United States Surgeon General Dr. Vivek Murthy has reignited a public health debate by proposing cancer warning labels on alcoholic beverages.

Murthy’s proposal was accompanied by a new consultation (PDF) highlight the growing evidence linking alcohol consumption to several types of cancer.

Why is this call for warning labels important, and what does science say about the risks associated with drinking alcohol?

Why is the US Surgeon General calling for cancer warnings on alcohol bottles now?

Current text-only alcohol warning labels, introduced in 1988, address the risks of pregnancy and impaired driving but fail to mention the cancer risks.

Murthy says these labels are outdated and inadequate given the current understanding of alcohol’s impact on health.

“For individuals, they should be aware that the risk of cancer increases the more alcohol they consume,” Murthy wrote on Friday on social media platform X. “Risk of cancer.”

How dangerous is alcohol from getting cancer?

report (PDF) from the Surgeon General claims that alcohol consumption in the country is directly linked to approximately 100,000 cancer cases and 20,000 deaths annually. It is also the third leading preventable cause of cancer, after tobacco use and obesity.

Similar results have also 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 WHO European region, representing 4.2 percent of all cancer cases.

In China, alcohol consumption was associated with 93,596 cancer cases (3.6% of total cases) and 78,881 cancer deaths (4.4% of total deaths), with men being much more affected than women. Women in China usually consume much less alcohol than men.

Other studies have also shown this association. A study published in the British Journal of Cancer analyzed data from 572 studies that included 486,538 cancer cases, making alcohol a major carcinogen that damages DNA and disrupts cell repair.

Despite these concerns, public awareness remains low—only 45 percent of Americans are aware of drinking alcohol (PDF) as a risk of cancer, compared to 91 percent for tobacco.

How much alcohol is needed to increase the risk of cancer?

There is no “safe” level of alcohol consumption when it comes to cancer risk. The World Health Organization and other public health bodies stress that even small amounts can be harmful to health.

For example, two drinks a day is associated with an increased lifetime risk of cancer in about five in 100 women and three in 100 men, according to data reported in the US Surgeon General’s Consultation.

Will the warning limit alcohol consumption?

The Surgeon General proposes updated warning labels on alcoholic beverages, drawing parallels to cigarette warnings, which studies have linked to lower smoking rates. However, there is some doubt about the effectiveness of text warnings.

In its push for cigarette packages to carry new pictorial health warnings, including pictures, the US Food and Drug Administration (FDA) said in 2019 that text warnings on cigarette packages, which have not changed since 1984, are ineffective and “ineffective.” “Almost visible.”

However, Timothy Naimi, director of the Canadian Institute for Substance Use Research at the University of Victoria, argues that warning labels serve an essential role in promoting transparency and consumer rights, regardless of their direct impact on public health.

Al Nuaimi points out 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 lack even basic consumer information.

“In most parts of the world there is not a lot of information about what people consume when it comes to alcohol,” he told Al Jazeera. “People should be allowed to make their own decisions, but at least have accessible information.”

This type of label plays a broader role that goes beyond individual behaviour, says Dr Carina Ferreira Borges, Head of the Department of Alcohol, Drugs and Prison Health at the WHO Regional Office for Europe.

“Alcohol health warning labels are a systemic tool for change – they raise awareness, support broader alcohol policies, and reduce the marketing appeal of alcohol packaging,” she told Al Jazeera.

How can alcohol consumption be reduced?

Experts say additional regulatory measures will also be key to reducing consumption.

“The single most effective step would be to increase the federal alcohol tax; instead, Congress reduced it in 2017, and made that tax cut permanent in 2020,” said David Jernigan, a professor of health law, policy and management at Boston University School of Public Health.

He adds that the greatest value of strong labels is in portraying alcohol as a “different and potentially unhealthy product,” which can help pave the way for more effective measures, such as raising taxes, to gain legislative support.

The World Health Organization also recommends three “best buys” for reducing alcohol consumption: increasing taxes, limiting marketing, and limiting physical availability, such as restricting the number of vendors and their hours of operation.

The Nordic countries and Thailand have successfully reduced alcohol consumption by increasing taxes and restricting marketing.

How does drinking alcohol affect your health?

Alcohol consumption increases the risk of at least seven types of cancer, including breast, colon, liver, mouth, throat, esophagus and larynx, according to the Surgeon General.

This is done through several mechanisms such as:

• DNA damage: Alcohol turns into acetaldehyde, a toxic compound that destroys DNA, the molecules that direct how humans grow and function, and prevents cells from repairing themselves.
• Hormonal imbalance: Alcohol disrupts hormone levels, especially estrogen, which increases the risk of breast cancer.
• Absorption of carcinogenic substances: Alcohol increases the body’s absorption of other carcinogens, such as those found in tobacco.

Does moderate drinking have health benefits?

It’s complicated.

One widely cited 1991 study in the Lancet presented the “French Paradox,” suggesting that moderate wine consumption may protect against heart disease despite high-fat diets. This has been supported by observational studies over the years that have linked moderate drinking (one or two drinks per day) to lower rates of cardiovascular disease.

However, new studies have largely debunked these claims, revealing problems with previous research and pointing to overall risks that outweigh any 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 based on flawed methodologies, especially a failure to account for “sick quitters” — people who stopped drinking because of health problems.

Al-Naimi acknowledges that discussions about whether small amounts of alcohol may benefit heart health have complicated public understanding, but he says emerging evidence supports the message that drinking smaller amounts is better for both heart health and cancer prevention.

“Even if you think a little alcohol might be good for your heart, it’s only a very small amount — maybe a drink or two a week,” Al Nuaimi explains. Beyond very low levels, alcohol increases the risk of heart disease, including heart attacks, high blood pressure, heart failure, and irregular heartbeat.

However, industry voices, such as Amanda Berger, senior vice president of science and research at the Distilled Spirits Council, argue that moderate drinking may have some health benefits and that any label updates should reflect a comprehensive review of the scientific evidence.

“Many lifestyle choices carry potential risks, and the federal government’s role is to determine any proposed changes to warning statements based on the entire body of scientific research,” Berger said in a statement.

Ferreira Borges, a representative of the World Health Organization, says that the responsibility of the alcohol industry is not to promote responsible drinking campaigns, but to limit the harm caused by its products through regulatory measures and reformulation.

“The alcohol industry’s claims that alcohol harms are a matter of personal responsibility serve to deny the pervasive nature and distort those who suffer from alcohol harms,” she said.

Will Congress approve new designations?

Despite advice from the Surgeon General and new research on the dangers of alcohol, Congress is unlikely to act quickly on updating warning labels.

The last alcohol warning label, which addressed the risks of pregnancy and impaired driving, was approved nearly 40 years ago.

The bill was called the Alcoholic Beverage Labeling Act of 1988, and was introduced in the House of Representatives in September 1988 and became law within a few months. But it faced significant opposition from the alcohol industry, which said the warnings would be ineffective and could hurt business. The resulting labels were also relatively small and lacked detailed health warnings.

Efforts to add a cancer warning are likely to face strong opposition from the hard liquor industry, which spends $30 million a year lobbying Congress.

Analysts also expect a decline.

“That seems to be one of the industry’s biggest concerns — that this could start to go down the same path that tobacco did,” Jernigan said.

Regardless of whether the labels are approved, alcohol use among young Americans is already declining — with 49.6% of 18- to 25-year-olds reporting drinking alcohol in the past month in 2023, down from 59.6% in 2013, according to For the 2023 National Survey on Drug Use. And health.

Trends among them suggest a growing preference for non-alcoholic alternatives, with movements such as Dry January gaining momentum, while social shifts may also play a role.

“Younger people start drinking later in life, which likely impacts their later drinking years,” Jernigan says. He adds that other risky behaviors, such as teen pregnancy, have also declined as teens increasingly communicate digitally rather than in person, leading to them spending more time alone.