A Cancer Warning Label on Alcohol?
U.S. Surgeon General Vivek Murthy has recommended alcoholic beverages carry cancer risk warning labels, citing a growing body of research that shows alcohol as a group 1 carcinogen.
While only Congress can order these product labels, oncology physicians and researchers at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System, praise the official government advisory released shortly after the new year.
“The surgeon general has been appropriately proactive about identifying a modifiable cancer risk and letting the population know what can be done about it,” says Mikkael Sekeres, M.D., M.S., chief of the Division of Hematology at Sylvester and professor of medicine at the Miller School of Medicine. “It’s a big step forward.”
Four months ago, Dr. Sekeres wrote a guest column for The Washington Post listing the behaviors he, as an oncologist, avoids to lower his cancer risk. Avoiding alcohol was number two. Even a modest intake of one drink a day is not without danger, he wrote.
“The more you drink, the higher your risk,” he adds. Yet, less than half of Americans know that higher alcohol consumption increases the risk of developing cancer. Alcoholic beverages already carry labels warning that consumption can impair driving ability and that pregnant women should not drink. The cancer risk warning, if approved, would go further.
7 types of cancer are linked to alcohol use.
In the advisory on Alcohol and Cancer Risk, the surgeon general draws the direct link between alcohol intake and at least seven types of cancer:
And the kind of alcohol consumed — wine, beer, or hard liquor — doesn’t matter.
If Congress votes to mandate new warning labels, the U.S. will join a handful of nations that already post such messages on alcoholic beverages. It likely would look similar to the warning box on cigarettes.
Alcohol is blamed for about 100,000 cases of cancer and 20,000 cancer deaths in the U.S. every year. That’s more than the annual 13,500 alcohol-associated traffic fatalities. Alcohol is also the third leading preventable cause of cancer, after obesity and tobacco, a fact health experts hope people will take more seriously with the attention brought on by the surgeon general’s warning.
“This is behavior you can change,” says Paola Rossi, M.D., M.S.Ed., Sylvester’s clinical program director for lifestyle medicine. “The take-home message here is that alcohol is a carcinogen — like tobacco and asbestos — but you can do something about lowering your risk.”
It will take time for people to embrace this news.
As director of lifestyle medicine, digital health and cancer prevention at Sylvester, Tracy Crane, Ph.D., RDN, has long advocated for healthy lifestyle choices. “Now we finally have enough hard evidence to make this statement,” she says, adding that curbing alcohol consumption will not be easy. She believes the campaign against tobacco smoking can provide a blueprint for the way forward. Just as smoking has gone from hip to unfashionable, so can drinking alcohol.
“Alcohol is part of our culture, part of the social fabric,” Dr. Crane acknowledges. “It’s been around forever. There are clubs and hobbies that exist around it. So, it’s going to take time for people to embrace this.”
Higher rates of cancer for those under 50 years of age.
The suggestion for warning labels comes at a particularly crucial time in the long history of alcohol consumption. More adults under the age of 50 have been diagnosed with colorectal and breast cancers during the past few decades, and research points the finger at alcohol use. One report published by the American Association for Cancer Research earlier this year reveals that even as cancer deaths have declined because of improved treatment, incidence among young adults has increased.
Two groups, women and seniors, are drinking more — and suffering the consequences.
The gap between how much men and women drink is narrowing.
An investigation published in 2023 by JAMA’s Substance Use and Addiction showed that deaths directly linked to alcohol were growing more rapidly among women. This is significant because alcohol consumption appears to be more detrimental to women, who usually have less body water and body weight and therefore metabolize alcohol differently, which, in turn, raises their risk not only of cancer but also cardiovascular disease and liver damage. In fact, more than 16% of breast cancer cases can be attributed to alcohol consumption. (Alcohol raises estrogen levels, which can power up disease development.)
Like women, older adults are drinking more. And like women, they metabolize alcohol more slowly because of physiological changes that come with age. Hence, blood alcohol levels tend to stay higher in seniors, which can also affect balance, coordination and reaction time.
The World Health Organization says there is no safe limit for alcohol.
The surgeon general’s warning follows a 2023 WHO declaration that there is no safe amount for alcohol consumption. However, the U.S. has been slow to update drinking guidelines.
Current U.S. Dietary Guidelines suggest men can consume two drinks or less a day and women one drink or less. (One drink is equivalent to 12 ounces of beer, 5 ounces of glass of wine, or 1.5 ounces of distilled spirits). A report five years ago suggested changing the guidelines to one drink a day for men, but, in the end, the published recommendations were not rewritten.
Changing long-held habits and beliefs — remember the adage that a daily glass of red wine is good for your heart? — won’t be easy. But it is certainly doable. “The warning draws attention, and it drives the message home,” Dr. Sekeres says. “We all make decisions that balance risks with benefits. In this case, more people will ask themselves, is drinking those beers really worth it?”
Try new mocktails to curb the urge to drink.
Dr. Crane says that when cancer patients at Sylvester are instructed about the health consequences of alcohol, their mindset changes. They don’t want cancer to come back. “Survivors are looking to be as healthy as they can. After you explain it to them, they’re all in.”
She and Dr. Rossi say the narrative around alcohol is already changing. People are embracing Dry January and Sober October. Recipes for mocktails – cocktails without alcohol — appear everywhere on social media, and the market for non-alcoholic beers and drinks is growing.
Dr. Rossi suggests people who want to stop drinking consider the choice not as an act of deprivation but one of discovery. In short, abstention isn’t a negative. Quite the contrary. She encourages people to be adventurous. Try new drink recipes without alcohol. Take non-alcoholic drinks to a party and share with friends. Always use a nice glass.
“For many people, being told not to do something makes them feel excluded, and it’s what they end up thinking about most,” Dr. Rossi adds. “Turn that around and look at it in a positive way. Make something special of your choice not to consume alcohol.”
Non-alcoholic drinks for better self-care:
Hibiscus Sour
2 1/2 ounces of hibiscus tea, chilled
3/4 ounce grapefruit juice, freshly squeezed
3/4 ounce lime juice, freshly squeezed
1/2 ounce agave nectar
1 egg white or 1 tbsp aquafaba (optional)
- Brew a cup of hibiscus tea, then chill.
- Add all ingredients to a cocktail shaker and (if using egg white) “dry shake” without ice for 20 seconds.
- Add ice, shake again until chilled, and double strain into a coupe glass.
Spicy Watermelon Splash
4 cups watermelon cubes
1/4 teaspoon sriracha
1/4 teaspoon black pepper
7-8 mint leaf
- Chop the watermelon into cubes and add it to the blender jar.
- Add mint leaves, sriracha, and black pepper to the blender.
- Add ice cubes (if the watermelon was not previously frozen)
- Blend everything together until it is smooth.
- Pour it on top of the ice, garnish with a piece of mint and serve cold.
Piña Colada
1 1/2 cups unsweetened frozen pineapple chunks
1/4 cup ice
3/4 cup unsweetened pineapple juice
3/4 cup unsweetened coconut milk
splash of lime juice (optional)
- Place frozen pineapple chunks and ice in a blender.
- Pour pineapple juice and coconut milk over the top. Puree until smooth. Taste test for your desired sweetness and add sugar if needed.
- Pour into glasses and garnish with fresh pineapple wedges or maraschino cherries.
Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked at The Miami Herald, The Miami News, and The Palm Beach Post.
Tags: Alcohol as a carcinogen, Alcohol consumption and cancer types, Cancer warning labels on alcohol, Dr. Mikkael Sekeres, Dr. Paola Rossi, Dr. Tracy Crane, Sylvester Comprehensive Cancer Center
