Well, dry January is off with a bang. Last week, surgeon general Dr. Vivek Murthy called to add cancer-risk warnings to alcohol labels. While it’s no secret that drinking is bad for you, studies cited in the Department of Health & Human Services’ new advisory report link alcohol consumption to at least seven different types of cancer, including breast, colorectum, liver, mouth, esophagus, throat, and voice box. Even moderate drinking, which the CDC classifies as one glass a day for women and two for men, won’t exempt you from the risk. “Many people out there assume that as long as they’re drinking at the limits or below the limits of the current guidelines … there is no risk to their health or well-being,” Dr. Murthy said in an interview with the New York Times. “That data does not bear that out for cancer risk.”
Alcohol, according to the advisory, is the third-leading preventable cause of cancer in the United States, behind tobacco and obesity, and contributes to an estimated 100,000 cancer cases and 20,000 cancer deaths a year; last September, the American Association for Cancer Research published a report that includes alcohol consumption as one of the factors driving increased rates of breast and colorectal cancers in adults under 50. A 2020 study found that, for women, the risk of developing an alcohol-related cancer was 17 percent for those who consumed less than one drink per week and rose to 22 percent for those who drank two drinks a day. The risks for men, meanwhile, were 10 percent and 13 percent. Though the link between drinking and cancer has been well documented for decades (the International Agency for Research on Cancer has classified alcoholic drinks as carcinogenic since 1988), public awareness of it has been low, even as Gen Z shifts away from drinking culture and interest in sober curiosity rises. The Cut spoke with three experts — Dr. Jane Figueiredo, an epidemiologist at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center in Los Angeles; Dr. Otis Brawley, an oncologist and epidemiologist at Johns Hopkins Kimmel Cancer Center and the Bloomberg School of Public Health; and Dr. Frances Lee, a gastroenterologist who specializes in liver disease at Mount Sinai — to better understand just how worried we need to be about drinking and cancer.
People seem to be really alarmed by the surgeon general’s call to put a warning label for cancer on alcohol, but alcohol’s link to cancer isn’t new — it’s something we’ve known for decades. Why do you think this got everyone’s attention?
“I think there was more of a layperson understanding of alcohol and liver disease and liver cancer, but the fact that there’s so many cancers linked to alcohol consumption has taken people by surprise — and called them to reflect upon their alcohol use more seriously,” Dr. Figueiredo says. “The health risks of alcohol aren’t underlined as much, because of how culturally accepted it is to drink, and, sometimes, to drink heavily,” says Dr. Lee.
Why are we only just now considering adding a warning label to alcohol?
“I wish it had come out earlier,” says Dr. Lee, who adds that she’s seen an uptick in alcohol-related disease since the pandemic. “My suspicion is it’s been too much of a political hot potato in the past,” says Dr. Brawley, who says the FDA has had discussions in the past about putting out a statement about the alcohol-cancer link, though those never came to fruition. “I suspect part of the surgeon general making his pronouncement may very well be because the surgeon general’s leaving office, but I’m speculating,” he says.
We also have more scientific evidence outlining health risks of alcohol than we ever did before. “As science grows, we have more and more studies,” says Dr. Brawley. For decades, studies suggested that moderate drinking was low risk and could even improve your health. Newer research shows that even moderate drinking has no benefits.
Dr. Figueiredo says old messaging about the purported health benefits of alcohol, like the cardiovascular benefits of red-wine compounds, “got overblown a bit.” She adds, “There was rationale for enjoying something people have consumed for a long time.”
Why is there so little awareness that alcohol can cause cancer?
Even the American Cancer Society’s guidelines around drinking — that it’s best not to, but those who do should stick to one drink or fewer for women and two or fewer for men — can also make people feel like it’s not as bad at it is, Dr. Figueiredo says. And then there’s the fact that drinking culture is just so pervasive, making it tricky to moderate one’s intake. “No one’s championed alcohol abstinence since the Prohibition,” says Dr. Lee. “It’s not as straightforward as tobacco, where there’s a clear villain.”
What do the moderate-drinking guidelines really mean, anyway? How does one drink a day compare to not drinking all week, then having three drinks on a Friday?
No surprises here, but binge-drinking — which the Substance Abuse and Mental Health Services Administration defines as four or more drinks in one sitting for women and five or more for men — is definitely bad for you. “We certainly know, even for non-cancer reasons, like liver cirrhosis, that binge-drinking is bad and unhealthy,” says Dr. Brawley.
But, according to Dr. Figueiredo, there’s more research to be done about the effects of how frequently you drink versus the total amount you drink. In the meantime, cutting back never hurts. “What we can say right now is whatever your drinking habits are, cutting down will reduce your risk,” she says.
Is there really any safe limit?
In terms of cancer risk, no, probably not. But experts stress that it’s simply important to be aware of the risks you’re taking; total avoidance can be impractical. “I think we have to be realistic when it comes to people, right? We’re not robots,” Dr. Lee says. “There are risks to taking a bus somewhere; there are risks to traveling versus just staying at home, and we all take those risks whether we acknowledge them or not. I think we all kind of have to think about alcohol that way — and that’s just new for all of us.”
Eliminating all the carcinogens from your environment, from air pollution to processed meats, is unrealistic, according to Dr. Brawley, and you’re better off controlling your exposure to them when possible. “That’s probably as far as we want to go with it,” he says. “Making sure people are aware these things are harmful, then they make their own decisions.”
We know Gen Z is already drinking less. How do you hope this will this change drinking culture?
“I hate to use the word responsible drinking, but I’d love to see a decline in binge-drinking,” Dr. Brawley says. “There’s people who are more than willing to accept that hard liquors cause cancer but are shocked when we say beer and wine.” Dr. Figueiredo finds the increasing buzz around dry January promising; it’s a helpful way to try out the benefits of cutting back, which include better sleep, improved energy, and potential weight loss. Plus, she says, think of the financial benefits. “You save money from not drinking,” Figueiredo says.