Starting in 2026, all alcoholic products sold in the Republic of Ireland must prominently feature bright red text that states: “THERE IS A DIRECT LINK BETWEEN ALCOHOL AND FATAL CANCERS.”
The mandate, signed into law last year, is based on decades of scientific research. It goes far further in communicating alcohol-related health risks than any other country has done so far—and is roiling the worldwide alcohol industry.
“We believe consumers would be best served by a health warning label that is consistent throughout the European Union and accurately reflects scientific data on alcohol and health,” says Dr. Amanda Berger, vice president of science and health at the Distilled Spirits Council of the United States (DISCUS). She points out this new warning label fails to differentiate between moderate and excessive alcohol consumption.
But combined with the World Health Organization’s (WHO) recent statement that “when it comes to alcohol consumption, there is no safe amount that does not affect health” it begs the question: what, exactly, is the correlation between alcohol consumption and cancer? And do these kinds of label warnings actually impact consumer behavior?
Does Alcohol Cause Cancer?
Alcohol has been shown to cause at least seven types of cancer, including the most common types: bowel cancer and female breast cancer. As ethanol (alcohol) breaks down in the body, biological mechanisms induce oxidative stress, which researchers hypothesize interferes with DNA repair mechanisms and may contribute to what some call a “carcinogenic cascade.” Though there are still questions as to why and how exactly it all works, this means that any beverage containing alcohol, regardless of its price and quality, poses a risk of causing cancer. Scientists are ringing alarm bells over this growing body of research.
In late November, the WHO and the International Agency for Research on Cancer (IARC) released a statement saying that “alcohol causes a substantial burden of cancer.” The two groups cited a study that found that more than 740,000 cancer cases diagnosed in 2020—4.1% of new diagnoses—worldwide were estimated to be caused by alcohol. Nearly a quarter of these global alcohol-related cancer cases were in Europe, which, according to WHO European Region “boasts the highest proportion of drinkers and the highest intake of alcohol in the world.”
Studies have causally linked oral cavity, pharynx, larynx, esophagus, colorectum, liver and female breast cancers to alcohol consumption. Because it has been identified as carcinogenic for these cancer sites (among other health issues), the organizations concluded that “no safe amount of alcohol consumption for cancers can be established,” adding that, “the risk starts at low levels and increases substantially the more alcohol is consumed.”
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Dr. Sylvia Crowder, a member of the Health Outcomes & Behavior Program at Tampa’s Moffitt Cancer Center adds that about 6% of all cancers and 4% of cancer deaths are alcohol related. “We do know that there are real, direct links between alcohol consumption and cancer, regardless of whether it’s red or white wine, beer or spirits,” she says.
She believes placing warning labels on alcoholic beverages can be a useful tool in increasing consumer awareness of the links between cancer and alcohol. “Just having a blunt statement would be beneficial,” she says. “At the end of the day, it’s about consumers making informed decisions. I think it really comes down to a person’s values.”
What About These Warning Labels—Do They Even Work?
Though these labels could help make consumers more aware of the risks associated with drinking alcohol, whether the public will change their longstanding drinking habits remains to be seen. One peer-reviewed longitudinal study of more than 6,000 adult smokers found that years after the European Union began requiring tobacco packages to carry health warnings with a picture, text and information on services to stop smoking that covered 65% of the packages, “cognitive and behavioral reactions did not show clear increases.” Put simply, many smokers ignored them.
However, among women who were more highly educated and less addicted, “the effectiveness of warning labels tended to be higher.” Other studies have found similar results regarding changed behaviors among smokers with lower levels of dependence. A 2019 article in the peer-reviewed journal Health Education Research established that with these labels in place “smokers with lower levels of dependence were much less likely to purchase cigarettes.”
And studies on other substances that are generally considered less addictive than nicotine have found that these kinds of labels do influence consumer purchases.
It may seem like overkill to many Americans. Still, eight Latin American countries, including Argentina, Chile, Colombia, Peru, Argentina, Brazil, Venezuela and Mexico, require mandatory nutritional labels that warn consumers of products high in excess sugar, sodium or saturated fat. Studies seem to be showing that these warnings are making a difference in the foods people buy. A paper published in the highly rated, peer-reviewed journal The Lancet demonstrated that “warning labels have consistently influenced most peoples’ purchase decisions in Chile and have proven to effectively reduce sales of products high in calories, sugars, sodium and saturated fats.” Another randomized controlled trial of more than 8,000 Colombians, published in the peer-reviewed journal PLOS One, concluded that these nutrient warnings “most discouraged participants from wanting to consume ‘high in’ products.”
Though it’s too early to tell whether these results will extend to alcohol purchases, an online experimental study of more than 6,000 regular beer and wine drinkers found that health-warning labels communicating the increased risk of cancers associated with alcohol consumption “reduced the selection of alcoholic versus non-alcoholic drinks” and text and image warnings were the most effective in doing so.
Will the U.S. Follow Suit?
Berger affirms that the spirits industry is aligned with public health initiatives to reduce alcohol abuse and that encourages adults who choose to drink to do so responsibly. “When it comes to health warnings, DISCUS supports appropriate labeling, which has been required in the United States since 1988,” she says.
She acknowledges that studies have found that drinking is associated with an increased risk of certain types of cancer, but believes U.S. labeling guidelines that the federal government has established reflect the latest scientific research. “When federal regulators last reviewed proposals to change the required warning label, they found that the current warning is sufficient,” says Berger. “While the current warning has served to remind consumers that consuming alcohol may cause health problems, we defer to the government’s authority to determine warning statements and will adhere to any decision to change the statement.”
Berger and DISCUS representatives have pushed back against the upcoming Irish labels, claiming they are “inaccurate” and “misleading.” She encourages people to enjoy alcoholic beverages in moderation according to the current USDA guidelines. Those recommendations state that adults of legal drinking age should limit intake to two alcoholic drinks or less in a day for men and one drink or less in a day for women. “We urge all adults who choose to consume alcohol to follow the recommendations of the 2020-2025 Dietary Guidelines for Americans,” Berger adds.
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According to the 2022, National Survey on Drug Use and Health, more than 61.2 million Americans ages 12 and up reported binge drinking (four or more drinks for a woman, five or more for men, within about two hours) and 16.1 million reported heavy alcohol use (eight or more drinks per week for women, 15 or more for men) in the previous month.
So, should the U.S. join Ireland in issuing cancer warnings on alcoholic beverages? If it does, it would be a long road of legislation, likely yielding a decision years into the future. Until then, moderation, knowledge–and maybe supplementing more non-alcoholic and low-alcohol alternatives—may be the keys to a healthier lifestyle.
Crowder, for one, is encouraged to see an uptick in more mindful drinking. “We’re seeing trends now that Gen Z is refraining from drinking alcohol,” she says. “Kombucha and probiotic sodas are good alternatives if you want to have a social outing without alcohol.”
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Published: April 25, 2024
