Alcohol is the leading cause of cancer, and alcoholic beverages should carry the same warning label as cigarette packages, the US surgeon general said on Friday.
It's the latest debate in a heated debate about the risks and benefits of moderate drinking as the US Dietary Guidelines, which influence Americans, are up for revision. For decades, moderate drinking has helped prevent heart disease and stroke.
That idea is rooted in the dietary advice given to Americans. But a growing body of research has linked drinking, sometimes even within recommended limits, to various types of cancer.
Labels currently attached to bottles and cans of alcoholic beverages warn against drinking while pregnant or before driving and using other machinery, as well as general “health hazards”.
But alcohol directly contributes to 100,000 cancer cases and 20,000 deaths each year, said the surgeon general, Dr. Vivek Murthy.
He called for the labels to be updated to include the increased risk of breast cancer, colon cancer and at least five other diseases that scientific studies have linked to alcohol consumption.
“Many people out there think that as long as they drink at or below the current guidelines of one a day for women and two for men, that there is no risk to their health or well-being,” said Dr. Murthy said in the interview.
“The data doesn't show that in terms of cancer risk.”
Only Congress can approve new warning labels of the type recommended by Dr. Murthy, and it is not clear that the incoming administration will support the change.
Still, President-elect Donald J. Trump doesn't drink, and his choice to head 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 question that overuse is dangerous. But proponents of moderate drinking—including wine, beer and spirits makers, and some doctors and scientists—argue that a small amount of alcohol each day may reduce cardiovascular disease, the No. 1 killer in the United States.
New scientific research has criticized the methodology of earlier studies, however, and has challenged that view, which was once the consensus.
Although most cancer deaths occur at drinking levels that exceed the current recommended dietary guidelines, the risk of breast, mouth and throat cancer may increase if you drink just one drink a day, or less, said Dr. Murthy. on Friday.
Overall, one in six breast cancer cases is caused by alcohol consumption, said Dr. Murthy. Recent research has linked moderate alcohol consumption to certain forms of heart disease, including atrial fibrillation, a heart arrhythmia.
Two scientific reviews will be used to inform revised recommendations on alcohol consumption in government dietary guidelines.
Five years ago, the scientific report that informed the drafting of the 2020-2025 dietary guidelines acknowledged that alcohol is a carcinogen and is generally unhealthy and proposed “strengthening guidelines” by setting men's recommendations at one standard drink, or 14 grams of alcohol. day.
However, when the final guidelines were drafted, there was no change to the recommendation that a moderate intake of two drinks a day is acceptable for men.
But the government acknowledged emerging evidence that “even drinking at recommended levels may increase the risk of dying from a variety of causes, including several types of cancer and other types of cardiovascular disease.”
Since then, more research has linked alcohol to cancer. Yet any attempt to change warning labels on alcoholic beverages is likely to face an uphill battle.
The current warning label has not been 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.
Recently, a scientific review of moderate drinking research, conducted under the auspices of the National Academies of Sciences, Engineering and Medicine, was approved by Congress.
That analysis found a link between alcohol consumption and a slight increase in breast cancer, but no clear link for any other cancer. The report also revived the theory that moderate drinking is linked to fewer heart attacks and strokes, and fewer deaths overall, compared to no drinking.
The World Health Organization says there is no safe limit for drinking alcohol, however, and 47 countries require warnings about alcohol. But cancer is rarely talked about.
So far, only South Korea has a label warning about liver cancer, although manufacturers may choose other labels that do not mention cancer. Ireland is currently set to introduce labels stating there is a “direct link between alcohol and fatal cancer” by 2026.
The industry has a strong history of fighting cancer warning labels, and alcohol-producing countries have also objected to warning labels under international trade law.
Industry opposition led to the early termination of a federally funded Canadian study on the impact of warning labels on cancer.
The surgeon general's advice provided an overview of research studies and reviews published over the past two decades, including a global study of 195 countries and territories involving 28 million people.
They all found that higher levels of alcohol consumption were associated with a higher risk of developing cancer.
Another study looked at certain cancers, such as breast cancer and oral cancer, and found the risks increased by 10 percent and 40 percent, respectively, in those who drank just once a day, compared to those who did not drink.
The report described the biological mechanisms by which alcohol is known to cause cancerous changes at the cellular level.
A widely accepted theory is that inside the body, alcohol breaks down into acetaldehyde, a metabolite that binds to DNA and damages it, allowing the cell to start growing out of control and creating a malignant tumor.
Animal experiments showed that rats whose drinking water was spiked with ethanol, alcohol used in alcoholic beverages, or with acetaldehyde produced a number of tumors in their bodies.
Studies have shown that alcohol causes oxidative stress, which increases inflammation and can damage DNA.
It also alters the levels of hormones such as estrogen, which can contribute to the development of breast cancer, and makes it easier for bacteria such as cigarette smoke particles to be absorbed into the body, increasing the risk of mouth and throat cancer.
The surgeon general's report also elaborates on the increased risk associated with drinking, distinguishing between increased absolute risk and relative risk.
For example, the total risk of developing breast cancer in a woman's lifetime is about 11.3 percent (11 in 100) for those who drink less than a week.
The risk increases to 13.1 percent (13 out of 100 people) for one drink a day, and up to 15.3 percent (15 out of 100) for two drinks a day.
For men, the overall risk of developing an alcohol-related cancer increases from about 10 percent (10 people in 100) for those who drink less than one drink a week to 11.4 percent (11 in 100) for those who drink regularly. day on average. It rises to 13 percent (13 out of 100 people) for those who drink two drinks a day on average.
Many Americans do not know that there is a connection between alcohol and cancer.
Less than half of Americans identified alcohol use as a cancer risk, compared to 89 percent who saw tobacco as a carcinogen, according to a 2019 survey of American adults age 18 and older by the American Institute for Cancer Research.
However, alcohol is the third most preventable cause of cancer, after tobacco and obesity, according to the surgeon general's report.
Dr. Murthy said it is important to know that the risk increases as the amount of alcohol increases. But each person's risk of developing cancer is different, depending on family history, genetic makeup and environmental exposures.
“I wish we could have a magic wand that could tell people they are safe,” he said. “What we do know is that less is better when it comes to reducing the risk of cancer.”
“If a person drinks occasionally on special occasions, or if you have a drink or two a week, your risk may be much lower than if you drink every day,” he added.
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