US Surgeon General Dr. Vivek Murthy has reignited the public health debate by proposing cancer warning labels on alcoholic beverages.
Murthy’s proposal came with new recommendations (PDF) highlights growing evidence linking alcohol consumption to several types of cancer.
Why is this warning label requirement important and what does the science say about the risks associated with drinking alcohol?
Why is the U.S. Surgeon General now calling for cancer warnings on alcohol bottles?
Current text-only alcohol warning labels, introduced in 1988, mention pregnancy risks and impaired driving, but not cancer risks.
Murthy argues that these labels are outdated and insufficient given today’s understanding of the health effects of alcohol.
“As individuals, please be aware that the more you drink, the greater your risk of cancer,” Murthy wrote on social media platform X on Friday.When considering whether or not to drink, or how much to drink, “Please keep in mind that the less you drink, the better.” cancer risk. ”
What is the cancer risk from alcohol?
Report (PDF) The Directorate General of Public Health claims that alcohol consumption in this country is directly linked to around 100,000 cancer cases and 20,000 deaths annually. It is also the third leading cause of preventable cancer, after smoking and obesity.
Similar findings have been published in other parts of the world. In 2018, alcohol consumption was associated with 180,000 cancer cases and 92,000 deaths in the World Health Organization’s European Region, accounting for 4.2% of all cancer cases.
In China, alcohol consumption was associated with 93,596 cancer cases (3.6 percent of total cancer cases) and 78,881 cancer deaths (4.4 percent of total cancer deaths), more than women. Men are more noticeably affected. Chinese women typically consume much less alcohol than men.
Other studies have also demonstrated this association. A paper published in the British Journal of Cancer analyzes data from 572 studies, including 486,538 cancer cases, and proves that alcohol is an important carcinogen that damages DNA and inhibits cell repair. did.
Despite these concerns, public awareness remains low, with only 45 percent of Americans aware of alcohol (PDF) Cancer risk was 91% 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 organizations emphasize that even small amounts can be harmful to health.
For example, data from the U.S. Surgeon General’s Recommendations shows that consuming two drinks a day is associated with an increased lifetime risk of developing cancer in 5 in 100 women and 3 in 100 men. .
Will warnings deter drinking?
The Surgeon General is proposing updating warning labels on alcoholic beverages, similar to those on tobacco, which studies have linked to lower smoking rates. However, there are some questions about how effective text warnings are.
The U.S. Food and Drug Administration (FDA) says that existing text warnings on cigarette boxes, unchanged since 1984, are no longer effective as it requires new health graphics, including photographs, to appear on cigarette boxes. It announced in 2019 that it would be considered “virtually invisible.”
But regardless of the immediate impact on public health, warning labels play a fundamental role in promoting transparency and consumer rights, said Timothy Naimi, director of the Canadian Institute for Substance Use Research at the University of Victoria. insist that it will be fulfilled.
Naimi said that while other packaged food and beverage products are required to display detailed information such as ingredients, calorie content and potential health risks, alcohol labels in North America have a basic He points out that even relevant consumer information is lacking.
“In most parts of the world, there is not much information about what people are consuming in terms of alcohol,” he told Al Jazeera. “People should be allowed to make their own decisions, but at least have the information accessible.”
Dr Carina Ferreira Borges, director of alcohol, drug and prison health at WHO’s regional office for Europe, says these kinds of labels have a broader role than individual behavior.
“Alcohol health warning labels are a systemic tool for change: raising awareness, supporting broader alcohol policy, and reducing the marketing appeal of alcohol packaging,” she told Al Jazeera.
How else can you reduce your alcohol intake?
Experts say additional regulatory measures will also be key to reducing consumption.
“The most effective measure would be to raise the federal excise tax on alcohol. Instead, Congress cut the tax in 2017 and made that cut permanent in 2020,” said a medical law professor at the Boston University School of Public Health. said David Jernigan, professor of policy and management.
He said the greater value of strong labels lies in framing alcohol as “another, potentially unhealthy product,” which could help gain legislative support for more effective measures such as tax increases. He added that it could help pave the way for
The WHO also recommends three “best buys” to reduce alcohol consumption: increasing taxes, restricting marketing, and reducing physical availability, such as limiting the number and opening hours of outlets.
The Nordic countries and Thailand have succeeded in reducing alcohol consumption by increasing taxes and restricting marketing.
How does drinking alcohol affect your health?
The Surgeon General said alcohol consumption increases the risk of at least seven cancers, including breast cancer, colon cancer, liver cancer, mouth cancer, throat cancer, esophagus cancer and laryngeal cancer.
This occurs through several mechanisms, including:
- DNA damage: Alcohol is metabolized to acetaldehyde, a toxic compound that damages DNA, the molecule that guides human growth and function, and prevents cells from repairing themselves.
- Hormone disturbance: Alcohol disrupts hormone levels, especially estrogen, which increases the risk of breast cancer.
- Absorption of carcinogens: Alcohol increases the body’s absorption of other carcinogens, such as those found in tobacco.
Does drinking alcohol in moderation have health benefits?
It’s complicated.
A widely cited 1991 study in the Lancet introduced the “French paradox” and suggested that moderate wine consumption despite a high-fat diet may protect against heart disease. This is supported by years of observational research showing that moderate drinking (one or two drinks per day) is associated with lower rates of cardiovascular disease.
However, new research reveals that most of these claims are false, highlighting problems with previous studies and pointing out that the overall risks outweigh the potential benefits.
A 2022 review in JAMA Network Open, which analyzed 107 studies, found that previous claims about the heart benefits of moderate drinking were particularly limited to “sick smokers”, i.e. those with health problems. It turns out it was based on a flawed methodology that didn’t take into account people who had quit drinking.
Naimi acknowledges that the debate over whether small amounts of alcohol is good for heart health complicates public understanding, but drinking less can help both heart health and cancer prevention. It says there is new evidence to support the message that it is good.
“Even if you believe that a small amount of alcohol may be good for your heart, it’s only a small amount, about one or two drinks a week,” Naimi explains. Above very low levels, alcohol increases the risk of heart disease, including heart attacks, high blood pressure, heart failure, and irregular heartbeats.
But industry voices like Amanda Berger, senior vice president of scientific research at the Distilled Spirits Council, say drinking in moderation may have health benefits and that label updates are based on scientific evidence. They argue that it is necessary to reflect a comprehensive review.
“Many lifestyle choices come with potential risks, and it is the federal government’s role to determine proposed changes to warnings based on the full body of scientific research,” Berger said in a statement.
WHO representative Ferreira Borges said the alcohol industry’s responsibility was not to promote responsible drinking campaigns, but to reduce the harm caused by its products through regulatory measures and formulation changes.
“The alcohol industry insists that alcohol harm is a matter of individual responsibility, denies the widespread nature of alcohol harm, and misrepresents who experiences it.” she stated.
Will Congress approve the new label?
Despite the Surgeon General’s recommendations and new research on alcohol’s risks, Congress is unlikely to act quickly to update warning labels.
The last alcohol warning label addressing pregnancy risks and impaired driving was approved about 40 years ago.
The bill, known as the Alcoholic Beverage Labeling Act 1988, was introduced in the House of Commons in September 1988 and became law within a few months. However, the warning faced significant opposition from the alcohol industry, who said it was ineffective and could harm business. The resulting labels were also relatively small and lacked detailed health warnings.
Efforts to add cancer warnings are likely to face strong opposition from the powerful alcoholic beverage industry, which spends $30 million a year lobbying Congress.
Analysts are also expecting a rebound.
“This seems to be one of the industry’s biggest concerns: Could this be the beginning of going down the same path as tobacco?” Jernigan said.
Regardless of whether the label is approved or not, alcohol use among American youth is already declining. In 2023, 49.6 percent of 18- to 25-year-olds reported drinking alcohol in the past month, down from 59.6 percent in 2013, according to the 2023 National Survey on Drug Use. And health.
Those trends show that movements like Dry January are gaining momentum and that preference for non-alcoholic alternatives is increasing, but societal changes may also be at play. be.
“Young people are starting to drink alcohol later in life, which may influence the number of years they drink later in life,” Jernigan said. He added that other risky behaviors, such as teen pregnancy, are also decreasing as teens are connecting more digitally rather than in person and spending more time alone.
