Alcohol intake entwined with cancer risk
The new year has begun with a new health warning. America’s Surgeon General Vivek Murthy has released an advisory, pointing to a direct link between alcohol consumption and increased cancer risk. Alcohol consumption is the third leading preventable cause of cancer in the US. Alcohol, the advisory says, increases risk for at least seven types of cancer (breast, colorectum, esophagus, liver, oral cavity, throat and voice box), regardless of the type of alcohol consumed. As much as 16.4 per cent of the breast cancer cases in the US are attributable to alcohol consumption. For certain cancers, such as breast, mouth and throat, the advisory warns that “the risk of developing cancer may start to increase around one or fewer drinks per day”. Even small amounts of alcohol can contribute to chronic conditions like liver cirrhosis. An individual's risk of developing cancer due to alcohol consumption, however, depends on several biological, environmental and social factors.
Warning labels on alcohol products can help people make informed decisions.
The advisory follows the 2023 statement of the World Health Organisation (WHO) on the risks and harms associated with drinking alcohol, based on a systematic evaluation of scientific evidence. Alcohol is responsible for a substantial disease burden directly, and accounts for a sizeable number of alcohol-related road accidents. The WHO statement published in The Lancet Public Health concluded, “When it comes to alcohol consumption, there is no safe amount that does not affect health.”
Back in the 1980s, the International Agency for Research on Cancer classified alcohol as a ‘Group 1 carcinogen’. This is the highest-risk category of cancer-causing substances that includes tobacco, radiation and asbestos. Ethanol causes cancer through biological mechanisms as it breaks down in the body. Therefore, any beverage containing alcohol (be it beer, wine or whiskey) poses a health risk. In its statement, the WHO pointed out that the risk increases substantially with the amount of alcohol going up.
This evidence busts the myth that some alcoholic drinks, particularly red wine, are beneficial for health if consumed in moderation. For decades, the alcohol industry has propped up cardiologists to promote the idea that wine in moderation is good for the heart’s health without any credible scientific study to back such claims.
On the other hand, data from the WHO’s European Region shows that half of all alcohol-attributable cancers are caused by what is generally considered ‘light’ and ‘moderate’ consumption like a bottle of wine or two bottles of beer per week. As per the WHO, there are no studies that demonstrate beneficial effects of light and moderate drinking on heart disease or diabetes or studies that outweigh the cancer risk associated with such levels of consumption. Carina Ferreira-Borges, an expert on alcohol and illicit drugs at the WHO, has said, “The only thing that we can say for sure is that the more you drink, the more harmful it is. In other words, the less you drink, the safer it is.”
When there is scientific evidence about the ill effects of a commonly produced and consumed commodity that also yields substantial revenue for governments, what are the available options to reduce the harm? The WHO’s statement on alcohol distils available scientific evidence and also presents policy options available to governments. It is for the governments to act. One of the most obvious options to reduce alcohol consumption is to make people aware of the potential harm through warning labels on alcohol bottles. This is among the measures Murthy has suggested for the US and what some European countries are planning to do. Murthy has also called for a reassessment of the guideline limits for alcohol consumption to account for cancer risk.
The warning labels under consideration by various countries are of many types — with messages against general harm to health, harms of excessive use and abuse and those for specific groups (underage people, pregnant women, etc.). For instance, the warning Ireland plans to introduce in 2026 says, “Drinking alcohol causes liver cancer”. In 2019, India mandated more generic warnings that say “Consumption of alcohol is injurious to health” for hard liquor and “Be safe, don’t drink and drive” for low-alcohol beverages.
Apart from warning labels, restrictions on alcohol marketing are in place in India. Alcohol advertising is banned in newspapers, radio and television, though surrogate advertising continues in many ways, taking advantage of loopholes in advertising regulations. In recent years, surreptitious advertising through social media and digital platforms is posing new challenges.
Like in the case of warnings on tobacco labels, industry and pro-industry groups argue that health warning labels are of little use in reducing consumption. But available evidence — as reported in a recent review published in The Lancet — points out that warning labels on alcohol products are useful in many ways. They can enhance awareness of alcohol-related harms, contribute to the denormalisation of alcohol use and help people make informed decisions, thereby promoting public health. The effectiveness of health labels depends on their design and content. At present, there is no standardisation of health warning labels and the content is very general, which may not help people make informed decisions.
India has implemented regulations on warning labels on alcohol products for about five years now. We are yet to know how effective this exercise has been. We need continuous research on the design and content of warning messages, and consumer feedback on the same. Unlike tobacco products, where health warnings occupy a good part of the packaging and are more graphic, warnings on liquor bottles occupy tiny space and are vague. Along with health warnings, additional measures like regulation of alcohol sale on highways, curbing sale to underage consumers and drunken driving need to be implemented more stringently.
It is critical to guard against industry lobbies that are constantly trying to stall health-related and other regulations in India. We need more champions of public health like Murthy to reduce the healthcare burden due to alcohol. Remember, the first warning on tobacco’s link with cancer, too, came from a Surgeon General in 1964.
