undermining the evidence that there is an independent relationship. Smoking is sometimes used to imply that the risk is confined to smokers. Not all these strategies are used by all these (or other) SAPROs, all the time.
The key strategies used by SAPROs to downplay cancer risk are:
- Providing inaccurate information
- Use of misleading language
- Using a range of confounders to undermine risk
In many cases accurate information is included, while at the same time inaccurate information is presented elsewhere. Thus, accurate information may be framed in such a way that it is simultaneously undermined. The inclusion of a wide range of potential confounders, and risk/ protective factors, has similarities to well‐documented tobacco industry strategies.
SAPRO material undermines cancer risk
There is also selective omission of breast cancer from some SAPRO materials. For example, The Drinkaware fact sheet ‘Alcohol and Young people’ stated (in a section headed ‘Liver Disease’) that ‘In the long‐term, alcohol use above the lower‐risk guidelines can also lead to cancers, such as bowel and liver cancer, heart disorders and impotence for men’, without mentioning breast cancer.
An example for undermining risk is found in the International Alliance for Responsible Drinking (IARD) who provides misleading information stating that there is no increase in risk associated with ‘light or moderate’ alcohol use, that the increased risk is ‘in general associated with heavy alcohol use’ (undefined), or where it appears to imply that alcohol is protective of colorectal cancer in smokers. They also include the unclear mechanism of hormone receptor status as potential mechanisms by which alcohol may affect cancer, which is used to undermine clearer statements about risk.
Another example is the Portman Group including the statement ‘the vast majority of cancer types are not associated with alcohol consumption’. This statement is used in many alcohol industry contexts. While it is accurate, it is meaningless in the context of discussion of the risk of cancer from alcohol. It is also misleading as it confuses between cancer type and cancer prevalence.
A Portman document also quotes the United Kingdom Chief Medical Officer’s statement about increased risk of a range of cancers, including bowel cancer, and then rejects it in the subsequent paragraph. They do this by stating ‘studies show that for light regular alcohol users, the risk is non‐existent or minimally increased. The exception is breast cancer’. The increased breast cancer risk is also undermined by stating it only applies to women who binge on alcohol, have a low folate intake, or are on hormone replacement therapy.
SAPROs provide inaccurate information, or accurate information with many confounders and misleading language to undermine cancer risk.
The analysis of cancer information disseminated by alcohol industry SAPROs, and the analysis of its accuracy and framing, is not only a professional necessity for public health experts, but is also essential, given the potential impact of such information on the public.