Alcohol is a leading preventable cause of cancer and alcoholic beverages should carry a warning label like cigarette packs do, the U.S. surgeon general said Friday.
It’s the latest salvo in a heated debate over the risks and benefits of moderate drinking as the influential U.S. Dietary Guidelines for Americans are about to be updated. For decades it was said that drinking moderately helped prevent heart attacks and strokes.
This perception has been incorporated into the dietary advice given to Americans. But growing research has linked alcohol consumption, sometimes even within recommended limits, to various types of cancer.
Labels currently on bottles and cans of alcoholic beverages warn of drinking during pregnancy or before driving or operating other machinery, and of “health risks” in general.
But alcohol directly contributes to 100,000 cancer cases and 20,000 related deaths each year, said Surgeon General Dr. Vivek Murthy.
He called for updating the labels to include an increased risk of breast cancer, colon cancer and at least five other malignancies now linked by scientific studies to alcohol consumption.
“Many people out there assume that as long as they drink within or below the limits of the current guidelines of one drink a day for women and two for men, there is no risk to their health or well-being.” , said Dr. Murthy said in an interview.
“The data does not support this for cancer risk.”
Only Congress can mandate new warning labels of the type recommended by Dr. Murthy, and it’s unclear whether the incoming administration would support the change.
However, President-elect Donald J. Trump does not drink, and his pick to run the Department of Health and Human Services, Robert F. Kennedy Jr., gave up alcohol and drugs decades ago, and says he regularly participates at AA meetings.
There is no doubt that excessive consumption is harmful. But advocates of moderate drinking – including wine, beer and spirits producers, and some doctors and scientists – argue that a little alcohol each day can reduce cardiovascular disease, the leading cause of death in the United States.
More recent scientific studies, however, have criticized the methodology of previous studies and have called into question this once-consensus view.
While most cancer deaths occur at levels of alcohol consumption that exceed current recommended dietary guidelines, the risk of breast, mouth, and throat cancer may increase with consumption of just one drink per day, or even less, Dr. Murthy said. on Friday.
Overall, one in six breast cancer cases are attributable to alcohol consumption, Dr. Murthy said. More recent studies have also linked moderate alcohol consumption to some forms of heart disease, including atrial fibrillation, a heart arrhythmia.
Two scientific reviews will be used to inform updated alcohol consumption recommendations in the federal dietary guidelines.
Five years ago, the scientific report that informed the drafting of the 2020-2025 Dietary Guidelines acknowledged that alcohol is carcinogenic and generally unhealthy and suggested “more restrictive guidelines” limiting the recommendation for men to a standard drink, or 14 grams of alcohol per day. day.
When the final guidelines were drafted, however, there was no change in the advice that moderate drinking of up to two drinks a day for men was acceptable.
But the government acknowledged emerging evidence indicating that “even drinking within recommended limits can increase the overall risk of death from various causes, such as several types of cancer and some forms of cardiovascular disease.”
Since then, more and more studies have linked alcoholic beverages to cancer. However, any attempt to change warning labels on alcoholic beverages will face an uphill battle.
The current warning label has not been changed since it was adopted in 1988, even though the link between alcohol and breast cancer has been known for decades.
It was first mentioned in the 2000 U.S. Dietary Guidelines. In 2016, the Surgeon General’s Report on Alcohol, Drugs, and Health linked alcohol abuse to seven different types of cancer.
Most recently, Congress commissioned a scientific review of research on moderate alcohol consumption, conducted under the auspices of the National Academies of Sciences, Engineering, and Medicine.
That analysis found a link between alcohol consumption and a slight increase in breast cancer, but no clear link with other cancers. The report also revived the theory that moderate drinking is linked to fewer deaths from heart attacks and strokes, and fewer deaths overall, than never drinking.
However, the World Health Organization says there is no safe limit for alcohol consumption and 47 nations require warnings on alcoholic beverages. But cancer is rarely mentioned.
To date, only South Korea has a label warning of liver cancer, although manufacturers can choose alternative labels that do not mention cancer. Ireland is currently planning to introduce labels stating there is a “direct link between alcohol and deadly cancers” in 2026.
The industry has a long history of fighting warning labels that mention cancer, and alcohol-producing nations have also challenged warning labels under international trade law.
Industry opposition led to the premature end of a federally funded Canadian study on the impact of warning labels mentioning cancer.
The Surgeon General’s Advisory provided a brief overview of research studies and reviews published over the past two decades, including a global study of 195 countries and territories involving 28 million people.
They all found that higher levels of alcohol consumption were associated with a greater risk of cancer.
Other studies looked at specific cancers, such as breast cancer and mouth cancer, finding that risks increased by 10% and 40%, respectively, for those who drank just one drink a day, compared to those who didn’t drink.
The report described the biological mechanisms by which alcohol is known to induce cancerous changes at the cellular level.
The most accepted theory is that within the body alcohol breaks down into acetaldehyde, a metabolite that binds to DNA and damages it, allowing a cell to begin growing uncontrollably and creating a malignant tumor.
Animal experiments have shown that rodents whose drinking water was laced with ethanol, alcohol used in alcoholic beverages, or acetaldehyde developed large numbers of tumors throughout their bodies.
Research has shown that alcohol generates oxidative stress, which increases inflammation and can damage DNA.
It also alters levels of hormones such as estrogen, which may play a role in the development of breast cancer, and makes it easier for carcinogens such as tobacco smoke particles to be absorbed into the body, increasing susceptibility to oral cancers and of the throat.
The surgeon general’s report also goes into detail about the increased risk associated with alcohol consumption, distinguishing between absolute and relative increased risk.
For example, a woman’s absolute lifetime risk of breast cancer is approximately 11.3% (11 in 100) for those who drink less than one drink per week.
The risk increases to 13.1% (13 out of 100 individuals) with one drink per day and up to 15.3% (15 out of 100) with two drinks per day.
For men, the absolute risk of developing alcohol-related cancer increases from approximately 10% (10 in 100 individuals) for those who consume fewer than one drink per week to 11.4% (11 in 100) for those who have a drink every week. day on average. It rises to 13 percent (13 individuals out of 100) for those who drink an average of two drinks a day.
Many Americans don’t know that there is a link between alcohol and cancer.
According to a 2019 survey of U.S. adults aged 18 and older by the American Institute for Cancer Research, fewer than half of Americans identified alcohol use as a risk factor for cancer, compared to 89 % who recognized tobacco as a carcinogen.
However, according to the surgeon general’s report, alcohol consumption is the third leading preventable cause of cancer, after tobacco and obesity.
Dr Murthy said it was important to know that the risk increases with increased alcohol consumption. But each individual’s cancer risk is different, depending on family history, genetic makeup and environmental exposures.
“I wish we had a magical outage so we could tell people they’re safe,” he said. “What we know is that less is more when it comes to reducing cancer risk.”
“If an individual drinks occasionally for special events, or if you have a drink or two a week, the risk is likely to be significantly lower than if you drink every day,” he added.