Cancer Warning on Alcoholic Drinks?

Cancer Warning on Alcoholic Drinks?

In the waning days of the Biden administration, Biden’s Surgeon General, Dr. Vivek Murthy, called for a cancer warning on alcoholic drinks. This article will review the evidence for the claimed need for such a warning label. It will also consider whether the benefits of alcohol consumption outweigh the risks or if the risks outweigh the benefits.

Overview of the Surgeon General’s Advisory

Murthy’s 22-page Surgeon General’s Advisory on Alcohol and Cancer Risk, released Friday [1/3/25], highlights a growing body of research over the last four decades showing alcohol consumption — regardless of the type — increases an individual’s risk for developing at least seven types of cancer. These include cancers of the breast, colorectum, esophagus, liver, mouth (oral cavity), throat (pharynx) and voice box (larynx) (Christian Post. Surgeon).

The Summary at the beginning of the Advisory itself states:

Alcohol use is very common—in 2019-2020, 72% of U.S. adults reported they consumed one or more drinks per week, but less than half of U.S. adults are aware of the relationship between alcohol consumption and cancer risk. The direct link between alcohol use and cancer was first established in the late 1980s, and evidence for this link has strengthened over time. This body of scientific evidence demonstrates a causal relationship between alcohol use and increased risk for at least seven different types of cancer, including breast (in women), colorectum, esophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx). The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day. This Advisory describes the scientific evidence for the causal link between alcohol consumption and increased cancer risk. It also helps to better inform the public of this relationship and offers key recommendations to reduce alcohol-related cancers (p.3).

Be sure to note that is a causal relationship not a casual relationship. The difference is the former means there is a cause and effect relationship, while the former means the two occur at the same time but there may not be any cause and effect. Their relationship is just incidental.

Section 1 of the Advisory is titled, “Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco.” This section then provides statistics to support that claim.

Section 2 is titled, “The Causal Relationship Between Alcohol Consumption and Cancer: Summary of Evidence.” This section details the evidence for the causal relationship between alcohol consumption and cancer risk and explains exactly how alcohol increases cancer risk. That is what is meant by cause and effect. The mechanism can be determined.

Section 3 is titled, “We Can Take Action.” The first recommended action is the aforementioned warning label. The rest of the recommendations are geared towards educating the public about these risks of alcohol. That education is important, as “Less than half of Americans are aware that alcohol consumption increases cancer risk” (p.6). However, “to add warning labels, Congress would have to act” (NYT. Surgeon).

To expand on the second point:

Drinking raises the risk of several types of cancer, including colon, liver, breast and mouth and throat. Alcohol breaks down in the body into a substance called acetaldehyde, which can damage your cells and stop them from repairing themselves. That creates the conditions for cancer to grow (AP. How Drinking).

Here are four ways that alcohol causes cancer. Alcohol:

Alters hormone levels — This includes estrogen, which increases breast cancer risk.
Breaks down into acetaldehyde — This chemical compound damages your DNA in different ways, causing an increased risk of cancer.
Induces oxidative stress — This imbalance at the cellular level increases inflammation (and the risk of cancer) by damaging DNA, proteins, and cells.
Leads to greater absorption of carcinogens — These substances cause cancer. This is especially true for particles of tobacco smoke, which dissolve in alcohol (UPMC. Does).

Alcohol and Heart Disease

This all sounds rather clear-cut, but there are caveats:

Increasingly, evidence has mounted against alcohol consumption because of its health risks, negating a decades-long perception that some alcohol – especially red wine – could benefit health. Still, nuances persist: A report in December [2024] from the National Academies of Sciences, Engineering, and Medicine concluded that moderate drinking – two drinks a day or fewer for men and one for women – may be associated with lower risks of cardiovascular disease. It also found moderate drinking was associated with a higher risk of certain types of cancer.

The news release for the report states:

A new report from the National Academies of Sciences, Engineering, and Medicine reviews scientific evidence on the relationship between moderate alcohol consumption and health outcomes. …

· All-Cause Mortality — The report concludes with moderate certainty that compared with never consuming alcohol, moderate alcohol consumption is associated with lower all-cause mortality. All-cause mortality refers to the total number of deaths in a population due to any cause….

· Cancer — The report concluded with moderate certainty that consuming a moderate amount of alcohol is associated with a higher risk of female breast cancer compared to never consuming alcohol. It also concluded with low certainty that higher amounts of moderate alcohol consumption are associated with a higher risk of breast cancer compared to lower amounts of alcohol consumption. Among moderate alcohol consumers, the report concluded with low certainty that higher amounts of moderate consumption are associated with a higher risk of colorectal cancer compared with lower amounts of alcohol consumption. No conclusions could be drawn when comparing the risk of colorectal cancer for moderate alcohol consumers versus lifelong non-consumers, nor could an association be made between moderate alcohol consumption and oral cavity, pharyngeal, esophageal, or laryngeal cancers….

· Cardiovascular Disease — The report concludes that compared with never consuming alcohol, consuming moderate amounts of alcohol is associated with a lower risk of nonfatal myocardial infarction or heart attack (low certainty), a lower risk of nonfatal stroke (low certainty), and lower risk of cardiovascular mortality in both men and women (moderate certainty) (National Academies. New).

But there are some caveats to these claims. First, this study was conducted in 2020, so it might have been colored by the effects of Covid. Second, the press release states, “The committee also indicated a level of certainty for each of its findings: high, moderate, or low certainty. None of the report’s conclusions reached a high level of certainty, which is unlikely without a randomized controlled trial to include in the systematic review. “

Then there’s the following:

That idea that moderate drinking has health benefits came from imperfect studies comparing groups of people by how much they drink. Usually, that was measured at one point in time. And none of the studies randomly assigned people to drink or not drink, so they couldn’t prove cause and effect….

People who report drinking moderately tend to have higher levels of education, higher incomes and better access to health care, said Dr. [Timothy] Naimi. “It turns out that when you adjust for those things, the benefits tend to disappear,” he said (AP. How Drinking).

But still, heart disease kills more Americans each year than cancer. Thus, some might conclude that the benefits of alcohol consumption for its heart benefits could outweigh its risk of cancer. However, the mortality difference is not that great:

Leading Causes of Death in the U.S. (CDC Data, 2022)

1. Heart Disease – 695,547 deaths (20.1% of total deaths)

2. Cancer – 605,213 deaths (17.5% of total deaths)

3. COVID-19 – 186,552 deaths (5.4%)

4. Accidents (Unintentional Injuries) – 180,000 deaths (5.2%)

5. Stroke – 160,000 deaths (4.7%) ...

Preventability:

· ~80% of heart disease is preventable through diet, exercise, and avoiding smoking.

· Cancer prevention is more complex (genetics, environmental factors). (Gab AI).

Thus, heart disease only kills 90,334 more Americans than cancer or about 13% more. That is not a great difference. Moreover, there are other ways to decrease your risk of heart disease. As such, to drink alcohol to lessen your risk of heart disease would not be wise, as you could just as much increase your risk of cancer as reduce your risk of heart disease.

Maybe if you are at a much greater risk for heart disease than for cancer due to personal risk factors and family history, it might be beneficial. But there is more to consider before making that choice (in consultation with your doctor of course).

Other Risks of Alcohol Consumption

UPMC is one of the two major health networks in the Pittsburgh, PA area. A newsletter it sent out contained the following:

Drinking alcohol can also lead to longer-term effects on your health. It can:

· Affect how the brain works, changing your mood and behavior.

· Damage the heart and raise your blood pressure, increasing your risk of stroke.

· Lead to liver problems, including fibrosis and cirrhosis.

· Lead to pancreatitis, a dangerous inflammation of the pancreas.

· Weaken your immune system, putting you at risk for increased infections.

Then there is the always present risk of moderate drinking morphing into abusive drinking and even alcoholism. And it is a truism that people will do stupid things while under the influence of alcohol that they would not do sober. Those risks must be considered as well.

But What About That Warning Label?

With this strong evidence of alcohol increasing the risk of cancer, the shaky nature of evidence it reduces the risk of heart disease, and its many other risks, should there be a warning label on alcoholic beverages?

The answer to that question is not that easy, as it is more tied into one’s view of the role of government than alcohol’s actual health effects. Some Americans think the government should just butt out of their lives and find such warning labels to be quite silly.

Moreover, a concern among this anti-government crowd is that once the federal government warns against something, it could eventually try to ban it. Of course, that was tried once with alcohol, with the 18^th Amendment to the US Constitution. It went into effect in 1920. But the ban proved so disastrous that it was repealed with the 21^st Amendment in 1933. Thus, there is little likelihood there will be any attempt to ban it once again.

But many still want stricter regulations around it. And a warning label would be a step in that direction. And many Americans think the federal government should be providing health advise to Americans. “But to add warning labels, Congress would have to act” (NYT. Surgeon).

However, the new Trump administration leans towards the less government crowd, and there have been no reports of Secretary of Health and Human Services, Robert F. Kennedy, Jr., revisiting this issue, and Trump’s new nominee for Surgeon General (Dr. Casey Means) has yet to be confirmed. But once he is, it will be up to him if he wishes to pursue this recommendation from the previous Surgeon General. But then it will have to pass the Republican-controlled Congress. But that seems unlikely, as they are focused on other matters and also by and large have a less government attitude.

Conclusion

The risks of alcohol consumption far outweigh any possible benefits. Americans need to be made aware of that fact. That is the reason for this article. But whether a warning label is the best way to go about it depends more on politics than its health effects.

References:

AP. How Drinking Alcohol Can Affect Your Health (via Newsmax).

Christian Post. Surgeon General calls for cancer warning on alcoholic drinks.

CNN. Surgeon General sounds alarm about link between alcohol and cancer (via WTAE).

Gab AI.

HHS. Surgeon General’s Advisory on Alcohol and Cancer Risk.

National Academies. New Report Reviews Evidence on Moderate Alcohol Consumption and Health Impacts.

New York Times. Surgeon General Calls for Cancer Warnings on Alcohol.

Reuters. Surgeon General Calls for Cancer Warning on Alcohol (via Newsmax).

UPMC. The Connection Between Alcohol and Cancer Risk.

USA Today. President Trump changes his mind on nomination for surgeon general.

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