U.S. Surgeon General Calls for Warning Labels on All Alcohol
U.S. Surgeon General Vivek Murthy issued an advisory today calling for alcoholic beverages to carry cancer warnings, arguing that Americans are uneducated about potential links between alcohol and seven types of cancer. He also suggested that the U.S. Dietary Guidelines on alcohol consumption, which are currently under review, be revised.
Dr. Murthy, who has served as surgeon general since 2021 and also held the office from 2014 to 2017, said he was motivated because of evidence that most Americans do not know of links between alcohol and cancer. “Alcohol is a well-established, preventable cause of cancer,” said Murthy in a statement. “Yet the majority of Americans are unaware of this risk.”
No Sign that Labels Are Imminent
Since 1988, bottles of wine in the U.S. have carried mandatory labels highlighting the risks of driving under the influence and of drinking during pregnancy. The surgeon general does not have the power to mandate warning labels; only Congress can do that. And it is unclear if there is any desire to do so in the current congressional session, which also began today. Incoming president Donald J. Trump, set to take office Jan. 20, has selected physician Janette Nesheiwat as his pick to succeed Murthy as surgeon general.
But statements and advisories by past surgeons general have sent important messages to the public, on everything from tobacco to HIV. Murthy’s advisory comes at a time when a growing chorus of anti-alcohol and health organizations have been waging a sophisticated PR campaign to change public attitudes toward alcohol. Rather than combat alcohol addiction and binge drinking, these groups have declared that no level of drinking is safe.
One strategy has been to argue that past studies linking moderate alcohol consumption with lower rates of cardiovascular disease used flawed methodology. But a recent report by the National Academies of Science, Engineering and Medicine (NASEM), commissioned for the regular review of the U.S. Dietary Guidelines, reaffirmed the scientific evidence that light to moderate drinking lowers rates of cardiovascular disease. The report also found with “moderate certainty” that people who drink alcohol in moderation have lower all-cause mortality than those who don’t drink.
Another anti-alcohol effort has focused on raising awareness of links between drinking and cancer. Several studies have found a correlation between alcohol consumption and cancers of the breast, colorectum, esophagus, liver, mouth, throat and larynx. There several hypotheses on how alcohol raises cancer risk, though the mechanism is not completely understood. (Studies of alcohol consumption are limited to showing correlation, not direct causation.) The recent NASEM report found with moderate certainty that moderate consumption of alcohol is associated with a higher risk of breast cancer. But it also found that the scientific evidence was insufficient to draw a conclusion on a link between moderate consumption and other cancers.
How Big Is the Risk?
Breast cancer is the most common cancer and the second leading cause of cancer death among women in the U.S., according to the American Cancer Society (ACS). Extensive research links heavy drinking to a substantially increased cancer risk, with lower risks for light and moderate drinkers.
When discussing risk, it’s important to look at the numbers. In his advisory, the surgeon general cites a 2021 study from the British Journal of Cancer. It found that in a group of more than 225,000 Australian women, those who drank less than a glass a day of alcohol had a 11.3 percent risk of developing breast cancer during their life. Those who drank one glass a day had a 13.1 percent chance and those who drank two glasses a day had a 15.3 percent chance.
Is alcohol’s cancer risk comparable to tobacco’s? According to the most recent annual report of the American Association for Cancer Research, nearly 20 percent of all cancer cases in the United States and almost 30 percent of all cancer-related deaths are caused by smoking cigarettes. Obesity was linked to 7.6 percent of all cancers. Alcohol consumption was linked to 5.4 percent of cancers.
A New Chapter in the Debate Over Dietary Guidelines
In addition to warning labels, the surgeon general called for several other steps. He advises individuals to be aware of the relationship between alcohol consumption and increased cancer risk when considering whether or how much to drink and suggests that public health professionals and community groups should highlight alcohol consumption as a leading modifiable cancer risk factor.
The surgeon general’s advisory comes as the industry is already closely watching the debate around updating the U.S. Dietary Guidelines, which happens every five years and is due in 2025. While the NASEM report found that moderate alcohol drinkers have lower all-cause mortality than nondrinkers, a panel of researchers with ties to anti-alcohol advocacy groups is conducting a second analysis for the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD). That report, which is unprecedented and will conduct original research, is expected to be released this month.
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