BU alcohol researcher applauds effort, says warning labels will better educate public to risks
An advisory issued by the US Surgeon General warns that alcohol consumption is linked to breast, colon and rectum, esophagus, larynx, liver, and throat cancer, as well as other cancers. Photo by Hiob/iStock
Public Health
BU alcohol researcher applauds effort, says warning labels will better educate public to risks
An advisory issued last month by the US Surgeon General warns of the explicit link between alcohol consumption and cancer and calls for measures for increasing awareness of alcohol’s contribution to cancer diagnoses.
In the advisory, Surgeon General Dr. Vivek Murthy notes that alcohol consumption is the third leading preventable cause of cancer in the United States. It contributes to almost 100,000 cancer cases and nearly 20,000 deaths every year. Drinking alcohol increases the risk for at least seven types of cancers, most notably breast, colon and rectum, esophagus, larynx, liver, and throat cancers. Troublingly, Murthy writes, while evidence of the link between cancer and alcohol has been mounting for decades, fewer than half of Americans are aware of the relationship.
Murthy’s recommendations for increasing public awareness include calling on public health professionals and community groups to create public education campaigns, asking healthcare providers to inform their patients about the link and promote alcohol screenings and treatment, and most imminently, updating the Surgeon General’s health warning label on alcoholic beverages.
David Jernigan, a professor of health law, policy, and management in the Boston University School of Public Health, studies the effects of alcohol and how alcohol marketing influences consumers. He says the current guidelines and messaging around alcohol and cancer are far behind what the research suggests.
Why? For one, “there’s no warning label [that says alcohol can cause cancer] on alcohol products,” Jernigan says. “Alcohol is also our favorite drug—we’re not well-disposed to hear bad news about it.” Finally, he adds, “you have billions of dollars being spent on marketing designed to give the complete opposite message, which is that alcohol is great and appropriate in virtually every situation.”
But at the end of the day, Jernigan says, “Alcohol is a carcinogen. Most people don’t know that, so we need stronger warning labels on alcohol bottles [among other measures] so people are more aware.”
Jernigan spoke to BU Today about the advisory, health warning labels, and how to reduce your risk of alcohol-attributable cancers.
Q&A
with David Jernigan
BU Today: Why do we need to update the warning labels on alcohol products?
Jernigan: The existing warning label is terrible. It flies in the face of everything we’ve learned from tobacco about how to do warning labels. It’s not specific about the health risks of drinking alcohol. It has what I call the “five dirty words”: “and may cause health problems”—which tells you nothing. And I can tell you that those words were added in the back room at the behest of the alcohol industry to protect them from product liability lawsuits. The other problem is that the label is located off to the side and the print is absolutely tiny. When it was implemented in the early 1990s, I remember telling the press that Congress passed a warning label, not an eye test. That’s in contrast to tobacco health warning labels, which are boxed and prominent [on products].
If all we did was add “and may cause cancer” to that warning label, it would be a tiny step forward—but we’re so far away from what we’ve learned is effective from tobacco that what are the chances of that actually happening? That would require Congressional action. The language in the alcohol warning label is mandated in the Alcoholic Beverage Labeling Act, which was passed in the late 1980s. That act also said that the Treasury Department, which actually has the most regulatory authority over alcohol in the federal government [not the Food and Drug Administration], should report back to Congress if there are changes in the science that are sufficient to require a change in the warning label. Since the warning label was implemented in the early 1990s, Treasury has never once reported back to Congress. A bunch of public health groups and public interest groups actually brought a lawsuit in the early 2000s basically saying, “Treasury Department, will you please obey the law?” and they still never have.
BU Today: Do you think it’s likely the recommendation would ever pass?
Jernigan: It’s great that the Surgeon General’s advisory is out there; it’s certainly gotten a lot of press attention, which is helpful. But that will fade over time, and the current Congress has a lot of priorities that are much higher than trying to change the warning label on alcohol bottles. This is sort of a last gasp from the outgoing Surgeon General. The Wall Street Journal, which is usually an indicator of business and Republican sentiment, has already published a commentary on [the advisory], saying, “Oh, gosh, this is the government interfering in private life again. When will those government busybodies get out of our lives and let us make our own choices?”
I anticipate that’s going to be pretty close to what this presidential administration’s attitude towards this will be—despite the fact that Donald Trump is a teetotaler and the possible incoming Secretary of Health and Human Services, Robert F. Kennedy, Jr., is in recovery from substance addiction. But still, I don’t think it has much hope of having an effect in the short term. At the same time, you have to remember the Surgeon General’s report on smoking was issued in 1964. It’s taken decades to get [public health messaging around] smoking to where it is now. One would hope it wouldn’t take that long for alcohol, but this is an even larger industry than tobacco, and at this point, the structure of alcohol consumption favors inaction by lawmakers. The people most likely to drink and binge drink are white males who have gone to college. That’s basically defining the people who write our laws. Alcohol is their favorite drug, in particular.
BU Today: Even if we never get better warning labels, what are the most pressing things people should know about the link between alcohol and cancer?
The first thing they should be aware of is that for some cancers—this is particularly true of female breast cancers—the risk starts the moment you start to drink. Compared to nondrinkers, women who consume up to a drink a day have a 10 percent greater relative risk [of developing breast cancer]. If that goes up to more than two drinks a day, they have a 32 percent greater relative risk. For males, the big cancers [linked to alcohol] are liver and colorectal. In high-risk populations, like if you’ve got a family history of cancer, I would add this to the reasons to be concerned. You can’t change your genes, but you can change your behavior, and this is one simple thing that people can do to reduce their level of risk.
The thing that we’re all pushing for in public health is: let’s just inform people. People deserve to have the information, and they deserve to be able to make informed choices. Right now, I think the Surgeon General cites a 2023 study of women between the ages of 18 and 25 where only 28 percent were aware of alcohol as a breast cancer risk, [which is in contrast with] people’s awareness of tobacco as a risk. For the mouth, throat, larynx, and esophagus cancers, there’s a synergistic relationship with tobacco use. That’s because what alcohol does in those parts of the body is it makes it easier for the cancer-causing agents in tobacco to get in, so together, they make your risk even bigger.
BU Today: What advice would you give to those who want to be more conscious of the way they consume alcohol?
The general advice we have for people is less is better. Whatever you’re drinking, drinking less will be better for your health. And what we certainly don’t want people doing is to get into the arena of what we define as binge drinking, which for women, is four standard drinks within two hours. For men, it’s five standard drinks within two hours. Your risk for all sorts of things, including your cancer risk, starts to go way up at that point—and these curves are really quite dramatic. It’s not a straight line. The risks start to climb really, really fast at those levels of consumption.
For the college-age population, your cancer risk is something that develops over time. Same goes for your patterns of drinking. So looking at what you’re doing at a younger age around alcohol is really important for thinking about this over the course of your life. If you’re a problem drinker in high school, you’re going to have much worse problems in college. If you’re a problem drinker in college, you are setting in place behavioral patterns that will influence you across your lifespan. There’s a lot we still don’t know yet. It’s not clear if quitting or reducing alcohol will also reduce the risk of all the alcohol-attributable cancers. So the most important thing from a prevention perspective is to not drink very much, if you’re going to drink.
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