The US Surgeon General wants cancer warning labels on alcoholic beverages

Alcoholic beverages are a leading cause of cancer and should carry a warning about this risk on their labels, the US surgeon general said Friday.

Alcohol is a factor in nearly 100,000 newly diagnosed cancers each year and about 20,000 deaths from the disease, US Surgeon General Vivek Murthy said in an advisory aims to focus public attention on the health risk. In comparison, traffic accidents linked to drinking kill about 13,500 Americans every year.

“Alcohol consumption is the third leading cause of preventable cancer in the United States, after tobacco and obesity,” the 22-page guidance said. “While scientific evidence for this connection has grown over the past four decades, less than half of Americans recognize it as a risk factor for cancer.”

Labels on bottles and cans of alcoholic beverages already warn against drinking while pregnant. They also warn about alcohol before driving or operating other machines. In California, voter-approved Proposition 65 also requires businesses that serve or sell alcoholic beverages to provide a warning about health risks, including cancer.

Any decision to update or expand the label would require congressional approval, an uncertain prospect. Murthy was appointed by President Biden, who has little more than two weeks left in office. President-elect Donald Trump has chosen Janette Newheiwat, an executive at a New York-based chain of urgent care clinics, as his nominee for surgeon general.

Beer, wine and spirits industry executives said Friday that the scientific data linking alcohol to cancer is mixed.

Amanda Berger, senior vice president, at the Distilled Spirits Council, pointed out that a latest report of the National Academies of Sciences, Engineering and Medicine found that alcohol was associated with a higher risk of breast cancer, but found no such associations with other types of cancer.

This report also concluded that moderate alcohol consumption is associated with lower risk of all-cause mortality and cardiovascular disease compared to never consuming alcohol.

“The current health warning on alcohol products has long informed consumers of the potential risks of consuming alcohol,” Berger said. “Many lifestyle choices carry potential risks, and it is the federal government’s role to determine any proposed changes to the warning statements based on the full body of scientific research.”

The surgeon general’s advice said cancers of the colorectum, oesophagus, liver, mouth, pharynx and larynx are all linked to drinking, as is breast cancer in women. The risk of developing breast, mouth or throat cancer may increase with less than one drink a day, it said.

Yet more than half of Americans are unaware that their drinking behavior affects their cancer risk. ONE map out by the American Institute for Cancer Research found that 89% of Americans recognized that smoking causes cancer and 53% knew that obesity was a risk factor, but only 45% realized that alcohol could also cause cancer.

Nearly half of alcohol-related cancers in the United States are breast cancer in women, according to the a study published by the American Cancer Society. About 1 in 6 female breast cancer cases are due to alcohol, and the disease accounts for about 60% of all alcohol-related cancer deaths in women.

As a result, drinking is a greater cancer risk for women than men. In 2019, around 54,330 women were diagnosed with a cancer that was a result of drinking, as were around 42,400 men. About 60% of alcohol-related cancer deaths in women are due to breast cancer, while liver and colon cancers are responsible for about 54% of alcohol-related cancer deaths in men.

For women who consume less than one drink per week, the absolute risk of developing an alcohol-related cancer is 16.5%. Having one drink a day increases this risk to 19%, and having two drinks each day raises it to 21.8%, according to the advice.

For men, drinking once a week is linked to a 10% absolute risk of an alcohol-related cancer. This risk increases to 11.4% by drinking one drink a day and to 13.1% by having two drinks a day, the adviser says.

The World Health Organization’s International Agency for Research on Cancer says alcohol is a Group 1 carcinogenputting it in the company of tobacco, asbestos and ultraviolet radiation. The U.S. National Toxicology Program declared in 2000 that alcohol causes cancer in humans, and organizations including the Centers for Disease Control and Prevention, the National Cancer Institute, the American Cancer Society, and the American Assn. for Cancer Research agrees that at least seven types of cancer are related to drinking.

There is also evidence to suggest that drinking contributes to skin, prostate, pancreatic and stomach cancers, although more research is needed, the surgeon general’s advice says.

Researchers first linked alcohol consumption to certain cancers almost 50 years agoand the evidence showing that drinking is a risk factor for at least seven types of cancer has grown since then, the adviser says.

e.g. an observational study of 28 million people in 195 countries and territories found that the more alcohol a person consumed, the higher their risk of cancer. A study involving more than 1 million women found that women who had up to 1 drink a day had a 10% greater risk of breast cancer compared to women who abstained. Likewise, a study with 36,000 people found that those who consumed about one drink a day were 40% more likely to develop oral cancer than people who did not drink at all.

Laboratory experiments have shown how alcohol leads to cancer.

When alcohol is metabolized in the body, it breaks down into a chemical called acetaldehyde that can bind to DNA. The resulting damage can trigger the uncontrolled cell growth that leads to cancer.

Drinking also creates unstable molecules called reactive oxygen species that can interfere with DNA, proteins and essential fats. They too increase inflammationwhich makes the body more hospitable to cancer.

There is also evidence that alcohol fuels breast cancer by affecting the levels of estrogen and other hormones, and that other types of carcinogens – such as those found in tobacco smoke – are more easily absorbed into the body when dissolved in alcohol.

The companies that sell alcoholic beverages say they have long encouraged consumers to drink the beverages safely.

“The American beer industry has been a champion of responsible consumption for decades,” a Beer Institute spokesman said Friday. “We encourage adults of legal drinking age to make choices that best suit their personal circumstances and, if they choose to drink, to consume alcohol in moderation.”

Dr. Laura Catena, who is both a winemaker and a doctor, said she would “welcome any kind of warning or communication from the surgeon about the cancer risk of heavy alcohol consumption,” but that it should not go beyond established science.

The American Assn. for Cancer Research says alcohol use is responsible for 5.4% of all cancers in the United States, making it a greater risk factor than exposure to UV radiation, poor diet, and infections from pathogens such as hepatitis and the human papillomavirus. (For comparison, 19.3% of US cancers can be attributed to smoking, according to the AACR.)

Studies suggest that people who cut back on alcohol or eliminate it altogether can reduce their risk of these cancers by 8% and reduce their overall cancer risk by 4%.

The Dietary Guidelines for Americans from the US Department of Agriculture and the Department of Health and Human Services say there is no health reason for non-drinkers to start consuming alcohol. Those who drink can minimize their risk by limiting their intake to no more than one drink per day for women and no more than two drinks per day for men.

A 5-ounce glass of wine, 12-ounce bottle of beer, or 1.5-ounce tumbler of distilled spirits counts as a single drink.

The Surgeon General’s advice says that about 83% of alcohol-related cancer deaths occur in people who exceed these limits. But this means that 17% of the deaths were in people who engaged in moderate alcohol consumption.