America’s Top Doctor Wants Alcohol Cancer Warning: What Does the Science Say? | Health news

Surgeon General of the United States of America dr. Vivek Murthy has reignited the public health debate by proposing cancer warning labels on alcoholic beverages.

Murthy’s proposal followed a new consultation (PDF) pointing out more and more evidence linking alcohol consumption with several types of cancer.

Why is this call for warning labels significant and what does science say about the risks associated with drinking?

Why is the US Surgeon General now requiring cancer warnings on alcohol bottles?

The current text-only alcohol warning labels, introduced in 1988, address pregnancy risks and impaired driving, but do not mention cancer risks.

Murthy argues that these labels are outdated and insufficient given today’s understanding of alcohol’s effects on health.

“For individuals, be aware that the risk of cancer increases as you drink more alcohol,” Murthy wrote Friday on social media platform X. “As you consider whether and how much to drink, remember that less is better when it comes to risk from cancer.”

What is the cancer risk of alcohol?

report (PDF) from the Surgeon General claims that alcohol consumption in the country is directly related to approximately 100,000 cases of cancer and 20,000 deaths annually. It is also the third leading cause of preventable cancer, after smoking and obesity.

Similar discoveries have been published in other parts of the world. In 2018, alcohol consumption was linked to 180,000 cancer cases and 92,000 deaths in the European Region of the World Health Organization, accounting for 4.2 percent of all cancer cases.

In China, alcohol consumption is associated with 93,596 cancer cases (3.6 percent of total cases) and 78,881 cancer deaths (4.4 percent of total deaths), with men significantly more affected than women. Women in China tend to consume much less alcohol than men.

Other studies have also shown this connection. One published in the British Journal of Cancer analyzed data from 572 studies involving 486,538 cancer cases, identifying alcohol as a key carcinogen that damages DNA and disrupts cell repair.

Despite these concerns, public awareness remains low—only 45 percent of Americans recognize alcohol (PDF) as a cancer risk, compared to 91 percent for tobacco.

How much alcohol does it take to increase the risk of cancer?

There is no “safe” level of alcohol consumption when it comes to cancer risk. The WHO and other public health authorities stress that even small amounts can harm health.

For example, drinking two drinks a day is associated with an increased lifetime risk of developing cancer in about five out of 100 women and three out of 100 men, according to data from the US Surgeon General.

Will the warning curb drinking?

The surgeon general is proposing updated warning labels on alcoholic beverages, drawing parallels to warnings on cigarettes, which studies have linked to reduced smoking rates. However, there are some doubts about how effective text alerts are.

In its push for cigarette packs to carry new graphic health warnings, including pictures, the US Food and Drug Administration (FDA) said in 2019 that existing text warnings on cigarette packs, unchanged since 1984, were considered ineffective and “almost invisible”.

However, Timothy Naimi, director of the University of Victoria’s Canadian Institute for Substance Use Research, argues that warning labels have a fundamental role to play in promoting transparency and consumer rights, regardless of their immediate effect on public health.

Naimi points out that while other packaged food and beverage products must display detailed information — such as ingredients, calorie content and potential health risks — alcohol labels in North America lack even basic consumer information.

“In most parts of the world, there’s just not a lot of information about what people are consuming when it comes to alcohol,” he told Al Jazeera. “People should be allowed to make their own decisions, but at least have the information available.”

dr. Carina Ferreira-Borges, head of alcohol, drugs and prison health at the WHO regional office for Europe, says these types of labels have a wider role beyond individual behaviour.

“Alcohol health warning labels are a systemic tool for change — they raise awareness, support broader alcohol policies and reduce the marketing appeal of alcohol packaging,” she told Al Jazeera.

How else can you limit alcohol consumption?

Experts say additional regulatory measures would also be key to reducing spending.

“The single most effective step would be to increase federal excise taxes on alcohol; instead, Congress cut it in 2017 and made that tax cut permanent in 2020,” said David Jernigan, a professor of health law, policy and management at the Boston University School of Public Health.

He adds that the greater value of strong labels lies in defining alcohol as a “different and potentially unhealthy product,” which could help pave the way for more effective measures, such as tax increases, to win legislative support.

The WHO also recommends three “best buys” to reduce alcohol consumption: increasing taxes, limiting marketing and reducing physical availability, such as limiting the number of vendors and their opening hours.

Nordic countries and Thailand have successfully reduced alcohol consumption by increasing taxes and restricting marketing.

How does drinking alcohol affect your health?

Alcohol consumption increases the risk of at least seven types of cancer, including cancer of the breast, colon, liver, mouth, throat, esophagus and larynx, according to the surgeon general.

This happens through several mechanisms such as:

• DNA damage: Alcohol is metabolized into acetaldehyde, a toxic compound that damages DNA, the molecules that govern human growth and function, and prevents cells from repairing themselves.
• Hormonal disorder: Alcohol disrupts the level of hormones, especially estrogen, increasing the risk of breast cancer.
• Carcinogen absorption: Alcohol increases the body’s absorption of other carcinogens, such as those found in tobacco.

Does moderate drinking have health benefits?

It’s complicated.

One widely cited 1991 study in The Lancet presented the “French Paradox,” suggesting that moderate wine consumption could protect against heart disease despite a high-fat diet. This is supported by observational studies over the years that link moderate drinking (one or two drinks per day) with lower rates of cardiovascular disease.

However, new studies have largely debunked those claims, revealing problems with earlier research and pointing to overall risks that outweigh potential benefits.

A 2022 review in the journal JAMA Network Open, which analyzed 107 studies, found that previous claims about the heart benefits of moderate drinking were based on flawed methodologies, particularly a failure to account for “sick people who stopped drinking.” — people who stopped drinking due to health problems.

Naimi admits that debate over whether small amounts of alcohol can benefit heart health has complicated public understanding, but says new evidence supports the message that drinking less is better for both heart health and cancer prevention.

“Even if you believe that a little alcohol might be good for your heart, it’s only a very small amount—maybe a drink or two a week,” Naimi explains. Except at very low levels, alcohol increases the risk of heart disease, including heart attacks, high blood pressure, heart failure, and irregular heartbeats.

However, industry voices such as Amanda Berger, senior vice president of science and research for the Distilled Spirits Council, argue that moderate drinking may have some health benefits and that any label update should reflect a comprehensive review of the scientific evidence.

“Many lifestyle choices carry potential risks, and it is the federal government’s role to determine any proposed changes to warning statements based on the full body of scientific research,” Berger said in a statement.

Ferreira-Borges, the WHO representative, says the alcohol industry’s responsibility is not to promote responsible drinking campaigns, but to reduce the harm their products cause through regulatory measures and reformulation.

“The alcohol industry’s claim that alcohol-related harm is a matter of personal responsibility serves to deny its prevalence and misrepresent who experiences it,” she said.

Will Congress approve new labels?

Despite the surgeon general’s advice and new research on the risks of alcohol, Congress is unlikely to act quickly to update warning labels.

The last alcohol warning label, which addressed pregnancy risks and impaired driving, was approved nearly 40 years ago.

Called the Alcoholic Beverage Labeling Act of 1988, the bill was introduced in the House of Representatives in September 1988 and became law within months. But it faced significant opposition from the alcohol industry, which argued the warnings would be ineffective and could hurt business. The resulting labels were also relatively small and lacked detailed health warnings.

Efforts to add a cancer warning would likely face strong opposition from the powerful liquor industry, which spends $30 million a year lobbying Congress.

Analysts are also predicting a pullback.

“This seems to be one of the biggest fears of the industry — that this marks the beginning of them moving down the same path as tobacco,” Jernigan said.

Regardless of whether the labels are approved, alcohol consumption among young Americans is already declining — 49.6 percent of 18- to 25-year-olds reported drinking in the past month in 2023, down from 59.6 percent 2013, according to the National Survey on Drug Use 2023 and Health.

Trends among them point to a growing preference for alcohol-free alternatives, with movements like “Dry January” gaining traction, while social change may also be playing a role.

“Young people start drinking later in life, which probably affects their later drinking years,” says Jernigan. He adds that other risky behaviors, such as underage pregnancy, have also declined as teens increasingly connect digitally instead of in person, leading to more time alone.