Most of us are aware that smoking is a leading cause of cancer, and that drinking alcohol can also have deleterious effects on our health. But the U.S. Surgeon General recently published an advisory underscoring that alcohol consumption is the third leading preventable cause of cancer in the U.S., after tobacco and obesity – and increases the risk for at least seven types of cancer.
While scientific evidence for this connection has been growing over the past four decades, less than half of Americans recognize it as a risk factor for cancer, according to Surgeon General Dr. Vivek Murthy. Alcohol is responsible for about 100,000 cases of cancer and 20,000 cancer deaths each year in the U.S. – greater than the 13,500 alcohol-associated traffic-related fatalities per year – “yet the majority of Americans are unaware of this risk,” Dr. Murthy said upon releasing the advisory on Jan. 3.
In addition, more than 220 million Americans over the age of 12 have reported drinking alcohol at some point in their life, with 16.4% reporting they drank heavily, according to the 2023 National Survey on Drug Use and Health (NSDUH). For adults ages 18 and older, 23%, or 60.4 million, reported that they were binge drinking, according to the NSDUH.
The advisory outlines the scientific evidence for the causal link between alcohol consumption and increased risk for such cancers as breast (in women; 16.4% of total breast cancer cases are attributable to alcohol consumption), colorectum, esophagus, voice box, liver, mouth, and throat. The type of alcohol being consumed – beer, wine, or spirits – does not matter, the Surgeon General states.
The Surgeon General’s Advisory includes a series of recommendations to increase awareness to help minimize alcohol-related cancer cases and deaths, including updating the existing Surgeon General’s health warning label on alcohol-containing beverages. The present required warning labels, last updated in 1988, state that women who are pregnant should not drink alcohol due to the risk of birth defects. They must also state that “consumption of alcoholic beverages impairs your ability to drive a car or operate machinery and may cause health problems.”
Dr. Murthy, noting that changing the label requires an act of Congress, maintains that an updated label should be “more visible, prominent, and effective in increasing awareness about cancer risks associated with alcohol consumption.”
Just as there is no “safe” number of cigarettes you can smoke per day – any number of cigarettes can increase your risk of developing cancer – any amount of alcohol consumption can also raise your cancer risk. Alcohol can damage your DNA in multiple ways as your body works to break it down, possibly resulting in mutations and DNA strand breaks which ultimately increase the risk of cancer, especially in tissues exposed to high levels of alcohol like the mouth and throat.
Medical oncologist and hematologist Dr. Yael Zack, who founded and leads the Young Women’s Program for Cancer Care at White Plains Hospital’s Center for Cancer Care, has long advised against alcohol consumption and applauds the Surgeon General’s latest move. “For cancer prevention, we should avoid alcohol altogether,” she says, “but my general guidelines are to limit alcohol intake to 1-2 times per week, or even less frequently.”
Dr. Zack says that she recommends the following tips she learned from White Plains Hospital Registered Dietitian Cheryl Leslie:
- Have alcohol-free days
- Find other outlets for relaxation instead of having an alcoholic beverage
- Don’t make having a glass of wine part of your food prep
- Limit alcohol consumption to only when socializing
- Alternate every other drink with a glass of water or seltzer
- Have a wine spritzer instead of a glass of wine
- Offer to be the designated driver at gatherings
- Enjoy many of the alcohol-free options that are now available
These recommendations underscore how, for many people, one’s alcohol consumption can be prudently self-regulated. “Essentially I tell patients that since we have control over this risk factor, we should definitely take control,” Dr. Zack says.
Of course, self-management may not be sufficient in some cases. For those patients, Dr. Zack recommends consulting a therapist; a list of local facilities can easily be found online.
