Q&A: Surgeon General’s warning exposes public ‘knowledge gap’ of alcohol links to cancer
Key takeaways:
- The 2025 Surgeon General’s Advisory stated there is no safe level of alcohol consumption.
- The harm of alcohol-related diseases outweighs any purported cardiovascular benefits from drinking.
There are approximately 100,000 alcohol-related cancer cases annually in the U.S. and 20,000 deaths due to alcohol-related cancer, according to an HHS press release.
This is one of the many tipping points that sparked U.S. Surgeon General Vivek Murthy, MD, MBA, to issue an advisory designed to raise awareness about alcohol consumption and reduce the incidence of alcohol-related cancers and deaths.
The 2025 Surgeon General’s Advisory on Alcohol and Cancer Risk recommends updating the existing Surgeon General’s health warning label on alcohol-containing beverages to include its effect on cancer risk. Further, the advisory calls for a reevaluation of current U.S. guideline limits for safe alcohol consumption and to increase education to boost awareness of the link between alcohol use and cancer risk.
The 21-page advisory urged health care providers to have conversations with their patients about the link between alcohol consumption and cancer risk. It also encourages the general public to better understand this link when making the decision to drink and, if they do, how much they should consume.
According to Brian P. Lee, MD, MAS, a transplant hepatologist and associate professor of clinical medicine at Keck Medicine of USC, the advisory is “very timely.” Not only is the advisory an update but a correction for the general public on where the data currently are in terms of alcohol consumption.
“There is a lot of focus on abstinence, but the reality is that not everyone can stop drinking completely — people enjoy drinking,” Lee told Healio. “From a public health standpoint what will people do and want to do? If you reduce or get rid of heavy drinking, you will see a lot of benefit from a public health standpoint.
“However, I always think it’s interesting that we just talk about getting rid of alcohol and talk about the harms of alcohol. Of course, if it were up to health care and public health, alcohol wouldn’t exist, but that’s not realistic. It is more about how to give people knowledge and empower them to make decisions for themselves.”
In an interview with Healio, Lee shares his perspective on the advisory as well as ways to boost awareness and help patients reevaluate their drinking habits.
Healio: Why are the Surgeon General’s recommendations important?
Lee: There has been a lot of confusion about light and moderate drinking and its effects on the body: There is this misconception that it’s healthy.
A lot of data have come out to the lay public showing that what we consider light or moderate drinking is not actually healthy and might be harmful.
The old data narrowly looked at only the risk for cardiovascular disease and wasn’t robust in terms of methodology and controlling for confounding factors. Now, when we look at all diseases together, any potential benefit that light or moderate drinking might have in terms of cardiovascular health is outweighed by the harm of other diseases like cancer, but also, liver disease and alcohol-related diseases that negate that benefit.
Healio: Where does the U.S. stand on guidance for healthy drinking limits?
Lee: The U.S. is far beyond what science would tell us and what other countries are recommending. The U.S. considers healthy drinking limits to be one drink per day for women and two drinks per day for men. In Canada, they consider two drinks per week as a healthy limit. The WHO states that there is no level of alcohol use that is safe.
Healio: As a hepatologist, do you have conversations with your patients about the link between alcohol use and cancer risk?
Lee: Every day I have conversations with patients about alcohol, but I am just one doctor. Everyone needs to pitch in to be able to address this big problem.
All medical professionals should take any health care touchpoint to talk and educate about alcohol. We know that the most problematic drinking patterns and alcohol use disorder starts at a young age, often in teenage years. In the end, 70% of Americans drink and up to 10% have an alcohol use disorder, which is a psychiatric disorder that is equivalent to addiction to alcohol. It’s a huge problem that is highly prevalent.
As a liver transplant specialist, I see people who have late-stage disease or need a liver transplant, but that is not ideal. My goal would be to prevent patients from even needing to see me and that should be the goal from a public health standpoint — to make policies that curb alcohol use and educate people before they develop organ damage, end-stage liver failure or other organ failure.
Healio: Have you seen an uptick in cancers or other liver diseases related to alcohol use?
Lee: It’s interesting because we have seen this extraordinary surge in alcohol-related disease; liver transplants due to alcohol use have increased fivefold in the past 20 years and now account for almost 50% of liver transplants.
Further, we know that alcohol use has increased since the COVID-19 pandemic, but it doesn’t account for this much of an increase that is being seen in liver disease or cancer. So clearly, there are other factors at play, and that is what I'm interested in. A lot of my research is looking at why some people drink heavily and they are perfectly fine, and others drink much less but then develop liver failure, cancer or heart disease.
It’s clear that genetics and the environment play a big role. For example, we have published a couple studies that show how obesity and obesity-related factors like high blood pressure and diabetes actually have a multiplicative effect with alcohol use to cause liver disease and other diseases.
A lot of recent findings show even if alcohol use has stabilized, the population now is much more sensitive because they have cofactors that predispose them to alcohol-related diseases.
Healio: What are other ways to increase awareness about alcohol use and cancer risk?
Lee: It is about trying to get the message across. I think articles in the media are super important. People read and trust the news from trusted sources. The average person is not reading scientific papers or medical journals. We need a way to translate what we find in medical studies to the general public.
People also look at signs and package inserts and use things like social media. They rely on word of mouth. We know that the lay public trusts their primary care doctors in terms of information. So, how do we get this information from a liver specialist or cancer specialist to primary care doctors? How do we get this to local communities and local leaders?
I think that it must be a multipronged approach. In the end, the public gets and trusts information through different means, and we need to make sure that we are making an effort to utilize all those channels for such an important message.
Healio: Do you think people will pay attention to a cancer risk warning on alcoholic beverage labels?
Lee: Anything that we can do to disseminate knowledge to those who might not have it but who might benefit from it would be helpful – namely, those people who are buying alcohol.
Studies have shown that less than half of Americans know that there is a risk between alcohol use and cancer. There is a big knowledge gap. If this is one way that we can get the information out, I’m all for it.
There is going be a lot of pushback from industry and other people who might not believe in this messaging. But in the end, it’s about getting the knowledge out there. It’s not about taking away things from people. It’s about empowering people with knowledge.
Healio: Do you think trends like Dry January, or the “sober curious” movement truly help promote safe drinking habits?
Lee: Trends like this grab attention and it’s good attention brought to an important cause, which is how to control the alcohol going into your body.
That being said, it’s only for January and there are 11 other months. Doing it for 1 month, but still drinking heavily for 11 other months does not benefit your health like you might think.
Alcohol causes cumulative risk on your body, so I think it’s a good initiative to draw attention, but in the end, it must be something more sustained than just 1 month a year.
Healio: How should people safely reduce their drinking?
Lee: I think it depends on the person. The vast majority of people who drink don’t have an addiction or alcohol use disorder so they can just stop. But for someone who has an addiction or a lot of tolerance, it can be challenging to stop drinking. They might need to be weaned down on drinking in a controlled manner.
My recommendation is that if you talk to your doctor about your drinking, it’s a no judgment zone so be honest about how much you drink and how it affects your day-to-day. Allow your doctor to give advice on how to cut down drinking.
References:
- Alcohol and Cancer Risk 2025: The U.S. Surgeon General's Advisory. https://www.hhs.gov/sites/default/files/oash-alcohol-cancer-risk.pdf. Published Jan. 3, 2025. Accessed Jan. 10, 2025.
- U.S. Surgeon General issues new advisory on link between alcohol and cancer risk. https://www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html. Published Jan. 3, 2025. Accessed Jan. 10, 2025.
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