Alcohol’s cancer risk is well known and documented across the world. Nevertheless, the general public still remains largely unaware of this risk. Evidence shows that Big Alcohol is doing everything they can from muddying the science to propagating myths to keep people in the dark.
But now, a new petition has been filed to the Treasury Department’s Alcohol and Tobacco Tax and Trade Bureau (TTB) in the United States to upgrade the warning labels on alcohol containers to include cancer risk. Labeling has been found through previous research to be effective in increasing public awareness about cancer risk and to reduce consumption.

Alcohol’s cancer risk is well documented and well known in science. A recent review of studies by authors Jürgen Rehm, Kevin D Shield and Elisabete Weiderpass found that in 2016, alcohol consumption caused an estimated 376,200 cancer deaths, representing 4.2% of all cancer deaths, and 10.3 million cancer disability-adjusted life years lost, representing 4.2% of all cancer disability-adjusted life years lost.

Alcohol’s cancer link is irrefutable. In 1988, the World Health Organization (WHO) concluded that there is a causal relationship between ethanol and throat, liver, breast, and colon cancers. This link has since been acknowledged both by the U.S. Centers for Disease Control and Prevention, which advises that “for some conditions, such as certain types of cancer [for example, breast cancer] and liver disease, there is no known safe level of alcohol consumption.” The U.S. Surgeon General has written that, “[for] breast cancer, studies have shown that even [low risk alcohol use] may increase the risk.” 

Movendi International has consistently reported about emerging evidence on alcohol and cancer.

However, despite the science the general public remains largely unaware about this risk. One reason why is that Big Alcohol aggressively blocks this knowledge from reaching the public. Evidence shows that the industry uses various strategies to muddy the science on alcohol harms. A recent scientific article by Petticrew and colleagues explores how the alcohol industry CSR bodies use dark nudges and sludge, which utilize consumers’ cognitive biases to promote mixed messages about alcohol harms and to undermine scientific evidence.

The alcohol industry has also been found to fund research to paint alcohol in a favorable light or cast doubt over existing evidence about alcohol harms such as cancer. The industry is also engaged in a practice dubbed “pinkwashing,” which involves branding alcoholic products with ribbons denoting breast cancer awareness to obscure ethanol’s carcinogenicity by confusing consumers.

As a result of these industry actions, public health advocates say, there is a frustratingly stubborn gulf between what experts know about alcohol’s cancer risk and the awareness of everyday users of alcohol. Thomas Gremillion, director of food policy at the Consumer Federation of America, holds the opinion that labeling on alcohol products can play a major role in increasing this awareness.

On the one hand, you have this huge contribution of alcohol to cancer and the public health burden, and on the other hand, you’ve got a majority of Americans for whom alcohol as a cancer risk is not on their radar,” said Thomas Gremillion, director of food policy at the Consumer Federation of America, as per The Counter.

Thomas Gremillion, director, food policy, Consumer Federation of America

Alcohol labeling increases awareness of alcohol’s cancer risk

A series of journal articles published on the Journal of Studies on Alcohol and Drugs (Volume 81, Issue 2) in March 2020 support that when alcohol bottles come with conspicuous labels providing information on the risks of alcohol consumption or alcohol use guidelines, people are better informed about alcohol’s harms and may cut down their alcohol use.

Key results from the studies are as follows:

  • Large, bright yellow alcohol labels with rotating health messages get noticed by consumers and can increase awareness of national alcohol use guidelines, improve knowledge of alcohol-related health risks, such as cancer, and reduce alcohol sales compared to control sites without the labels.
  • Such labels to alcohol bottles (300,000 labels in all) decreased total sales of alcohol by 6.9% compared with sales in regions without the new labels (Zhao et al. 2020).
  • Awareness of Canada’s low-risk alcohol use guidelines increased nearly three times in the site in which the labels were placed compared with a control location (Schoueri-Mychasiw et al. 2020).
  • Before the label intervention, only about 25% of participants knew alcohol consumption can cause cancer. After the labeling, awareness in Yukon rose to 42%, a 10% greater increase in awareness of the alcohol-cancer link relative to the control site in neighboring Northwest Territories (Hobin et al. 2020).
The suggested health warning labels for alcohol products as per the research published on Journal of Studies on Alcohol and Drugs (Volume 81, Issue 2)

The alcohol industry was so threatened by studies on labeling that the Yukon study which was to test cancer warnings on 47,000 bottles in the sole liquor store in the city of Whitehorse, Yukon for eight months was discontinued due to alcohol industry’s aggressive lobbying and threats. The study which was funded by the Canadian government was carried out by researchers Erin Hobin, Timothy Stockwell and colleagues for one month before being discontinued.

On their own, well-designed labels can increase consumer knowledge of national [alcohol use] guidelines and serious, largely unknown alcohol-related health risks, such as cancer, as well as reduce per capita alcohol consumption,” said researcher Erin Hobin in an email as per The Counter.

Erin Hobin, researcher of the Yukon study

Call to implement cancer warning labels on alcohol products in the United States

In late October, eight organizations including Alcohol Justice, the American Institute for Cancer
Research, the Consumer Federation of America, American Society of Clinical Oncology, American Public Health Association, Breast Cancer Prevention Partners, Center for Science in the Public Interest, and U.S. Alcohol Policy Alliance filed a petition to the Treasury Department’s Alcohol and Tobacco Tax and Trade Bureau (TTB).

The petition calls for the TTB to report to Congress that an update to the government health warning on alcoholic beverages is required and that it should include a cancer warning statement, such as:

WARNING: According to the Surgeon General, consumption of alcoholic beverages can cause cancer, including breast and colon cancers.

This is not the first time public health advocates have pushed for cancer warning labels on alcohol products in the United States. As Movendi International reported in June 2019, the American Institute for Cancer Research, the American Public Health Association, Breast Cancer Action, the Center for Science in the Public Interest, and the U.S. Alcohol Policy Alliance sent a letter to the TTB to undertake a congressional reporting process provided for by the Alcoholic Beverage Labeling Act of 1988, with the objective of amending the health warning statement required to appear on all alcoholic beverage labels.

Since November 1989, federal law has required that alcohol products carry warning labeling on alcohol’s risk regarding motor vehicle operation and pregnancy. The current petition argues that considering the mounting evidence on alcohol’s risk to cancer this same law requires the TTB to report to Congress that this change in labelling is now required.

The process of making these labels a reality requires several steps:

First, the TTB has to recommend any proposed label changes to Congress.

Lawmakers will then have to approve them. As history has shown the alcohol industry will undoubtedly aggressively oppose this process such as with the study in Yukon and the recent American experience with lowering the recommended limit for alcohol consumption for men from two to one unit of alcohol per day in the US Dietary Guidelines. Big Alcohol front groups, their representatives, and lawmakers raised aggressive opposition over the recommendation. They challenged its scientific basis, and in statements to the media, resuscitated the discredited idea that alcohol use can have health benefits.

Greater awareness means bigger policy support
As per the study by Hobin and Stockwell in Yukon, Canada awareness of alcohol’s cancer risk increased public support for health warning labels by 1.6 times comparative to no awareness.

However, drawing attention to labeling and even alcohol industry opposition can work to the benefit of the campaign to implement labeling. In the Yukon study the industry pushback resulted in vocal outrage and widespread coverage in both the domestic and international press.

In the long-run recognition of alcohol’s cancer risk leads to increasing support for alcohol policy. The Yukon study found that awareness of the alcohol cancer risk increased support for labeling 1.6 times compared to no awareness.

A warning – and even short of that – just drawing attention to this could have a real, significant public health impact,” said Thomas Babor, professor of public health science at the University of Connecticut and the editor-in-chief of the Journal of Studies on Alcohol and Drugs, as per The Counter.

Thomas Babor, professor, University of Connecticut and editor-in-chief, Journal of Studies on Alcohol and Drugs

A 2018 study from the UK found that awareness of the alcohol-cancer link increases public support for alcohol policy solutions, highlighting why the alcohol industry is so afraid of warning labels and rising recognition of the real effects of their products.


The Counter: “Less than half of Americans know that alcohol is a carcinogen. Big Booze wants to keep it that way

Alcohol Justice [PDF]: “Consumers Demand Alcohol Cancer Warning Labels