Oncologists: Surgeon General’s 'bold statement' elevates conversation about alcohol, cancer
Click Here to Manage Email Alerts
Key takeaways:
- The U.S. Surgeon General called for updated warning labels on alcohol-containing beverages that specify their impact on cancer risk.
- Alcohol consumption increases risk for at least seven types of cancer.
U.S. Surgeon General Vivek Murthy, MD, MBA, issued an advisory that includes several recommendations designed to reduce the impact of alcohol on cancer incidence and mortality.
One recommendation calls for updating the existing Surgeon General’s health warning label on alcohol-containing beverages to specify their impact on cancer risk.
The 2025 Surgeon General’s Advisory on Alcohol and Cancer Risk also calls for reevaluation of guideline limits for alcohol consumption to account for cancer risk, as well as expanded education efforts to increase public awareness about the link.
The 21-page advisory also urges health care providers to tell patients about the relationship between alcohol consumption and cancer risk — promoting alcohol screening or referrals to treatment when necessary — and encourages the public to be aware of the link between alcohol consumption and cancer risk when deciding whether to drink and, if they do, how much to consume.
“Alcohol is a well-established, preventable cause of cancer responsible for about 100,000 cases of cancer and 20,000 cancer deaths annually in the United States — greater than the 13,500 alcohol-associated traffic crash fatalities per year in the U.S. — yet the majority of Americans are unaware of this risk,” Murthy said in the release. “This advisory lays out steps we can all take to increase awareness of alcohol’s cancer risk and minimize harm.”
Alcohol consumption is the third leading preventable cause of cancer death in the United States behind only tobacco and obesity, according to an HHS press release issued in conjunction with the advisory.
Research shows a “well-established” link between alcohol consumption and risk for at least seven types of cancers, according to the release. These include cancers of the breast, colorectum, esophagus, liver, oral cavity, pharynx, and larynx.
An estimated 741,300 cancer cases worldwide in 2020 could be attributed to alcohol consumption, according to research published in The Lancet Oncology.
Approximately 185,100 (25%) of those cancer cases occurred among individuals who consumed two or fewer alcoholic drinks per day, according to the Surgeon General’s advisory.
Higher alcohol consumption increases risk for alcohol-related cancers, according to data cited in the advisory from a study of more than 226,000 people that aimed to assess absolute risk for cancer over time based on quantity of alcohol consumed.
Findings showed the risk a woman would develop any alcohol-related cancer during her lifetime increases from about 16.5% for those who consume less than one drink per day to 19% for those who consume one drink per day on average and 21.8% for those who consume two drinks per day on average.
The risk a man would develop any alcohol-related cancer increases from about 10% for those who drink less than one drink per week on average to approximately 11.4% for those who consume one drink per day on average to about 13.1% for those who have two drinks per day on average.
The advisory also describes — based on evidence from biological studies — four ways that ethanol, found in all alcoholic beverages, causes cancer:
(1) In the body, alcohol breaks down into acetaldehyde, a metabolite that binds to DNA and damages it. This can cause a cell to grow uncontrollably, leading to tumor formation.
(2) Alcohol generates reactive oxygen species that can lead to inflammation and damage DNA, lipids or proteins in the body.
(3) It alters levels of estrogen and other hormones, potentially contributing to breast cancer development.
(4) Carcinogens from tobacco smoke and other sources can dissolve in alcohol, making them more likely to be absorbed in the body.
Despite growing evidence about the link between alcohol and cancer, many Americans are unaware of the association between alcohol consumption and increased cancer risk.
As Healio previously reported, a study published in 2022 showed only a third of Americans knew liquor consumption affected cancer risk (31.2%). Even fewer thought beer (24.9%) or wine (20.3%) contributed to cancer risk.
In addition, more than 10% of respondents reported that wine decreases cancer risk, whereas 2.2% reported beer decreases risk and 1.7% reported liquor decreases risk.
References:
- Alcohol and Cancer Risk 2025: The U.S. Surgeon General's Advisory. Available at: https://www.hhs.gov/sites/default/files/oash-alcohol-cancer-risk.pdf. Published Jan. 3, 2025. Accessed Jan. 3, 2025.
- U.S. Surgeon General issues new advisory on link between alcohol and cancer risk (press release). Available at: 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. 3, 2025.
Perspective
Back to TopBruce Scott, MD
The AMA applauds the Surgeon General’s work to make completely clear the link between alcohol consumption and increased cancer risk. 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. And yet, despite decades of compelling evidence of this connection, too many in the public remain unaware of alcohol’s risk. [This] advisory, coupled with a push to update the Surgeon General’s health warning label on alcoholic beverages, will bolster awareness, improve health, and save lives.”Perspective
Back to Top
Dale Shepard, MD, PhD
These types of advisories are a reminder that there are modifiable risks associated with cancer. Even though we in the health care field may appreciate that alcohol consumption is a risk factor for cancer, that is not widely known in the public. This advisory raises public awareness, and that’s the biggest thing we can hope for.
People also may have perceptions that some types of alcohol are better or worse than others. There are some data, for example, that suggest cardiovascular benefits from red wine. The messaging, however, should be that alcohol is alcohol, and there are risks involved with all forms.
Most patients I see have already had a cancer diagnosis, so our conversations focus on what they can do to minimize risk for recurrence and the lifestyle changes they can make to be as healthy as possible if their cancer does recur. However, given the amount of time, energy and money we spend treating cancers, if we have the ability to have a significant impact on the number of people who develop cancer, we should grab it. That’s why awareness is so important.
We have had warning labels on cigarettes for a long time and people still smoke, so I don’t think this advisory will cause massive changes in public behavior or policy. However, even if a small number of people make lifestyle changes — whether it be avoiding alcohol, or consuming less of it and occasionally choosing non-alcoholic beverages instead — that would be beneficial. It comes down to balance. Any diet or lifestyle modification recommendations have to be practical, so our goal should be to raise awareness and hope people choose to do the right things. One reason why this advisory may be particularly powerful is because it gives the ‘why.’ It lays out four very clear ways in which alcohol can contribute to cancer risk: the breaking down of alcohol into acetaldehyde, the fact there may be hormonal changes, the fact it may cause inflammation, and the fact that if alcohol and tobacco are combined, more of those carcinogens may get absorbed. Part of the messaging that could be helpful is that not only can we say there likely is a risk, but we know why there might be a risk.
Perspective
Back to Top
Noelle LoConte, MD
I was pleasantly surprised by this news. This comes less than 2 weeks after the National Academies of Sciences, Engineering, and Medicine released a report that most of us with an interest in alcohol’s impact on cancer felt watered down the association a bit. However, the Surgeon General made a pretty bold statement trying to elevate the conversation around alcohol and cancer, which I was thankful to see.
It’s been pretty well established across multiple studies and surveys that only about one-third of the general public is aware of the link between alcohol and cancer risk. If the Surgeon General’s advisory increases awareness, that’s great; however, awareness doesn’t generally drive behavior as much as policy, so we are really hoping that this is a bit of a boost to continue policy discussions.
I co-authored Alcohol and Cancer: A Statement of the American Society of Clinical Oncology, published in 2017. That policy statement outlined several policy strategies that we think could be implemented at the local or federal levels to reduce the burden of alcohol-related cancers — currently about 5% of all malignancies, but that number is rising. These include raising the price, having municipalities control their liquor licensing laws, stronger enforcement of existing laws and reducing points of sale.
It has been known for quite some time that alcohol is a carcinogen. However, that policy statement raised awareness and supported policy efforts aimed at reducing alcohol-related cancers. It also addressed the idea that oncologists have a role to play in screening patients for alcohol use or supporting alcohol policies.
The work being done with regard to alcohol and cancer continues to be challenging. Every physician can stand up and say there is no safe amount of tobacco use. When it comes to alcohol, however, it has been more nuanced. That’s largely because we have not been able to do a prospective randomized controlled trial on this subject. Retrospective work also has a lot of nuances. Participants don’t always recall their consumption accurately, and there is no standardized amount across countries for what constitutes ‘a drink,’ so the data can be difficult to interpret.
However, when a patient asks me, ‘What can I do to reduce my risk for cancer coming back?’, I do have conversations about alcohol. I can pretty confidently say to a patient that if they want to be healthier, they need to drink less.
UW Carbone Cancer Center
Perspective
Back to Top
Pashtoon Kasi, MD
If you look at the seven types of cancer that the Surgeon General’s warning primarily talks about, these are patients I see on a daily basis. This question comes up often with someone who has cancer, when they ask if there was something they could’ve done differently to prevent it. There are things we have no control over, but raising awareness about preventable risk factors is a very positive development.We only have screening or early detection tests for a handful of cancers, and the key to curing cancer is catching it early. That makes primary prevention — and secondary prevention — very important. For patients who are undergoing treatment or in the survivorship phase, this is something that will be part of the discussion about behavioral changes that could reduce risk for recurrence of the same cancer or development of a new type of cancer.
This advisory puts a complex question into context. There have been many studies that examined the effect of diet or alcohol intake on cancer risk, but this is difficult to assess and quantify. There are variations in how ‘moderate intake’ is defined, as well as variations between individuals in terms of how they metabolize something. The risk for each cancer type also is different. This document not only helps raise awareness, but it puts these numbers into context and provides a good reference document when we’re answering questions from patients and their caregivers.
Behaviors are complex to intervene upon, and there is a mixed body of evidence when it comes to alcohol. Some studies talk about how moderate intake may be cardioprotective or have other benefits, and you can find evidence to support any practice you’re looking for. However, I do think this advisory will make the average person think twice or at least have the conversation about the impact of this behavior. Only time will tell what the impact will be but, in terms of generating debate, it’s already doing what it was intended to do.
Cancer treatment is horrendously expensive. We are making a lot of promising advances in treatment but, unfortunately, we’re not able to talk about cure with every patient we see in clinic. Consequently, it is important to recognize any potentially preventable cause of cancer and for that to be part of the conversation between health care providers and their patients.
Click Here to Manage Email Alerts