The Buzz This Week
Last week, Surgeon General Vivek Murthy, MD, issued a report recommending that labels on all alcohol products in the US include a warning that consuming alcohol increases cancer risk. Murthy’s report also recommended revisiting alcohol consumption guidelines so consumers are aware of the increased cancer risk, and making alcohol labels more visible and prominent on packaging.
Currently, labels warn against drinking while pregnant or prior to operating machinery like a motor vehicle. The warnings on these labels have not been updated since Congress approved them in 1988.
The report examined numerous studies over the last two decades from around the globe, all of which demonstrated a correlation between alcohol consumption and increased cancer risk. The report notes that alcohol is the third leading preventable cause of cancer behind only tobacco use and obesity.
Estimates from the advisory report attribute 100,000 cases in the US to alcohol consumption. That’s 5% of all cancer cases in patients over the age of 30. The report attributes 20,000 cancer deaths per year to alcohol consumption, shortening these patients' lives by 15 years on average. Increased risk was seen for seven types of cancer: breast, colorectal, mouth, throat, larynx, esophagus, and liver.
While the negative effects of excessive drinking long have been known and stated, it was previously believed that moderate drinking (one drink a day for women and two drinks a day for men) bore no increased health risks and may provide some protection against cardiovascular disease. This report highlights that even moderate consumption has an impact on cancer risk, which grows with rising consumption, and may contribute to certain forms of heart disease.
The report noted multiple possible biological explanations for alcohol increasing cancer risk. The most prominent theory is that alcohol converts to acetaldehyde in the body, which can damage DNA and create an environment for malignant tumors to develop. Experts also believe that alcohol increases inflammation through oxidative stress, which also leads to DNA impairment. Alcohol may also change hormone levels in the body, including estrogen, which specifically may increase breast cancer risk. Finally, alcohol appears to make the body more susceptible to the absorption of other carcinogens like tobacco smoke.
Why It Matters
Surgeon general warnings are historically reserved for significant health issues that demand awareness and action. The 1964 surgeon general warning on cigarettes was a large contributor to changing public perception of the dangers of smoking. It was also the impetus for cigarette warning labels and the removal of cigarette advertising from television and radio. Cigarette usage peaked at approximately 45% of adults prior to the warning but now sits near 10%.
Awareness of the risks of alcohol and cancer are not currently widely known or understood by the public. While 89% of the US adult population knows tobacco is a risk for cancer, according to the American Institute for Cancer Research in 2019, only 45% of Americans understood that alcohol was a cancer risk. The new advisory report aims to bring the same attention to alcohol that the 1960s advisory brought to tobacco.
Early-onset cancer rates are also rising, and alcohol may be one contributor to that trend. While early-onset cancer causes are multi-faceted and complex, evidence-based advice to reduce or eliminate tobacco and alcohol are certainly beneficial and may diminish some risk. Public health messaging (like clearer warning labels) that better allows consumers to assess the risks of drinking may be one tool to increase awareness.
Murthy is nearing the end of his term as surgeon general, and it is not yet clear whether the next administration and its healthcare leaders will also view alcohol consumption as a health priority. President-elect Trump, Department of Health and Human Services (HHS) Secretary nominee Robert F. Kennedy Jr., and Surgeon General nominee Janette Nesheiwat, MD, have not publicly commented on the advisory report, though Kennedy and Trump personally do not consume alcohol.
Congress has ultimate authority over changing the warning labels on alcohol products, whether through legislating new regulations or requesting the Alcohol and Tobacco Tax and Trade Bureau to change the messaging and visuals.
Surgeon general warnings are rare but can be turning points in public health habits, as was the case for tobacco consumption. Changing the labels on alcohol packaging alone may not have a significant impact on consumption. But if the labels are part of a broader public health awareness campaign, much like tobacco, the US may see a substantial change in behavior over time.
RELATED LINKS
STAT News:
The surgeon general wants the U.S. to know alcohol causes cancer. Plenty stands in his way
New York Times:
Surgeon General Calls for Cancer Warnings on Alcohol
Wall Street Journal:
The Mystery of What’s Causing Young People’s Cancer Leads to the Gut
