Alcoholic beverages need cancer warning, surgeon general says

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Alcohol is a leading cause of preventable cancer in the United States and it should be labeled as such, said Surgeon General Vivek Murthy, MD, MBA.

On Jan. 3, Murthy published “Alcohol and Cancer Risk: The U.S. Surgeon General’s Advisory,” with sobering statistics about the relation of beer, wine and liquor to at least seven different types of cancer. Alcohol consumption contributes to almost 100,000 cancer cases and approximately 20,000 cancer deaths a year, according to the advisory.

Vivek H. Murthy, MD, MBA
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“The more alcohol consumed, the greater the risk of cancer,” Murthy said in the advisory.

Alcohol is widely used, with 72% of American adults reporting they consumed at least one drink a week in the 2019-2020 period, according to the advisory. The nation’s 20,000 annual alcohol-related cancer deaths outnumber the 13,500 drunk driving deaths a year in the United States, he said in a news release.

Women bear greater risk because alcohol is a contributing factor in breast cancer. In 2019, there were 54,330 alcohol-related cancer cases in American women and 42,400 cases in men. Over a decade, that tallies up to almost 1 million preventable cancer cases, according to the advisory.

_{© U.S. Department of Health and Human Services}

Consuming alcohol also increases risk of other forms of cancer:

• Mouth
• Pharynx
• Larynx
• Esophagus
• Liver
• Colon and rectum

Do people know the risks?

“Despite clear evidence demonstrating the effect of alcohol consumption on cancer risk, there is a large gap in public understanding of the risk,” Murthy said in the advisory. Alcohol ranks last among factors that Americans recognize for cancer risks, with 45% of people aware of carcinogenic effects, according to 2019 survey. The same poll found people recognized potential cancerous effects of radiation exposure (91%), smoking and tobacco use (89%), asbestos exposure (81%), and obesity (53%).

But the connection between alcoholic beverage consumption and cancer has become clear, based on two decades of study around the world, Murthy said. Alcohol is classified as a Group 1 carcinogen – a rank shared by tobacco, asbestos, formaldehyde and other dangerous substances – by the International Agency for Research on Cancer, the specialized agency under the World Health Organization.

“Extensive research has demonstrated specific biological mechanisms by which alcohol causes cancer as well,” he said.

There are at least four known ways:

• Alcohol breaks down to acetaldehyde, which damages DNA in multiple ways.
• It induces oxidative stress, damaging DNA, proteins and cells through increased inflammation.
• It alters levels of multiple hormones, including estrogen, increasing risk of breast cancer.
• It leads to greater absorption of carcinogens through the mouth and throat.

Cancer risk starts with less than one drink per week and increases with more consumption, regardless if people drink beer, wine or liquor, according to the advisory.

Let people know

Since 1988, alcoholic beverages have been labeled to warn pregnant women should not drink due to risk of birth defects, and that drinking impairs the ability to drive a car or operate machinery, and may cause health problems. Murthy said the warning label should be updated, and he cited the 2026 warning that will be applied to alcohol sales in Ireland: “There is a direct link between alcohol and fatal cancers.”

Changing the label lies with Congress, and Murthy said he recommends the House of Representatives and Senate update the warning.

Health leaders also should reassess recommended limits for alcohol consumption and generally expand education about the connection. Physicians and other clinicians should inform patients in clinical settings about risks, and promote screenings, brief interventions and referrals to treatment as needed, the advisory said.

AMA praise

Murthy’s advisory prompted praise from American Medical Association President Bruce A. Scott, MD, who issued a statement on it.

“The American Medical Association applauds the Surgeon General’s work to make completely clear the link between alcohol consumption and increased cancer risk,” Scott said. “For years, the AMA has said that alcohol consumption at any level, not just heavy alcohol use or addictive alcohol use, is a modifiable risk factor for cancer.

“And yet, despite decades of compelling evidence of this connection, too many in the public remain unaware of alcohol’s risk,” Scott said. “Today’s advisory, coupled with a push to update the Surgeon General’s health warning label on alcoholic beverages, will bolster awareness, improve health, and save lives.”