Putting a cancer warning on alcohol is overdue, doctors say

Doctors on Friday applauded a new report from the U.S. surgeon general that highlights links between alcohol consumption and seven types of cancer and suggests that alcoholic drinks should come with cancer warning labels.

The association between alcohol and cancer is well established, and many doctors have long called on the federal government to make the connection clearer to the public.

“For years, the AMA has said that alcohol consumption at any level, not just heavy alcohol use or addictive alcohol use, is a modifiable risk factor for cancer,” Bruce Scott, president of the American Medical Association, said in a statement. “And yet, despite decades of compelling evidence of this connection, too many in the public remain unaware of alcohol’s risk.”

In the new report, Surgeon General Vivek Murthy outlines the scientific evidence linking alcohol to cancer and offers recommendations to reduce rates of alcohol-related cancers. In addition to proposing warning labels on alcoholic drinks, Murthy suggests reassessing the recommended limits for alcohol consumption in the U.S.

Six in 10 U.S. adults report that they drink, but several doctors told NBC News that their patients generally aren’t aware that alcohol consumption can lead to cancers of the mouth, throat, esophagus, larynx, liver, breast and colon.

“We have not done a good job with public health messaging about alcohol in the United States,” said Dr. Rotonya Carr, head of gastroenterology at the University of Washington.

The new report may raise questions for some people about the long-term damage of drinking, safe limits and how to reverse the negative health effects. Here is what medical experts across the country think people should know.

Is any level of drinking safe?

The World Health Organization says there’s no safe amount of alcohol consumption. As alcohol breaks down in the body, it can damage DNA and proteins in a way that may allow cancer to develop. It can also alter hormone levels and make it easier for the body to absorb other carcinogens like tobacco smoke, thereby increasing the risk of breast, mouth or throat cancers.

“The safest thing for all sorts of health outcomes, not just cancer, is no alcohol consumption,” said Paul Gilbert, an associate professor at the University of Iowa College of Public Health. “But, of course, not many people go that route, because alcohol is such an important, central part of our social and cultural customs.”

The health risks associated with drinking are lower if you drink less and higher if you drink more. A 2020 study found that among women, the risk of developing an alcohol-related cancer in one’s lifetime was 17% for those who consumed less than one drink per week, but 22% for those who consumed two drinks daily. For men, the risks were 10% and 13%, respectively.

How does drinking compare to other factors that increase cancer risk?

Alcohol is the third leading preventable cause of cancer in the U.S., behind tobacco and obesity, according to the surgeon general’s report. It estimates that alcohol contributes to nearly 100,000 cancer cases and about 20,000 cancer deaths annually.

The WHO’s International Agency for Research on Cancer classifies alcohol as a “Group 1” carcinogen, meaning there’s sufficient evidence that it can cause cancer in humans. Other carcinogens in that group include tobacco, asbestos and radiation.

Given that, Carr said, people should be as worried about the health risks of drinking as they are about smoking.

If someone stops drinking, can they reverse the damage?

Compared to smoking, doctors said, there’s less research on how long it takes to see reductions in cancer risk after a person stops drinking. (Studies have estimated that people who quit smoking 10 years ago have half the risk of dying from lung cancer than someone who currently smokes cigarettes.)

While some research has found that a single month of sobriety — a dry January, say — can lead to weight loss and improved blood pressure and cholesterol levels, the story is less optimistic when it comes to cancer risk, Carr said. She noted that it can take at least 20 years after someone stops drinking for their risk of liver cancer to equal that of a person who has abstained from alcohol.

“Alcohol does do damage at the cellular level,” she said. “That damage sometimes can be undone, but over a very, very long period of time.”

Dr. Frances Lee, a hepatologist at Mount Sinai in New York, said many factors could influence the degree to which a person might see benefits from reducing their drinking, including their family history.

“For someone who has been binge drinking a lot, there is likely a lot of DNA damage,” she said. “If there’s a history of certain cancers, then perhaps they won’t be able to undo that risk.”

What about the U.S. dietary guidelines on alcohol?

The current guidelines recommend no more than one drink per day for women and two per day for men, based on an overall assessment of the health risks associated with alcohol. According to a study last year, about 83% of yearly alcohol-related cancer deaths could be prevented if adults lowered their consumption to within those limits.

However, the guidelines also point to “emerging evidence” that even drinking within the recommended limits may increase the overall risk of cancer, heart disease or death.

The guidelines are set to be updated this year, so Murthy’s suggestion that the alcohol limits be reassessed may factor into that process. A forthcoming report from a group within the Department of Health and Human Services will also likely inform the update.

Last year, Canada issued new guidance stating that no amount of alcohol is healthy.

What about research suggesting alcohol has health benefits?

Some studies over the years have pointed to potential health benefits of drinking in moderation. That includes research suggesting that the antioxidants in red wine could improve heart health, and a December report from the National Academies of Science, Engineering and Medicine that said moderate drinking is linked to a lower risk of death than abstaining from alcohol.

However, many doctors and scientists remain unconvinced.

“There was lots of talk in years past about the benefit, potentially, of red wine. A lot of that has been difficult to validate in further studies,” said Dr. William Dahut, chief scientific officer for the American Cancer Society.

Even if there were some health benefit to drinking, experts said, it would be offset by the risks.

“I don’t think you’ll ever find a doctor who will tell a patient, ‘You don’t drink at all. Go ahead and drink two glasses at night,’” Lee said.

Are certain types of alcohol any better than others?

Doctors said it’s most important to pay attention to the quantity or concentration of alcohol, as opposed to whether it’s liquor, beer or wine, since the alcohol molecules themselves are responsible for raising a person’s cancer risk.

Several experts also cautioned that it’s not always easy to tell how much alcohol a drink contains.

Dr. Kenneth Nahum, an oncologist at Hackensack Meridian Jersey Shore University Medical Center, said that spiked seltzers and teas in particular — which have become popular among young people — might be deceiving in terms of alcohol content.

“They’re drinking it like it’s a soft drink,” he said. “They don’t even realize they’re drinking that much.”

Will the surgeon general’s warning make a difference?

Gilbert said it’s unlikely that people will immediately change their drinking habits after Friday’s report, but he noted that it could eventually lead to changes in how people perceive their risk.

“This advisory is a good step in the direction of just getting the word out so everybody can be better informed and make the best choice for themselves,” he said.

Already, adults under 35 have become less likely to drink alcohol than that group was decades ago, according to a 2023 analysis. However, drinking has increased among those ages 55 and older. Experts suggested that young adults may be socializing in person less than earlier generations, or might simply prefer other substances.

“Some are drinking less, and that might be because vaping and edibles are more available,” said Elizabeth Kovacs, a professor of surgery at the University of Colorado Anschutz Medical Campus.