Alcohol is the leading cause of preventable cancer and alcoholic beverages should carry a warning label like cigarette packs, the US surgeon general said Friday.
It’s the latest leap in a heated debate about the risks and benefits of moderate drinking as the landmark US Dietary Guidelines for Americans is set to be updated. For decades, moderate alcohol consumption has been said to help 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 affixed to bottles and cans of alcoholic beverages warn of drinking alcohol during pregnancy or before driving and operating machinery, as well as general “health hazards”.
But alcohol directly contributes to 100,000 cases of cancer and 20,000 related deaths each year, said the surgeon general, Dr Vivek Murthy.
He called for the labels to be updated to include an increased risk of breast cancer, colon cancer and at least five other malignancies now scientifically linked to alcohol consumption.
“Many people out there assume that as long as they drink at or below the current guidelines of one per day for women and two per day for men, there is no risk to their health or well-being,” said Dr. Murthy said in an interview.
“The data don’t support that for cancer risk.”
Only Congress can mandate new warning labels of the kind recommended by Dr. Murthy, and it is not clear that the new government would support the change.
But President-elect Donald J. Trump doesn’t drink, and his pick to run the Department of Health and Human Services, Robert F. Kennedy Jr., swore off alcohol and drugs decades ago and says he regularly attends AA meetings .
There is no doubt that heavy consumption is harmful. But advocates of moderate drinking — including wine, beer and spirits makers, and some doctors and scientists — argue that a little alcohol each day can reduce heart disease, the No. 1 killer in the world. United States.
However, newer scientific studies have criticized the methodology of earlier studies and challenged this once-consensus view.
While most cancer deaths occur at levels of alcohol consumption that exceed current recommended dietary guidelines, the risk for breast, mouth and throat cancers can increase with one drink a day or even less, Dr. Murthy said. on Friday.
Overall, one in six breast cancer cases is attributable to alcohol consumption, Dr Murthy said. More recent studies have also linked moderate alcohol consumption to certain forms of heart disease, including atrial fibrillation, a heart arrhythmia.
Two scientific reviews will be used to inform updated recommendations on alcohol consumption in the federal dietary guidelines.
Five years ago, the scientific report that informed the drafting of the 2020-2025 dietary guidelines recognized that alcohol is carcinogenic and generally unhealthy and proposed “tightening guidelines” limiting the recommendation for men to one standard drink or 14 grams of alcohol. day.
When the final guidelines were drawn up, however, there was no change to the advice that moderate consumption of up to two drinks a day was acceptable for men.
But the government acknowledged emerging evidence showing that “even drinking alcohol within recommended limits can increase the overall risk of death from various causes, including various types of cancer and some forms of cardiovascular disease.”
Since then, even more studies have linked alcoholic beverages to cancer. However, any attempt to change warning labels on alcoholic beverages is likely to face an uphill battle.
The current warning label has not 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 US Dietary Guidelines. In 2016, the surgeon general’s report on alcohol, drugs and health linked alcohol abuse to seven different types of cancer.
More recently, a scientific review of research on moderate drinking was commissioned by Congress under the auspices of the National Academies of Sciences, Engineering, and Medicine.
This analysis found a link between alcohol consumption and a slight increase in breast cancer, but no clear link to other cancers. The report also revived the theory that moderate drinking is linked to fewer deaths from heart attack and stroke, and fewer deaths overall, compared to never drinking.
The World Health Organization says there is no safe limit for alcohol consumption, however, and 47 nations require warnings on alcoholic beverages. But cancer is rarely mentioned.
To date, only South Korea has a label that warns of liver cancer, although manufacturers can choose alternative labels that do not mention cancer. Ireland is currently set to introduce labels saying there is a “direct link between alcohol and fatal cancers” in 2026.
The industry has a strong history of fighting cancer warning labels, and alcohol-producing nations have also challenged warning labels under international trade law.
Industry opposition led to the early termination of a federally funded Canadian study into the impact of cancer warning labels.
The surgeon general’s advice provided a brief overview of research studies and reviews published over the past two decades, including a global study in 195 countries and territories involving 28 million people.
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 oral cancer, finding that the risks increased by 10 percent and 40 percent, respectively, for those who drank just one drink a day, compared to those who did not.
The report described the biological mechanisms by which alcohol is known to cause cancerous changes at the cellular level.
The most widely accepted theory is that inside the body, alcohol breaks down into acetaldehyde, a metabolite that binds to DNA and damages it, allowing a cell to start growing out of control and create a malignant tumor.
Animal experiments showed that rodents whose drinking water was laced with either ethanol, the alcohol used in alcoholic beverages, or acetaldehyde developed large numbers of tumors throughout their bodies.
Research has shown that alcohol causes oxidative stress, which increases inflammation and can damage DNA.
It also changes hormone levels such as estrogen, which can play a role in the development of breast cancer, and facilitates the absorption of carcinogens such as cigarette smoke particles into the body, increasing susceptibility to mouth and throat cancers.
The surgeon general’s report also details the increase in risk associated with drinking, differentiating between increases in absolute risk and relative risk.
For example, a woman’s absolute lifetime risk of breast cancer is about 11.3 percent (11 in 100) for those who drink less than one drink per week.
The risk increases to 13.1 percent (13 in 100 people) with one drink a day and up to 15.3 percent (15 in 100) with two drinks a day.
For men, the absolute risk of alcohol-related cancer increases from about 10 percent (10 in 100 people) for those who consume less than one drink a week to 11.4 percent (11 in 100) for those who they drink one drink every day on average. It rises to 13 percent (13 in 100 people) for those who drink an average of two drinks a day.
Many Americans are unaware that there is a link between alcohol and cancer.
Fewer than half of Americans identified alcohol use as a risk factor for cancer, compared with 89 percent who identified tobacco as a carcinogen, according to a 2019 survey of American adults age 18 and older by the American Institute for Research for Cancer.
However, alcohol consumption is the third leading cause of preventable cancer, after smoking and obesity, according to the surgeon general’s report.
Dr Murthy said it is important to know that the risk increases as alcohol consumption increases. But each person’s cancer risk is different, depending on family history, genetic makeup, and environmental exposures.
“I wish we had a magic threshold where we could say people are safe,” he said. “What we do know is that less is better when it comes to reducing cancer risk.”
“If a person drinks occasionally for special events, or if you have one or two drinks a week, your risk is likely to be significantly lower than if you drink every day,” he added.
