Earlier this month, U.S. Surgeon General Vivek Murthy issued an advisory linking alcohol consumption to increased risk of seven types of cancer and called for warning labels to be affixed to alcohol products. The advisory was issued less than two weeks before Murthy’s term as surgeon general would end as the Biden administration left the White House for the Trump administration.

The advisory states, “The direct link between alcohol consumption and cancer risk is well-established for at least seven types of cancer, including cancers of the breast, colorectum, esophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx), regardless of the type of alcohol (e.g., beer, wine, and spirits) that is consumed. For breast cancer specifically, 16.4% of total breast cancer cases are attributable to alcohol consumption.”

The advisory says alcohol is the third leading preventable cause of cancer, behind tobacco and obesity. It states, “For certain cancers, like breast, mouth, and throat cancers, evidence shows that the risk of developing cancer may start to increase around one or fewer drinks per day. An individual’s risk of developing cancer due to alcohol consumption is determined by a complex interaction of biological, environmental, social, and economic factors.”

This conclusion has been challenged by other medical doctors, including Vinay Prasad, who said the surgeon general is “relying on very confounding, problematic observational data compared to people who chose to drink against people who don’t drink at all.” He added that those who don’t drink include a “motley crew” of individuals, including those who are alcoholics and need to stop, those who don’t drink for health reasons, and those who don’t drink because they have a medical condition.

Prasad points out that the individuals in these studies are not evaluated based on their socioeconomic status or other important confounding factors. “I don’t put a lot of stock into the idea that very little alcohol consumption increases the risk of seven cancers, and neither would anyone who is an expert in reading the methodology.”

Prasad posits that there aren’t good studies that evaluate the long-term risks of light to moderate alcohol consumption and suggests a “multi-arm randomized trial” is the best option to determine risk associations. Prasad wrote, “A large, multi-arm RCT is the only path forward. In fact, the NIH almost ran one. Before he was smearing scientists who were correct on lockdown and school closure, Francis Collins almost did this.”

Prasad suggested that Dr. Jay Bhattacharya could lead the NIH to conduct a 15-year $250 million NIH-funded trial to obtain the best information on this topic. Prasad added, “Short of that, the best studies are likely those where an economic crash changes alcohol consumption, or the effect of new alcohol tax, or other natural experiment. Ultimately, these are imprecise, however, and there is no substitute for randomization.”

Chris Masterjohn, who has a PhD in Nutritional Sciences, said the surgeon general’s conclusion is false and that he “can’t read a meta-analysis.” Masterjohn points to a 2022 study funded by the NIH and HHS. Masterjohn said, “All but four types of cancer have inverse associations with light alcohol intake; no one has any clue what the causality is.”

The study says, “Compared with non-drinkers, low alcohol consumption decreased the risk of liver cancer (29), endometrial cancer (32) and renal cell carcinoma (72). However, low alcohol consumption increased the risk of esophageal cancer (73), breast cancer (22), cutaneous basal cell carcinoma (40), and cutaneous squamous cell carcinoma (40). Low alcohol consumption was also related to a 23% reduction in colorectal cancer mortality (43) and an 11% reduction in all cancers mortality.”

The CDC reports that 178,000 people died each year in 2020 and 2021. This is a 29% increase from the 138,000 deaths from 2016 and 2017. A report in November found that Americans increased alcohol consumption by 20% during the peak of the COVID-19 pandemic, and that increase lasted for the next two years.

A 2023 Gallup poll found that alcohol consumption among young adults (18-34) decreased from 72% to 62% while those 55 and older increased alcohol consumption from 49% to 59%. Regular drinkers are classified as individuals who had an alcoholic drink in the last seven days.

Two decades ago, young adults had the highest percentage of regular drinkers, but now they have the lowest rate. From 2001-2003, 49% of young adults were regular drinkers compared to 45% (age 35-54) and 31% (55 and older). Now, only 38% of young adults drink regularly, while the rate for other age groups increased to 48% and 40%, respectively.

The average number of drinks consumed by young adults in the last seven days dropped from 5.2 to 3.4 over the last two decades. This indicates a sharp reduction, not only in the number of regular drinkers in the young age group but also a reduction in binge drinking. In 2020, 0.6% of the population drank non-alcoholic beer every week, which is more than eight times larger in 2023 with 5.2% of the population.

Fox News reported that about 80% of survey respondents support adding a cancer label to alcoholic drinks, but the majority (66%) of respondents will not alter their drinking habits as a result of the recommendation. While the previous surgeon general has called for cancer warning labels on alcoholic beverages, that would require an act of Congress. So far, no U.S. Congress members have pushed for this policy.