Surgeon General Calls for Cancer Warning Labels on Alcohol

The United States Surgeon General, Dr. Vivek Murthy, today issued a report calling for cancer warning labels on alcohol. To my knowledge, he becomes the first Surgeon General to make such a recommendation. Dr. Murthy's call for cancer warning labels is based on scientific evidence that even low levels of alcohol consumption (i.e., one drink a day) increase the risk of breast, mouth, and throat cancers. It is also based on the fact that unless a non-linear dose-response relationship has been demonstrated, carcinogens are assumed not to have a threshold response; thus, there is no level of exposure that can be deemed "safe." According to the Surgeon General, there are nearly 100,000 cancer cases and 20,000 deaths each year that are attributable to alcohol use.

Importantly, the Surgeon General noted that although cancer risk is lower at lower levels of alcohol consumption, the number of people drinking at this level is so much higher than the number of heavy drinkers that there are actually more alcohol-related cancer cases among people who drink 2 drinks or less per day than among those who drink 4-6 drinks per day. Globally, the Surgeon General estimates that 25% of all alcohol-related cancer cases occur among people who are light drinkers (no more than 2 drinks per day). 

Among the Surgeon General's recommendations are:

• "Update the existing Surgeon General’s health warning label on alcohol-containing beverages to include a warning about the risk of cancer associated with alcohol consumption. Pursue changes to label characteristics to make the warning label more visible, prominent, and effective in increasing awareness about cancer risks associated with alcohol consumption.
• Reassess recommended limits for alcohol consumption to account for the latest evidence on alcohol consumption and cancer risk.
• Strengthen and expand education efforts to increase general awareness that alcohol consumption causes cancer."

The Rest of the Story

I have already explained why I think the conclusions of the NASEM report were a death knell for the possibility of the Dietary Guidelines recommending low dose alcohol consumption for the reduction of cardiovascular risk. The Surgeon General's report puts the nail on the coffin.

The evidence is strong that alcohol consumption - at low doses within the current Dietary Guideline limits - increases cancer risk at multiple sites including the breast and the GI tract. There is no dose of alcohol consumption that can be considered safe. For this reason, it is no longer tenable for national dietary guidelines to recommend any level of alcohol consumption, even if it were to turn out that moderate drinking lowers cardiovascular disease risk. Just as we would not recommend smoking for the prevention of Parkinson's disease and Alzheimer's disease (there is some evidence that this is the case), we cannot recommend drinking for the prevention of heart disease.